The Dark Reality of Medicare for All: How Doctors Are Sued
Abdul El-Sayed, a prominent proponent of Medicare-for-all and a US Democratic Senate candidate from Michigan, campaigned in Detroit on July 18, 2026. While El-Sayed’s platform champions universal coverage without co-pays or deductibles, a recent report from the Washington Free Beacon highlights a persistent political tension: his partner, psychiatrist Sarah Jukaku, does not accept Medicare at her private practice.
This political irony exposes a major structural hurdle facing American healthcare reform. According to a 2026 study from economists at the University of Chicago, Stanford, and the US Census Bureau, American physicians earn about twice as much as Canadian doctors and four times as much as Swedish ones. Furthermore, roughly 42 percent of American specialty physicians rank in the top 1 percent of income earners domestically, compared to 27 percent in Canada and just 7 percent in Sweden.
The Economics of U.S. Healthcare Prices
American healthcare remains remarkably expensive largely because doctors, hospitals, and drugmakers charge exceptionally high rates compared to international peers. According to industry analyses, the United States spends about twice as much per person on medical goods and services as other wealthy nations. Despite this massive expenditure—totaling $5.7 trillion in 2025—Americans do not secure more frequent care or shorter hospital stays than foreign populations.
Instead, these funds support exorbitant procedural costs. A routine coronary bypass surgery typically runs past $89,000 in the United States, contrasted with just $17,741 in Australia, according to comparative health data. For single-payer advocates like El-Sayed, who envisions expanding medical access so that uninsured populations gain universal entry and co-pays drop to zero, these high prices present an overwhelming financial barrier. A comprehensive single-payer system cannot function sustainably at current U.S. medical billing rates.
Provider Compensation and Single-Payer Realities
While advocates frequently target the administrative bloat of private health insurance—which generates an estimated $500 billion in excess costs due to overlapping bureaucratic requirements—provider compensation remains the primary driver of excess spending. Public insurance programs like Medicare and Medicaid reimburse at rates closer to international benchmarks, whereas private insurance and boutique cash practices yield significantly higher margins.
This dynamic explains why clinicians such as Jukaku frequently decline Medicare participation. When affluent patients seek private care, accepting government-mandated reimbursement rates lowers practice revenue. Consequently, implementing a universal Medicare-for-all framework requires steep cuts to provider payments. Economist Charles Blahous demonstrated in a widely cited 2018 analysis that keeping provider payments constant under a single-payer system would raise national health spending by $3.25 trillion over a decade, whereas forcing all providers to accept Medicare rates would reduce spending by $2.05 trillion.
Confronting provider pay cuts remains politically perilous. Unlike faceless private insurance corporations, doctors enjoy widespread public admiration and robust lobbying representation through organizations like the American Medical Association (AMA), which helped defeat previous single-payer legislative pushes.
Addressing Supply Constraints and State-Level Reforms
To mitigate the financial friction of lowering doctor compensation, policymakers can target systemic supply shortages. The United States maintains roughly 2.7 physicians for every 1,000 residents, trailing a comparable nation average of 3.9 physicians per 1,000 residents, per Kaiser Family Foundation data. Federal policies initiated in 1981 restricted domestic training and capped residency funding in 1997, alongside stringent immigration barriers requiring foreign-trained doctors to repeat multi-year residencies.
States are increasingly moving to bypass federal bottlenecks. In 2023, Tennessee established a legal pathway allowing foreign-trained physicians to practice without repeating a residency, a reform subsequently adopted by multiple other states. Additionally, state-level pricing regulations offer immediate cost containment. Maryland enforces uniform hospital rates regardless of whether patients pay via private insurance, cash, or Medicare, while capping hospital budgets. Rhode Island caps hospital reimbursement growth at the rate of general inflation.
Expanding the physician pipeline and enforcing state-level cost controls help lay the groundwork for sustainable healthcare reform.