We spoke to Bernie Sanders about alleged health insurance CEO shooter Luigi Mangione, the crisis of for-profit health care in America, why only a mass movement can win Medicare for All, and how to fight the growing share of working-class votes for the Right.
The assassination of UnitedHealthcare CEO Brian Thompson in Manhattan last week has drawn more media scrutiny to America’s health care system than we saw in the entire 2024 presidential election. Many are taking the occasion to debate the appropriateness of the public response, which has tended to be unsympathetic. Perhaps a more pressing question is: If Americans feel this way about private health insurance, then why have politicians dropped the issue?
It’s clear in the aftermath of the murder, allegedly carried out by twenty-six-year-old Luigi Mangione, that people across the political spectrum are outraged at insurance companies’ greed and the system’s inability to provide adequate care for Americans. But without a mass movement around Medicare for All helmed by strong political leadership, it is difficult to imagine how people’s rage and despair can be channeled into lasting change.
Senator Bernie Sanders spoke with Jacobin contributor Chandler Dandridge about the reaction to Thompson’s murder, the cruelty of the for-profit health care system, the case for Medicare for All, how to promote unity among working-class voters, and the need for Democratic Party leaders to say which side they are on.
- Chandler Dandridge
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We are approaching the fifteenth anniversary of the Affordable Care Act [ACA] and the US is still in the throes of a serious health care crisis. In fact, over the past ten years profits have only increased for insurance companies, premiums keep going up, and basic claims continue to be denied. Why did President [Barack] Obama’s signature legislation fail to fix our health care system?
- Bernie Sanders
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Because the ACA’s major function is to increase health care coverage by subsidizing the insurance industry. Its function was never to get to the root causes of the problems and ask why we spend about twice as much per capita on health care as the people of other countries. It didn’t address the issue that the function of the current health care system does not — underline not — provide quality care in a cost-effective way.
The function is very clear, and that hasn’t changed: it is to make as much money as possible for the insurance companies and the drug companies. So if you have a system that is designed to make tens of billions a year in profits for insurance companies and drug companies, by definition it is not going to address the needs of the American people.
- Chandler Dandridge
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Despite the current crisis, health care was largely absent from the 2024 general election — a stark difference from when you ran for president in 2016 and 2020. You’ve traveled all across the country these last few months: Have average people lost interest and resigned themselves to the status quo?
- Bernie Sanders
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[shouting] NO! Is that clear enough?
Look, when we talk about the health care crisis, in my view, and I think the view of a majority of Americans, the current system is broken, it is dysfunctional, it is cruel, and it is wildly inefficient — far too expensive. That’s what people understand that the situation is. When I give public speeches most of the time, I’ll say, “Listen, I want you to tell me what you think. How many of you think the current American health care system is working well? Please raise your hand.” Very few hands go up. “How many of you think it’s broken?” Almost every hand in the room goes up. That’s what the American people understand for obvious reasons.
We’ve had eighty-five million people uninsured. We pay the highest price in the world for prescription drugs. Our outcomes are worse than most other health care systems. Our life expectancy is lower. Some sixty thousand people a year die because they don’t get to a doctor on time. You don’t have to be a genius to understand that this is a wildly dysfunctional system. We spend twice as much per capita on health care, and we get less in value than other countries.
But the real crisis is not a health care debate. It’s a political debate. It’s a campaign finance debate. The reason we have not joined virtually every other major country on Earth in guaranteeing health care to all people as a human right is the political power and financial power of the insurance industry and drug companies. They spend huge amounts of money making sure that we do not challenge the basic premises of the current system, and that we continue to maintain a health care system run by insurance companies and drug companies. It will take a political revolution in this country to get Congress to say, “You know what, we’re here to represent ordinary people, to provide quality care to ordinary people as a human right,” and not to worry about the profits of insurance and drug companies.
So it’s a political issue primarily. That’s what we’ve got to address. To answer your question, I believe that people are more than aware of the health care crisis. I think it is on their minds. And it saddens me that not only do Republicans have nothing to say on it, or, I guess, Trump is still “working on a plan,” but Democrats can’t go much beyond trying to protect the Affordable Care Act.
- Chandler Dandridge
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After Donald Trump’s victory in November, it was impossible to ignore his rising support among working-class people of color, building on a trend of working-class white voters abandoning the Democratic Party in earlier elections. Could that process have been stopped if the Democrats had embraced Medicare for All and other universal social programs earlier?
- Bernie Sanders
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Early on in this campaign, I commissioned a poll. We asked the American people questions about some of the most important issues facing America, including health care, including Medicare for All. And it will not surprise you that, in fact, a strong majority of the American people understand that health care is a human right. There was very strong support for Medicare for All.
And while you have support for Medicare for All, you could turn on the television and watch it twenty-four hours a day, every day of the year, and you’ll not hear any discussion of Medicare for All. Only a handful of us — Physicians for a National Health Program, myself, and some others — are talking about it. Imagine what would happen if you had a whole political party taking on the insurance industry and the drug companies and demanding change.
But even without that megaphone, with a limited megaphone, the American people understand the current system is broken. We need to move in a very different direction. And you talk about why working-class people have abandoned the Democratic Party? That is one of the answers. If you go around saying, “The only thing I can say about health care is I will oppose cuts to the Affordable Care Act” — man! That doesn’t address the crisis we have in Vermont, where insurance costs are going up 10 to 15 percent a year. Small businesses can’t pay it.
I talked to some trade unionists just the other day, largest unions in Vermont. They tell me every time they sit down to negotiate, they can’t get a wage increase because the health care costs have gone up so much, public employees and private sector as well. So no, I do not agree with anybody who thinks that health care is not on the minds of the American people. I don’t agree with people who don’t think politically that this is a winning issue. Taking on the insurance and drug companies is exactly what working-class Americans want, whether you are a Democrat, Republican, or Independent.
As I said before, we did polling, and Medicare for All, health care as a human right, cutting the cost of prescription drugs in half, expanding Social Security benefits by lifting the cap on taxable income, immediately expanding Medicare to cover dental, hearing, and vision — all of these issues are wildly popular. But in every instance, you’re taking on powerful special interests, and unfortunately, right now, given the role of big money in politics, there are far too few politicians who are prepared to stand up and say the obvious.
People understand the system is broken. You had two campaigns: the Democratic campaign saying, “Hey, the status quo is working okay, we’re going to fix a little bit around the edges.” And Trump coming in saying, “The system is completely broken and I’m going to fix it.” Well, unfortunately, he’s going to make a broken system even worse. But he won support because people know that the system is broken. It is broken. The campaign finance system is broken, the health care system is broken, the housing system is broken, the education system is broken. It is broken. And we need a movement to create a society that works for all of us, and we can do it. It ain’t easy, but that is what the struggle is about.
- Chandler Dandridge
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It seems we are in the process of class dealignment, where the working class no longer votes as a bloc in its economic interests but rather disperses across the political spectrum — including, in many cases, falling behind reactionary billionaires. Do you see Medicare for All as a campaign that can reverse that process?
- Bernie Sanders
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Yes, it might. Not all. But I will tell you in Vermont, I’ve seen it. People say, “I disagree with you on the abortion issue” or “I disagree with you on gay rights, but you’re right on the economic issues.” That’s why we do well with working-class people. So I think if you want to save American democracy, if you want to protect the working class of this country, where wages, in many cases, have not gone up for decades, the bottom line is you’ve got to make it clear which side you’re on. Are you on the side of the working class or on the side of the 1 percent? Once you make that decision, then the issues fall right into place.
Health care is a human right. We’re going to take on the insurance companies. We’re going to have a tax system that is fair. We’re going to demand a wealth tax and a tax on the very wealthiest people in this country. We’re going to have campaign finance reforms so billionaires don’t buy elections. All of those things fall naturally into place, and they make sense to people, but you need leadership that is prepared to say this.
There was a poll I just saw the other day in the New York Times that said something like, “Do you think Congress is more interested in benefiting the elite and themselves than ordinary people?” And very strongly, people said yes. So we need leadership that says, “No, we are on your side.” And to be on your side, you got to take on powerful special interests, including the insurance companies and drug companies. You do that and you not only make good policies, you win elections.
- Chandler Dandridge
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Last week, twenty-six-year-old Luigi Mangione allegedly murdered UnitedHealthcare CEO Brian Thompson on a Manhattan sidewalk. Much has been made of the public’s reaction to Thompson’s murder, which at least online tended to range from outright jubilance to a more somber “the industry had it coming.” Some are saying this event is a turning point in public awareness around health care inequality and the profit-hungry insurance industry and a harbinger of invigorated public resistance. Others worry the embrace of vigilante violence is a morbid symptom of a mass movement in decline — a sign of political hopelessness. What do you think?
- Bernie Sanders
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Let me just say this: it goes without saying that killing anybody — this guy happened to be a father of two kids. You don’t kill people. It’s abhorrent. I condemn it wholeheartedly. It was a terrible act.
But what it did show online is that many, many people are furious at the health insurance companies who make huge profits denying them and their families the health care that they desperately need. The stories unfold all the time: “My mother was on cancer treatment and I couldn’t get care for her. The insurance company rejected it. Some bureaucrat rejected it. She died.” Or “My kid is suffering because we can’t get the prescription drugs that we need, they rejected the doctor’s request.”
What you’re seeing, the outpouring of anger at the insurance companies, is a reflection of how people feel about the current health care system. It is broken. It is cruel. I mentioned to you: 60,000 people a year die because they don’t get to a doctor when they should. 60,000 people!
And here’s another statistic that I’ll throw out, which is never talked about: it’s not only that our life expectancy is lower than virtually every other wealthy country, it’s that if you are working-class, you’re going to live five to ten years shorter than people who are wealthy. So if you’re a working-class person in this country, the stress that you live under, the economic duress that you live under, the lack of health care that you’re receiving, five to ten years shorter life than people who are rich. All of that is unacceptable. It’s an outrage, and the fact that we don’t even talk about that stuff is even more of an outrage.
So you got a system that’s broken. It’s cruel. People know it, and unfortunately, we have not had the political leadership to take on the greed of the insurance companies and drug companies and say, “You know what, we’ve got to join the rest of the world and move in a very different direction.”
The murder is absolutely abhorrent. We are not going to reform the health care system by killing people. The way we’re going to bring about the kind of fundamental changes we need in health care is, in fact, by a political movement which understands the government has got to represent all of us, not just the 1 percent. And absolutely at the very top of that list is the understanding that health care is a human right. The insanity of the situation is this is not even a question of spending more money. Right now, what the studies clearly show is that there’s so much waste and so much administrative costs and so much bureaucracy in the current system that you could, in fact, provide quality care to every man, woman, and child in this country without spending any more than the $4.4 trillion that we’re currently spending — an astronomical sum of money.
We’ve got to put that money into disease prevention, into getting more doctors and nurses, much greater focus on primary care, cutting back radically on administrative costs. The cost of administering Medicare is something like 2 percent and for private insurance companies, 12 to 14 percent. And millions and millions of dollars a year for these CEO salaries in the private sector. That is not how we should be spending health care dollars. Meanwhile, we don’t have enough doctors and nurses and dentists.
Killing people is not the way we’re going to reform our health care system. That is abhorrent and immoral. The way we’re going to reform our health care system is having people come together and understanding that it is the right of every American to be able to walk into a doctor’s office when they need to and not have to take out their wallet. Not a radical idea! It exists fifty miles away from me in Canada and exists in one form or another all over the world.
I remember talking to Europeans: “Do you know what a deductible is?” They don’t even know what the hell you’re talking about. The system is so complicated and inhumane. So my answer to that question is yes, we need a political movement. Health care is an integral part of any progressive political movement.
- Chandler Dandridge
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One common refrain is, “Bernie Sanders’s Medicare for All idea is pie in the sky. Of course it would be lovely, but it is pure fantasy,” the idea being that it’s aspirational but structurally unworkable, politically unachievable, and so on. What is your response to criticisms like that?
- Bernie Sanders
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If it’s bloody pie in the sky, why does it exist fifty miles away from where I live? Now, the Canadian health care system is not perfect, to be sure. But if you end up with a heart transplant at a Toronto hospital, which is high quality health care, do you know how much you pay when you leave the hospital? Do you know? Zero. Depends if you park your car in the parking lot. They charge you for that. But that’s it. You go to any doctor you want and you don’t take out your wallet.
Now, if it is so goddamn utopian and pie in the sky, why does it exist in every other bloody country other than the United States? That’s number one. So it ain’t pie in the sky. We are the exception to the rule.
Number two: in terms of “It doesn’t work!” Elon Musk just posted something the other day in which he pointed out the administrative costs in the United States health care system compared to other countries. In some cases it’s three times as much. We are wasting hundreds and hundreds of billions of dollars.
Go to your local hospital, okay? And your hospital probably doesn’t have enough doctors or nurses. But you know what they got? Go down in the basement to the billing department, and you’ll see dozens and dozens of people on the phone, telling people that they owe $58,000 and they’ve got to pay the bill. That’s what Canada has eliminated. That’s what the UK and other countries have eliminated.
So we’ve got to work on a nonprofit health care system, universal, covering all people, cost effective, and not insurance bureaucrats making decisions, but doctors making decisions. It exists all over the world — not a radical idea. There is study after study showing that we are wasting huge amounts of money in bureaucracy, billing, and compensation costs for CEOs rather than providing the health care that we need.
This gets back to what I said a moment ago: you turn on the television, who’s talking about Medicare for All? Me occasionally, a few other people. Yet, despite that, you got a lot of support for it. Imagine if you had a political party that said that.