The Rise & Future of Medicare for All: Advancing the Single-Payer Movement in the 21st Century

Abstract

The U.S. health care system’s lack of universal health insurance coverage and health security, combined with rapidly rising costs, have contributed to growing calls for health reform (Jones & Reinhart, 2018). Moreover, this sense of urgency is juxtaposed with a long history of reform failures, incremental approaches, and public mistrust in government interventions. Against this historical backdrop, to the surprise of many health policy-making stakeholders, a single-payer Medicare for All plan emerged as a serious policy topic debated by experts, presidential candidates, and legislators throughout 2019. The goal of this thesis is to analyze why and how this occurred, and how to maintain support and build political momentum for Medicare for All in order to propel it towards a policy window. The problem statement underlying this thesis is: attempts for a single-payer policy have persisted and failed for more than a century, so a deeper understanding of the factors contributing to Medicare for All’s current rise in prominence is needed to sustain its momentum. Understanding how Medicare for All has reached a window of opportunity and the state of the political environment for health reform enables identifying barriers and developing strategies to address these barriers. This thesis uses John W. Kingdon’s Multiple Streams Framework (MSF) to explain how a policy proposal gains traction and rises up the policy agenda. The methods used to provide context and analysis of the three streams and the current window of opportunity include 1) a quasi-ethnography analysis, which is a qualitative method used to capture naturalistic observations by acting as a participant-observer for the policy process of Medicare for All; 2) a stakeholder network analysis of the Medicare for All Coalition; and 3) a series of key informant interviews with stakeholders of varying levels of support for Medicare for All. Political recommendations and strategies for future progress on Medicare for All were developed using a stakeholder commitment matrix and an analysis of political factors through the Kingdon’s Multiple Streams model. While similar single-payer proposals have failed to gain considerable traction in the past, the recent push for Medicare for All is unique in the scale of its grassroots movement and the level of its legislative and political consideration. Therefore, the conclusion of this analysis is that even if this particular attempt does not succeed, single-payer will continue to be offered as a policy solution until it is achieved.