Adding Principle to Pragmatism: The Transformative Potential of "Medicare-for-All" in Post-Pandemic Health Reform

William M. Sage

ABSTRACT. "Medicare-for-All" should be more than a badge of political identity or opposition. This Article examines the concept's potential to catalyze policy innovation in the U.S. health care system. After suggesting that the half century of existing Medicare has been as much "Gilded Age" as "Golden Era," this Article arrays the operational possibilities for a Medicare-for-All initiative. It revisits America's recent history of pragmatic rather than principled health policy and identifies barriers to more sweeping reform. It then applies to Medicare-for-All four health policy insights not known when "single-payer" reform was debated a generation ago: simultaneous inefficiency and injustice in medical care, neglect of the social determinants of health, inertia resulting from the legal architecture of health care, and the latent power of generational change. It concludes by explaining how applying a Medicare-for-All frame to post-pandemic health reform might prompt ethical re-engagement by the medical profession and help the health care system take specific steps on a path to improvement.

AUTHOR. William M. Sage, James R. Daugherty Chair for Faculty Excellence, School of Law, and Professor of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin; Visiting Professor of Population Health, New York University School of Medicine. A.B., Harvard, 1982; M.D., J.D., Stanford, 1988.

RECOMMENDED CITATION. William M. Sage, Adding Principle to Pragmatism: The Transformative Potential of "Medicare-for-All" in Post-Pandemic Health Reform, 20 YALE J. HEALTH POL'Y L. & ETHICS (2021).