Democrats must take the offensive on healthcare, not just defend the status quo. You don’t need a doctor to tell you America’s healthcare system is broken, but the fact remains: after leading two public health departments, the reality is clear — working people struggle to survive in a system that has become both unaffordable and needlessly confusing. The frustration is universal. Scheduling a visit, waiting hours for a brief encounter, and facing bills you can’t pay even with insurance — these experiences are all too common.
The political stakes are equally clear. Republicans are pushing to dismantle the Affordable Care Act by slashing Medicaid and ACA subsidies, which would force millions to lose coverage. In response, Democrats can’t simply defend existing programs. It’s time to propose a bold, comprehensive reform that aligns with what Americans deserve: a healthcare system without medical debt, anchored by Medicare for All.
Over the past fifteen years, Republican policy choices have undermined stability in favor of large insurance and pharmaceutical donors. After a government shutdown tied to expiring ACA tax credits, some Republicans appear determined to end ACA subsidies entirely, pricing many Americans out of coverage. When people lose coverage, they still need care. Emergency rooms become a default source of treatment, and the costs are ultimately borne by everyone. The consequences of ending ACA subsidies will be dwarfed by the broader impact of Medicaid cuts — potentially a trillion dollars in reductions paired with tax giveaways to the wealthiest, creating a collapse in the safety net. In Michigan, about 2.3 million people rely on Medicaid, and vulnerable groups such as people with disabilities and seniors would lose critical care. Medicaid covers a substantial share of children in the state, and rural hospital closures have affected communities across the state — realities that demand clear, decisive action.
At this moment, Democrats should respond with a plan that matches the scale of the crisis: eliminate medical debt — a burden currently totaling around $220 billion — and provide durable protections to prevent debt from accruing in the first place. A proven path is to expand and secure universal coverage through Medicare for All. This means a guaranteed, comprehensive government health insurance program available to every American from birth, with no copays, premiums, or deductibles, and without excluding private plans as add-ons. It would protect against loss of coverage due to job changes, marriage, or aging, and would permit those who prefer private employer or union-based coverage to keep it as an optional supplement. The key is that the public option would shield people when employment ends or a workplace closes.
Medicare for All would reduce overall healthcare costs by cutting out inefficiencies and the administrative burden that comes with complex billing. It would enable stronger drug price negotiation by the government, lowering prescription costs for everyone.
Expanding Medicare to cover all Americans would also strengthen the program for seniors by enlarging the risk pool with younger, healthier participants. From a business perspective, it would unlock entrepreneurship: people wouldn’t be tied to low-paying jobs solely for insurance, paving the way for innovation and new ventures.
Recent signaled weakness within the party — eight Democratic senators voting against a shutdown in the face of rising healthcare costs — underscores the need for a principled, proactive approach. Proposing an ambitious expansion of coverage, not merely defending against Republican attacks, could energize the base and signal a serious commitment to reform ahead of elections.
This is the moment for Michigan and for the nation to demonstrate what functional government can do for real people. Progress isn’t about earning gratitude for scraps; it’s about delivering tangible results and earning trust through results that improve lives. Leaders must show the courage and vision to deliver the healthcare system Americans deserve, unburdened by debt and built on universal access.
Dr. Abdul El-Sayed served as health director for Michigan’s two largest health departments and is a candidate for the U.S. Senate.
