The features of a single-payer or a Medicare-for-all (M4A) health care system would provide economic benefits for individuals, families, doctors, hospitals and the nation. For most households, M4A saves money and provides more disposable income. Gerald Friedman, PhD and Professor of Economics at the University of Massachusetts—Amherst, has studied M4A for many years. He estimates that a M4A system financed by progressive taxes would cover more and cost less for 95 percent of U.S. households than our current health care system. Further, he estimates that a family of four with an income of $50,000 would save more than $5,800.

Opponents have made the claim that M4A is too expensive. They say that over 10 years we would need to pay $32 trillion in extra taxes, our current expenditure on health care multiplied by 10. This assessment implies that we need to increase taxes and still spend just as much on insurance premiums and deductibles. That claim is disingenuous.

First, insurance is not used in a M4A system, so there are no premiums. Friedman’s data showed that the family of four that had an income of $50,000 would save $6,273 in insurance premiums and deductibles that are no longer collected. The family would pay an extra $466 in taxes for a net gain in disposable income of $5,807. Again, 95 percent of households would save money.

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Other countries have implemented Medicare-for-all systems that do not require “skin in the game,” and they get better health outcomes at much lower costs. In fact, “skin in the game” causes consumers to forgo necessary health care. The most common way to implement “skin in the game” is with high-deductible health plans. As one health expert stated:

The nation continues to push forward with expanding deductibles in health plans in spite of evidence that they are creating great harm by increasing financial burdens on individuals and families and by impairing access to essential health care services and products.

Meanwhile, health insurance and pharmaceutical executives have no incentive to improve the system. For too long these executives have been able to act however they want without any consequences. This has literally killed people and caused bankruptcies—all in efforts for the companies to keep their profits high and for the CEOs to keep their salaries astronomical.

It is time to force these executives to have “skin in the game.” We need to define a series of performance goals for our health care system.

The first goal should be that our health system covers everybody.

The second goal should be to eliminate financial stress from accessing health care. Eliminating copayments and deductibles can achieve this.

The third goal is that patients should have the freedom to choose any medical professional or hospital.

The fourth and fifth goals should be to have the per capita health expenditure equal to or less than $4,750 and the health expenditure as a percentage of GDP that is equal to or less than 10 percent. According to data from the Organisation for Economic Co-operation and Development, which represents 35 countries, the average per capita health expenditure is about $4,750 for developed countries, and the average expenditure as a percentage of GDP is about 10 percent.

Until all goals are met, health insurance and pharmaceutical executives are limited to compensation that does not exceed ten times the minimum wage. Profits from the companies shall be used to reduce health care costs until the goals are met. Once met the companies may use their profits and compensate their executives however they want.

These executives have perpetuated a system that requires too many patients to sacrifice their good health, their financial well-being, and/or their lives. It is only fair that we make the executives have “skin in the game.”