In 2024, then-candidate Kamala Harris lost the presidential election in a campaign featuring Medicare for All (M4A). M4A is a proposal for a single-payer health program managed by the federal government. All health care costs would be covered by the federal government: Premiums, deductibles, copays, and any other out-of-pocket costs would be completely paid for through federal funds. That plan would also eliminate all other federal health programs as well as the private marketplace, and expand the Medicare program to include the entire population.

The Harris loss builds upon the records of Bernie Sanders and Elizabeth Warren, both of whom advocated M4A variants and failed to even secure the nomination. Indeed, the campaign trail for offices at many levels of government is littered with losses by M4A supporters. Medicare for All is the shiny bauble that everyone wants to talk about, but which the electorate rejects when its vote (and money) is on the line.

Medicare for All is a political loser.

From a policy perspective, M4A is a disaster. As a 2024 AAF report notes:

The health insurance coverage provisions under current law for the non-elderly are estimated to increase federal spending by $43.9 trillion between 2026 and 2035.

…

The tax revenue is expected to be about $1.7 trillion; however, this is more than offset by $4.1 trillion in spending, leaving a net federal cost of $2.3 trillion for the year 2028. Over eight years of full operation between 2028 and 2035, the total net cost is $24.1 trillion.

So, M4A makes no sense as a policy reform and has no record of political success. Why, then, is M4A suddenly popping up all over the place? Examples include Senate candidate Abdul El-Sayed in Michigan, Troy Jackson – a candidate for Senate in Maine – and others. Have there been improvements in the proposal in the past several years?

A new report  by Stephen Parente for AAF’s Center for Health and Economy revisits the facts around M4A (referred to as “the Plan”). It concludes:

• Coverage under the Plan reaches effectively universal levels almost immediately: The ranks of the uninsured fall from 13 million in 2027, the first year of implementation, and to zero from 2028 onward, as the individual market, employer-sponsored insurance, and Medicaid are fully absorbed into the new federal program.
• Total insured population grows from 332 million in 2027 to 358 million by 2036, tracking total U.S. population growth — which now reflects undocumented and other illegal entrants who begin receiving coverage in 2026 — as essentially all net growth occurs in the new “Other Public Insurance” category that replaces private and Medicaid coverage.
• Medical productivity is projected to fall as the newly insured population enters the system and network-based cost controls disappear: The Medical Productivity Index declines 14 percent in 2027 relative to the current-law baseline, worsening to a 22-percent decline by 2036.
• Provider access improves as cost sharing is eliminated and coverage becomes universal: The Provider Access Index rises 12 percent in 2027 and climbs to a 19-percent improvement by 2036, assuming provider supply keeps pace with demand.
• Absent new revenue, the coverage provisions of the Plan carry a net budgetary cost of $2.5 trillion in 2027, rising to roughly $5.9 trillion annually by 2036, for a cumulative net cost of $47.4 trillion over the 2027–2036 period.
• Layering in the pay-fors identified in the Sanders M4A financing framework — which candidate Harris pointed to as a viable option — still leaves a shortfall: For 2028, $1.7 trillion in new revenue offsets only part of the $4.1 trillion coverage cost, leaving a net budgetary gap of $2.4 trillion for that year alone and $19.0 trillion cumulatively from 2028–2036.

The twist this time around is a separate Yale School of Public Health preprint that claims M4A would instead save $1.04 trillion annually and prevent 114,000 deaths a year. The AAF report reveals the overly optimistic assumptions and analytic flaws that undercut these findings.

The enduring popularity of M4A remains a puzzle. But Eakinomics has long held that there is no more fertile environment for bad ideas than a political campaign. Perhaps it is as simple as that.