Dear Indiana Delegates and Members of the Indiana Democratic Party:
The Indiana Democratic Party would be well-served by including “Medicare for All” as outlined in the Medicare for All Act of 2025 as one of the pillars of its platform.
Our healthcare system as it stands is broken and the election of Donald Trump in 2024 demonstrates that ordinary Hoosiers feel left behind and are thirsting for transformative, radical economic change.
In 2024 alone, the United States spent nearly $15,000 per person on health care, $5,000 more than its closest peer nation, Switzerland. Japan, with a far older median population (50 vs. 39), only spent $5,790 per person. Yet, people in the U.S. consistently have a lower life expectancy, higher rates of disability and death due to chronic health conditions, more hospitalizations for preventable conditions, and fewer insured people than comparable countries.
Why?
The administrative morass caused by private medical insurance goes a long way toward explaining these discrepancies. Whereas traditional Medicare spends approximately 98 cents of every dollar on care, private insurers only spend 83 cents.
The top four insurance companies by revenue — UnitedHealth, CVS Health, Elevance, and Cigna — averaged annual stock buybacks of $3.7 billion in the decade ending in 2022.
The difference in efficiency of Medicare Advantage (run by private insurers) versus traditional Medicare directly illustrates this point. The increase in stock value for insurance company shareholders comes directly off the backs of ordinary Hoosiers.
Vertical integration further increases the financial leverage of the top U.S. private insurers. Four of our top seven public health insurance companies own the four largest prescription benefits managers: CVS Health (Caremark), with a 33-percent market share; Cigna (Express Scripts), 24 percent; UnitedHealth Group (OptumRx), 22 percent; and Humana (Humana Pharmacy Solutions), eight percent.
Medicare for All offers a way to control these skyrocketing costs immediately.
A 2020 study estimated that implementing Medicare for All would have reduced total national healthcare expenditures by 13 percent by unifying and leveraging the vast buying power of all Americans (348 million in 2024) to reduce reimbursement rates to hospitals, doctors, and clinics and lower pharmaceutical prices via negotiation.
Switching from today’s for-profit, multi-payer health insurance system to a not-for-profit, single-payer system would lower costs for marketing and billing and better able administrators to focus on detecting and reducing healthcare fraud.
Medicare for All would also save the lives of 68,000 people who die needlessly each year for lack of health insurance, saving 1.73 million life-years annually.
In addition to extracting value from the healthcare system via administrative overhead and profits, the disparate private health insurance stifles labor market flexibility and deters small business development. Currently, approximately 60 percent of people under age 65 have employer-sponsored health care. Each employer plan may have a different negotiated provider network, meaning that an employee runs the risk of being forced to change doctors if they change jobs. That “job lock” acts to restrain upward mobility for people looking to get ahead in our economy. It also prevents people from taking risks to start a new business. Finally, the private insurance market also creates a strain on small employers, forcing them to spend time and resources on benefit selection and compliance, rather than growing the business. A 2025 survey of small business owners showed many are concerned about their ability to afford employee coverage and remain competitive.