*4.3.3 Single-payer Medicare for all*

This is the only way forward that can get bring system reform to our present non-system, with its inadequate access, unaffordable prices and costs, unacceptable quality, and widespread disparities. A fix can be on the way if we can muster the political will to enact an updated Medicare for All bill now in the House of Representatives in Congress, H. R. 1976. As stated by Rep. Pramila Jayapal (D-WA), one of its two lead sponsors, when the bill was introduced:

*While this devastating pandemic is shining a bright light on our broken, for profit health care system, we were already leaving nearly half of adults under the age of 65 uninsured or underinsured before COVID-19 hit. And we were cruelly doing so while paying more per capita for health care than any other country in the world [36].*

Among its many benefits, H. R. 1976, when enacted, will bring:


*Primary Care in the USA: The Long Struggle to Build its Foundational Role DOI: http://dx.doi.org/10.5772/intechopen.98792*


It is little known that our multi-payer private health insurance industry has been propped up by various subsidies from the federal government for many years,


#### **Table 1.**

*Comparison of three reform alternatives based on evidence.*


**Table 2.**

*Comparison of three reform alternatives based on values.*

averaging about \$685 billion a year today [38]. Well known economist Gerald Friedman, who has studied the costs of Medicare for All for more than ten years, estimates that we would have saved more than \$1 trillion in 2019 had it been in place at that time [39].

The U. S. has tried market-based alternatives for many years, and they have all failed the public interest. Privatization and commodification of health care leads to higher prices and costs, decreased access and worse outcomes of care, as well as more bureaucracy and waste. **Table 1** compares our three reform alternatives in terms of experience and evidence, and **Table 2** compares them in terms of values [40].
