Advocates for Medicare-for-all, a system designed to provide comprehensive healthcare coverage to all Americans without copays, premiums, or deductibles, face a significant political hurdle: the high compensation of U.S. physicians. This challenge is highlighted by the situation surrounding Abdul El-Sayed, a prominent proponent of Medicare-for-all and a candidate in Michigan's Democratic Senate primary. A recent report indicated that his wife, a psychiatrist, does not accept Medicare at her private practice, illustrating a broader tension between universal healthcare ambitions and the financial interests of medical providers.
El-Sayed's platform advocates for a system where Medicare covers all necessary healthcare for every American and is accepted everywhere. However, achieving such a system in the U.S. involves addressing the fundamental reason for the nation's high healthcare costs: the unusually high prices charged by hospitals, doctors, and drugmakers. Compared to other wealthy countries, the U.S. spends significantly more per person on healthcare, yet Americans do not necessarily receive more or better care. For instance, coronary bypass surgery in the U.S. can cost upwards of $89,000, compared to approximately $17,741 in Australia.
While proponents of Medicare-for-all often focus on the administrative inefficiencies of private health insurance as a source of high costs, a substantial portion of the excess spending stems from provider charges. A 2026 study by economists from the University of Chicago, Stanford, and the U.S. Census Bureau found that American physicians earn about twice as much as their Canadian counterparts and four times as much as Swedish doctors. This disparity is not solely due to general wage differences but also reflects the fact that a significant percentage of American specialty physicians fall within the top 1 percent of national income earners, a much higher proportion than in Canada or Sweden.
The ability of U.S. doctors to command high salaries is partly due to fewer price controls in the healthcare sector compared to other nations. Public insurance programs like Medicare and Medicaid pay rates that are closer to international norms, but doctors often earn significantly more when billing private insurers or affluent patients. This leads some physicians, like El-Sayed's wife, to decline Medicare patients if they have a strong base of higher-paying clients.
Implementing Medicare-for-all without addressing provider payment rates could lead to a dramatic increase in national health spending. An analysis by economist Charles Blahous in 2018 suggested that if a single-payer system maintained current provider payments, national health spending would rise significantly. Conversely, if all providers were mandated to accept Medicare's rates, health spending could decrease.
Confronting the financial interests of doctors and hospitals presents a political challenge for progressive healthcare reformers. Unlike private insurance companies, which are often viewed as faceless bureaucracies, doctors are generally held in high public regard. Publicly calling for reduced physician compensation can be politically difficult, as demonstrated by the historical opposition from groups like the American Medical Association (AMA) to single-payer proposals.
To mitigate these challenges and lower healthcare costs, policymakers are exploring various approaches. Some states have implemented payment regulations, such as Maryland's system where hospitals receive uniform rates regardless of the payer, or Rhode Island's cap on hospital reimbursement rate increases. Another strategy involves addressing the physician shortage that contributes to high salaries. The U.S. has fewer physicians per capita than many comparable countries. This shortage is partly a result of policies enacted in the 1980s that aimed to curtail the training and immigration of doctors, based on concerns about a future surplus that did not materialize.
Reforms to increase the supply of physicians, such as ending the federal freeze on residency funding and easing restrictions on foreign-trained doctors, could put downward pressure on salaries. While these measures won't eliminate the political hurdles to Medicare-for-all, they could make universal coverage more feasible by ensuring that the healthcare system has sufficient resources to meet increased demand without incurring prohibitively high costs. Ultimately, achieving affordable and accessible healthcare for all Americans may require a willingness to adjust physician compensation and increase the overall capacity of the healthcare sector.