YOUR MOLARS ARE PART OF YOUR BODY.

JUSTICE · SOCIAL JUSTICE

Published by | Langhorne P. Breedlove

MONDAY, NOVEMBER 9, 2026 · 12:30 AM ET

Tags: Universal Healthcare · Dental · Vision · Hearing · Mental Health · Prescription Drugs

Dear fellow American proletariat: The human body is not a collection of optional accessories. Teeth are attached to the head. Eyes and ears have a rather important relationship with the brain. Yet Americans are routinely asked to shop for coverage as though an organ became a luxury the moment an insurance contract placed it in another department.

American Proletariat proposes a publicly financed guarantee of comprehensive, clinically appropriate healthcare, independent of employment, income, disability or the ability to purchase private insurance. The package would include prevention, primary and specialist care, hospital treatment, prescription medications, maternity and reproductive healthcare, mental-health and substance-use treatment, rehabilitation, necessary long-term support, dental care, vision and hearing services. We would preserve room for private supplementary services without making basic medical security depend upon them.

THE MANDATE

Establish a national entitlement to medically necessary healthcare with no point-of-service charge for covered essential services, a clearly published benefits schedule, strong patient rights and enforceable access standards. Financing would come through a congressionally enacted public arrangement rather than coverage being conditional on an employer's benefits package. No one would have to keep a job solely to keep necessary coverage.

This is AP's proposed policy, not the current entitlement established by Medicare, Medicaid or the Affordable Care Act. The comprehensive benefits package must specify clinical criteria, evidence review, excluded elective services, appeals, medical privacy and how it interacts with existing Veterans Affairs, military, Tribal and disability services. A national entitlement cannot responsibly be a promise to pay every submitted medical bill without examination.

ROOTS & HISTORY

The political argument is older than most living Americans. Congress held hearings on national health insurance in 1916, and President Harry Truman sent Congress a comprehensive federal health-insurance proposal in November 1945. Lawmakers did not enact Truman's plan. On July 30, 1965, President Lyndon B. Johnson signed the legislation creating Medicare and Medicaid at the Truman Library in Independence, Missouri. (Source 01)

The programs continued evolving. Medicaid later expanded services for children and other populations; Congress established the Children's Health Insurance Program in 1997; Medicare prescription-drug benefits began in 2006; and the Affordable Care Act of 2010 changed coverage rules and expanded available pathways. Each development broadened access, but none created one comprehensive federal medical entitlement for everyone. (Source 02)

The World Health Organization defines universal health coverage as access to needed, quality services without financial hardship, spanning prevention, treatment, rehabilitation and palliative care. That is an outcome standard, not an endorsement of one specific national financing mechanism. (Source 03)

TODAY · THE HUMAN BILL

The Census Bureau's September 15, 2026 report estimated that 26.7 million Americans, or 7.9% of the population, were uninsured for the entirety of 2025. Employment-based coverage was the most common type, covering 53.5% of the population for some or all of that year. Those measures come from the Current Population Survey and must not be casually mixed with insurance statistics based on different survey definitions. (Source 04)

The Centers for Medicare & Medicaid Services estimated U.S. health expenditures at $5.3 trillion in 2024, equivalent to $15,474 per person and 18.0% of gross domestic product. The total included approximately $1.64 trillion in private health-insurance spending, $1.12 trillion in Medicare spending, $932 billion in Medicaid spending and $557 billion paid out of pocket. The categories are not a ready-made savings account from which a new system can simply withdraw everything twice. (Source 05)

Even having insurance is not the same as having every service covered. Original Medicare generally excludes routine dental care, hearing aids and associated fitting exams, and eye exams for ordinary prescription eyeglasses; particular medically related exceptions exist, and Medicare Advantage plans may offer additional benefits. (Source 06)

This is why AP's proposal explicitly includes teeth, eyes, ears, behavioral health, medicines and needed supports. A reform that advertises universal coverage while leaving common necessary services behind should disclose those limitations, not bury them in sixty pages of exclusions.

THE LEGAL PATH

Congress would need to enact eligibility, covered benefits, federal financing, provider-payment rules, enforcement rights and transition protections, and amend or coordinate the statutes governing Medicare, Medicaid, CHIP, employer-based coverage and federally supported health programs. Health agencies could administer the new framework only within authority granted by law; the president alone cannot create a fully funded nationwide entitlement.

States retain substantial healthcare licensing and public-health responsibilities, while Tribal Nations have their own sovereign interests and healthcare arrangements. Any federal reform must respect lawful medical practice, protect reproductive and disability rights, and preserve continuity for patients receiving life-sustaining treatment during the transition.

THE PLAN · CARE FIRST, BILLING SECOND

01 · DEFINE THE WHOLE BENEFIT

Publish a unified schedule of covered medical, dental, vision, hearing, mental-health, substance-use, maternity, rehabilitation and appropriate long-term services. Use transparent evidence review for new treatments, medically appropriate safeguards against waste, and fast independent appeals when care is denied. Ensure preventive and primary services are available in every community, not merely promised on paper.

02 · MAKE ACCESS REAL

Build provider networks and public capacity with specific standards for appointment waits, travel distance, disability access, interpreter services, rural hospitals, emergency treatment and telehealth. Finance workforce training and residency expansion where shortages are demonstrated. If the card says YES but no clinician is available for six months, the card is lying.

03 · REPLACE THE COVERAGE MAZE

Choose a financing and administrative architecture only after comparing public single-payer, national public-plan and coordinated multi-payer designs. Each model must show exactly how existing Medicare, Medicaid, CHIP and employer coverage would transition, how claims would be paid and how patients would retain continuity of treatment. The public shouldn't have to memorize an insurance company's organizational chart to get an MRI.

04 · PROTECT MEDICINE FROM PATRONAGE

Create transparent rates, fraud controls, conflicts-of-interest rules, drug purchasing standards and independent clinical oversight. Maintain privacy, reproductive autonomy, and due process for patients and providers. Report denials, appeals, geographic access and quality outcomes publicly without revealing individual health records.

THE TEN-YEAR LEDGER

A national healthcare guarantee cannot be responsibly costed by multiplying the current $5.3 trillion spending total by ten. Current national spending includes public and private payments, direct patient expenses, administration and investments that would change under reform. The required ledger must track what spending shifts to federal accounts, what remains with states and households, and how total national spending changes. (Source 05)

The Congressional Budget Office has explained that single-payer models can produce very different federal outlays and national expenditures depending on provider payment rates, patient cost sharing, service use and the treatment of long-term services and supports. Its illustrative models are not a cost estimate for AP's unfinalized benefit package. (Source 07)

The first-year forecast must account for statutory setup, enrollment systems, transitional coverage, expanded benefits, clinical capacity, workforce and capital expenditures, negotiated reimbursement, administrative changes and revenue from any enacted financing instruments. The ten-year model must separate gross government outlays, existing public expenditure redirected, household and employer payments displaced, net new taxation, provider effects, utilization changes, medical inflation and uncertainty.

Because AP has not yet selected a financing model, provider rates, eligibility details or ten-year economic assumptions, a defensible first-year net cost and decade-long fiscal balance cannot presently be stated. The decision must be modeled transparently before anyone calls it paid for. A promise of care without a budget is a wish; a budget without real access is an accounting trick.

WHAT COULD GO WRONG?

A faster expansion of coverage than the clinical workforce can absorb may create bottlenecks, longer queues and reduced access even as financial barriers disappear. Paying providers too little can undermine hospital finances or discourage participation; paying too much can forfeit savings. Broadly removing patient charges can increase demand, which requires workforce, facility and scheduling plans rather than wishful arithmetic.

Critics of a single public payer emphasize disruption to employer plans, federal fiscal exposure and risks of centralized payment decisions; advocates emphasize universal eligibility, simpler administration and bargaining power. A coordinated multi-payer model may reduce transition shocks but can retain complexity and uneven access. AP should evaluate these alternatives on common assumptions rather than treating an ideological label as a cost-benefit study. (Source 07)

A national benefits promise must also respect patient choice, medical evidence, institutional independence and fair appeals. It should neither compel a particular provider relationship nor allow profit-maximizing utilization rules to substitute for clinical judgment. The practical aim is secure healthcare, not a new bureaucracy with better stationery.

MEASURING SUCCESS

Publish coverage and effective-access rates, preventable hospitalizations, appointment wait times, maternal and infant outcomes, dental treatment rates, vision and hearing access, avoidable mortality, prescription affordability, patient-reported experience, rural facility capacity, workforce retention, fraud losses and net cost per person. Evaluate differences by geography and population without exposing private medical records.

The test is wonderfully uncomplicated: Can people obtain the care they need, in time, without sacrificing their financial security? An American should be able to get a tooth filled, a hearing aid fitted or a cancer diagnosis treated without having to establish that the body part in question belongs to the correct insurance department.

SOURCES & FURTHER READING

01 · United States Senate Historical Office — Medicare Signed into Law, July 30, 1965; history of national health insurance proposals. https://www.senate.gov/artandhistory/history/minute/Medicare_Signed_Into_Law.htm

02 · Centers for Medicare & Medicaid Services — History of Medicare and Medicaid; program milestones, 1965–2010. https://www.cms.gov/about-cms/who-we-are/history

03 · World Health Organization — Universal Health Coverage (UHC), definition and service continuum. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-%28UHC%29

04 · U.S. Census Bureau — Health Insurance Coverage in the United States: 2025, Lisa N. Bunch and Halelujha Ketema, September 15, 2026. https://www.census.gov/library/publications/2026/demo/p60-291.html

05 · Centers for Medicare & Medicaid Services — National Health Expenditure Data: NHE Fact Sheet, 2024 actual expenditures. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet

06 · Medicare.gov — What's Not Covered? Original Medicare dental, vision and hearing limitations. https://www.medicare.gov/providers-services/original-medicare/not-covered

07 · Congressional Budget Office — How CBO Analyzes Proposals for a Single-Payer Health Care System, December 10, 2020. https://www.cbo.gov/publication/56898

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WE ARE ONE.  ·  E PLURIBUS UNUM.