Hakeem Jeffries cosponsored Medicare for All for years. Then he became the Democratic leader, had to actually figure out how the damn thing would work, and now he’s against it. Naturally, the socialists are losing their minds. How could he turn on us? Let me tell you how.
He fucking thought it through.
Before I explain, a warning. For the next few paragraphs I’m going to talk like the socialists’ fearless leader, Hasan Piker. Maybe that’s the only language some of you understand. I have almost nothing in common with the guy, except apparently I can get pissed off and talk shit too. So here goes.
Do you really think you can snap your fingers and boom, 350 million Americans suddenly have incredible health care, nobody gets a bill, everybody gets whatever doctor they want, and the whole thing just magically works? That isn’t a health care plan. That’s a fucking Disney movie.
Let’s get one thing straight. Health care in America sucks. No argument from me. Everyone in the health care industry knows it. From top to bottom. EVERYONE!!!
But the socialists who love explaining how business works, while having apparently never run anything more complicated than a group chat, have skipped one tiny step. They haven’t thought the fucking thing through. Not once.
A lot of you have probably barely dealt with the health care system. You watch AOC post videos about freezing her eggs, a sophisticated, expensive medical procedure, or see controversies about campaign-paid health and wellness expenses, and somehow come away thinking that is the health care debate. It isn’t.
Health care is the 78-year-old diabetic with heart disease taking nine medications. It’s a cancer patient getting chemo. It’s the kid in the emergency room at 2 a.m. It’s the nurse covering too many patients. It’s the primary care doctor spending half the day fighting insurance companies. And that isn’t even the half of it. It’s the ambulance crew, the pharmacist, the lab tech, the radiologist, the respiratory therapist, the surgeon, the receptionist, the billing department, the janitors, the people who are just there to try and make things more palatable during what might be the scariest thing in your life, and thousands of other people you never think about until you desperately need one of them.
And here’s the part nobody wants to hear. Health care is a business. And every one of those people wants to get paid and needs to get paid.
You can hate that sentence. You can scream at it. You can throw a little socialist tantrum and call me a capitalist pig. It will still be true. And guess what. Somebody has to decide how much.
There is another problem nobody wants to admit. Talking about actually fixing health care is boring as shit.
I know because I lived it. I hosted a radio show in Las Vegas for four years with a co-host who had spent his entire career in the health care business. He was also very active in the Republican Party and spent years trying to get common-sense health care reforms in front of both state legislatures and Congress. He knew his shit, and like just about everybody else who has tried to seriously fix this mess, he mostly got nowhere.
When Obama finally got Obamacare passed, Obama himself said this was just a starting point. It still needed a ton of work. That was the important part everybody missed. Obamacare was never going to fix American health care in one shot. It had to be the beginning of a long process. Fix what worked, change what didn’t, and keep improving it year after year.
Instead, Washington did what Washington does best. Absolutely fucking nothing.
Trump screamed repeal and replace, except he never quite got around to the replace part. And now the socialists have arrived saying, essentially, fuck you assholes. You had your chance. We’re taking the whole fucking thing over.
And you know what? I understand why that sells. Medicare for All fits on a bumper sticker. “Let’s spend six years restructuring reimbursement rates, expanding the medical workforce, changing hospital incentives, reforming drug pricing, increasing primary-care capacity, and figuring out how to pay for all of it” does not.
My co-host understood all of this. He could explain exactly where the system was broken and what might actually make it better. And guess what happened every single time we talked about it on the air? Our ratings dropped like a fucking stone. Straight off a cliff.
People on the left didn’t want to hear it. People on the right didn’t want to hear it. Everybody loves saying health care is broken. Everybody loves screaming about insurance companies, drug companies, Obamacare, Medicare for All, and greedy hospitals. But the second you get down to brass tacks, reimbursement rates, physician shortages, hospital margins, Medicare payments, Medicaid payments, malpractice costs, drug development, nursing shortages, who gets paid what and where the money actually comes from, click. They change the fucking station.
And therein lies the problem. The slogans are exciting. The solutions are boring. Unfortunately, the boring shit is where the answer is.
People love bitching about their doctor. They hate talking about how the doctor gets paid. Unfortunately, how the doctor gets paid is how you get the fucking doctor.
So let’s go fast before everybody changes the channel.
Forget the entire American health care system for a minute. Start with one doctor’s office.
Before the doctor even walks into the room, somebody answered your call, found you an appointment, checked you in, took your vitals, pulled up your chart, and made sure the doctor knew why the hell you were there. After the doctor leaves, somebody has to order the blood work, schedule the MRI, send the referral, and somehow get the prescription to the pharmacy without a hitch. If all that works, you probably think you have a great doctor. If it doesn’t, the smartest doctor in America can’t save the experience. Nobody calls you back, the MRI never gets scheduled, the referral goes nowhere, CVS says they never got the prescription, and you’re sitting at home wondering whether anybody involved remembers you exist.
Here’s the boring part again. Every one of those people is vitally important, and every one of them wants to get paid. And every doctor I know complains about some version of the same thing. There isn’t enough money coming through the door to hire really good people, pay them what they’re worth, keep enough of them around, and still run the damn practice.
Then we do something even more ridiculous. We spend ten or twelve years teaching somebody how to diagnose cancer, replace a hip, or operate on a human brain, and then one day we say, “Congratulations. Here’s payroll, hiring, firing, health insurance, rent, billing, insurance contracts, computer systems, software, and twenty employees who all have problems. Good luck.” Running a business isn’t brain surgery. That’s exactly the fucking point. We trained them to operate on brains. Maybe let them do that.
Now take that doctor’s office and multiply it by a hundred or a thousand and you have a hospital.
A hospital is basically a small city whose entire purpose is dealing with people on some of the worst days of their lives. Nurses, doctors, MRI techs, phlebotomists, pharmacists, respiratory therapists, x-ray technicians, transporters, receptionists, billing people, maintenance workers, security guards, and don’t forget the janitor cleaning the room you’re lying in so the hospital doesn’t accidentally make you sicker than you already are.
Like I said before, every single one of those people is vitally important. And every single one of them wants, and deserves, to get paid. The building costs money. The MRI machine costs money. The drugs cost money. Electricity costs money. Computers cost money. The nurse has a mortgage. The technician has kids. The surgeon spent half his adult life learning how to keep you alive.
This is the part the bumper sticker crowd never seems to get. You can change who pays the bill. You can have an insurance company pay it. You can have the government pay it. You can have employers pay it. You can raise taxes and have all of us pay it together. Fine.
But you cannot snap your fingers and make the fucking bill disappear.
Here is something the whole debate skips. There are two parts to health care, and we only ever argue about one of them. There is sick care, which is what everything above is about, the doctor, the hospital, the bill. And then there is well care, which is everything you do so you never end up in the hospital in the first place. Food, exercise, sleep, weight, blood pressure, catching things early. Nobody fights about well care because there is no slogan for it and no villain in it.
I know the Democrats hate RFK Jr., and plenty of what he says I would not touch with a ten foot pole. But he is right about one thing. This country is sick because of how we live, and no amount of insurance fixes that. Somebody I actually admire on this is Jillian Michaels. She has spent her whole life saying the same thing. Our system is built to treat you after you get sick, not to keep you from getting sick. She is right, and she has been right for twenty years, and nobody in Washington listens because there is no money in prevention for the people who write the checks. At least RFK Jr. is trying, as we all should.
And here is where the schools come in, because they are making it worse. We spend years teaching kids about society, politics, identity, injustice, who has power, who doesn’t, and all the ways the world can screw them over. Fine. Some of that matters. How about we teach them to take care of themselves instead? How to eat, how to move, how to sleep, how their own body works. You know the old saying. Give a man a fish and he eats for a day. Teach him to fish and he eats for life. Right now we are handing out fish and lectures, and wondering why nobody knows how to fish. SOOO, could we maybe teach them what the fuck a carbohydrate is?
Teach them how blood sugar works. Teach them what being overweight does to their joints and heart. Teach them how to cook five healthy meals. Teach them why sleep matters. Teach them how to exercise without needing a $200-a-month gym. Teach them what blood pressure means before they’re 45 and sitting in a cardiologist’s office asking why theirs is 170 over 100. That would be FUCKING useful.
A person with diabetes, heart disease, kidney problems, and a medicine cabinet that looks like a pharmacy costs the system a hell of a lot of money year after year. Helping that same person twenty or thirty or forty years earlier is a hell of a lot cheaper. Now multiply that by millions of people. That is real money.
Maybe we should spend a little less time arguing about who is going to pay for everybody once they’re sick and a little more time figuring out how to keep millions of them from getting so damn sick in the first place. That could actually be part of the solution.
And this is where the conversation gets uncomfortable. If your position is that anyone who wants to come to America should be allowed to come, and that everyone who arrives should immediately receive government paid health care, okay. But then you owe me more than an answer about money. Because money isn’t health care. People are health care.
So snap your fingers and produce another hundred thousand doctors. Go ahead. Conjure an experienced ICU nurse out of the air. You can’t. Nobody can. They take years to train, and those years are not negotiable.
Add millions of patients without adding doctors, nurses, and facilities and something has to give. Waits get longer. Appointments get harder to get. Doctors spend less time with each patient. Nurses carry more patients. And I don’t want the solution to be that exhausted nurses should simply work harder.
Then there’s the name itself. Medicare for All. It sounds like Medicare is free. It isn’t.
Part A generally arrives without a premium at 65 because you spent decades paying Medicare taxes, and it primarily covers hospital care. Want doctors and outpatient care? That’s Part B. Monthly premium. Then deductibles. Then coinsurance. Then many people buy Medigap from, brace yourself, a private insurance company to cover what Medicare doesn’t. Then there’s prescription drug coverage. Money, money, money, money.
So when somebody says Medicare for All, I have boring questions again. Which Medicare? Part A? A and B? Are prescription drugs included? Are the deductibles gone? Does everybody get supplemental coverage? And here’s the really important one. What are you paying the doctors and hospitals?
Because if the answer is substantially less, congratulations, we’re right back in that little doctor’s office. There’s no money for another person on the phones. The great scheduler leaves for a better paying job. The doctor sees more patients in less time. The nurse gets another bed. And the new free health care system looks fantastic on paper while the actual care quietly gets worse.
None of this makes the system we have defensible. It isn’t. Nobody should go bankrupt because they got cancer. Nobody should stand in an emergency room doorway doing math about whether they can afford to help their own child. Nobody should spend three weeks fighting an insurance company over a drug their doctor already prescribed. We have to fix this. Which is exactly why the slogans make me crazy.
Slogans don’t answer phones. Slogans don’t clean hospital rooms. Slogans don’t hire nurses. Slogans don’t pay technicians. And slogans sure as hell can’t tell me where another hundred thousand doctors are supposed to come from.
Now, I will give you this. The future might look a little better. AI may take a real bite out of the paperwork, the billing, the scheduling, the insurance fights, and that could knock a lot of cost out of the system. Good. But there is no replacement for a human being when you are scared and suffering and looking for help. Nobody wants a chatbot holding their hand in the ER. The new drugs are helping too. The GLP-1s are doing things for weight and diabetes that nobody thought possible ten years ago. And there is a whole biohacking industry out there promising to keep us all young, which right now seems available to the ultra wealthy and nobody else.
So maybe things get better down the road. That does not change a damn thing right now. What are we going to do now?
In the last piece I wrote about how the Swedes didn’t fix their country by deciding which side was morally superior. People who disagreed with each other sat in a room, looked at the numbers, and changed what wasn’t working. That is what health care needs. Not a slogan, not a takeover, not a bumper sticker. Boring people doing boring work on the boring stuff, year after year, and not changing the channel.
Go back to what Obama said. Obamacare was just the start. It was never supposed to be the finish line, it was supposed to be the first draft, and then we were supposed to keep working on it. Instead we spent fifteen years fighting about whether to rip it up. So let’s sit down and figure out the rest, or we are just going to keep sounding doomed.
Boring? Absolutely. Won’t do numbers on TikTok. Do it anyway.
The Middle Is Still the Majority. Let’s Prove It.
If this resonated, get counted. Join the DemUnited newsletter — no outrage, just the reasonable middle making its case.