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The U.S. Healthcare System is Already Mostly Socialized
Now that Abdul El-Sayed is the Democratic nominee for Michigan’s open Senate seat, the outcome of this crucial race will depend mainly on two things: Whether Republicans succeed in demonizing El-Sayed because he’s brown and a Muslim, and whether they succeed in demonizing him as a left-wing radical. I will defer for the now the question of whether bigotry will be effective this year, although I will address it another day. What I want to address instead is El-Sayed’s signature issue — healthcare. Yes, El-Sayed advocates Medicare for All, a position the usual suspects denounce as “socialism.” I will get to the politics of his stance soon. Today, however, I want to talk about the substance. We should be clear that El-Sayed doesn’t even call himself a socialist. On the contrary, he explicitly disavows the label, saying “I’m a capitalist who just knows about capitalism”. In fact, as I explained in a previous post, the policies that El-Sayed advocates qualify him as a social democrat, not a socialist. Still, El-Sayed advocates a system under which the government would pay almost all medical expenses. Isn’t that socialism? Well, if that is the criterion then much of U.S. healthcare is already socialist. In fact, the government’s role is so large that U.S. healthcare is better described as partially privatized socialism than as anything resembling a free market. Let’s start with the raw numbers on health insurance, which pays the bulk of Americans’ medical expenses. Americans receive health insurance either from private companies or from public programs, overwhelmingly Medicare and Medicaid. Here’s what the breakdown of coverage and spending between private and public looked like in 2024: While a majority of Americans with health insurance get it from private companies, well over 100 million of us are covered by government programs instead. And these government programs pay more total dollars for medical bills than the private insurers do. Why do government programs that cover a minority of the population account for a majority of health insurers’ outlays? Mainly because Medicare covers seniors, and we’re expensive. Also, while Medicaid covers many younger Americans, disabled and elderly beneficiaries account for most of its spending. Even by the raw numbers, then, U.S. health insurance looks as much public as private. But that understates the government’s role: Private health insurance in the U.S. is both highly regulated and heavily subsidized. This is obviously true for the insurance coverage purchased by tens of millions of Americans through the exchanges established by the Affordable Care Act. But employment-based health insurance, which covers 161 million Americans, is far more of a government creation than most people realize. For employment-based insurance exists largely because of huge implicit government subsidies that come with major strings attached. Here’s how that works. If your employer pays you $10,000, that’s taxable income. But if your employer pays $10,000 toward a company health insurance plan that meets certain criteria, it isn’t taxable. That’s a huge effective subsidy, running at more than $300 billion a year. Take that subsidy into account, along with the more than $100 billion per year spent subsidizing policies purchased under the ACA, as well as the outlays on Medicare and Medicaid, and net effect is that the government pays for more than two-thirds of Americans’ health insurance. Granted, there are strings attached. Roughly speaking, employment-based health plans can’t discriminate based on medical history — that is, they can’t deny coverage to employees with pre-existing conditions — and they also can’t offer the plans only to highly compensated employees — a health plan that is only for the C-suite is considered taxable income. So given the restrictions of the federal tax code, employer-based health insurance is a lot like Obamacare, which also prohibits discrimination based on medical history and provides subsidies to make insurance affordable to lower-paid workers. The fact is that virtually all of private healthcare insurance is already well under some form of government control through regulation and tax subsidies. How should we think about this system? First of all, is Medicare socialist? Don’t tell anyone, but the way Medicare operates — it covers every senior’s medical expenses, whatever they turn out to be, while being funded by taxes that depend on one’s income — could be summarized by the old Marxist slogan “From each according to his ability, to each according to his need.” And back in 1961, when Ronald Reagan was the face of a last-ditch effort by the American Medical Association to block the creation of Medicare, he denounced Medicare as “socialized medicine” and warned that it would destroy our freedom. In reality, American freedom survived until Jan. 20, 2025, while Medicare is immensely popular, with an 82 percent favorable rating in the most recent KFF survey. Medicaid, government health insurance for lower-income Americans, comes in at 73 percent. This is in sharp contrast to public views about private insurers, who are widely disliked if not hated and accused of denying essential care. Furthermore, if Medicare is socialism, then the whole U.S. health insurance system, with the government paying most of the bills and placing conditions on private insurers, is almost equally socialist. If you insist on calling any program the government pays for and regulates socialist, then U.S. healthcare would best be described as a partially privatized form of socialism. And one must ask, what is the point of the part that is privatized? Do private insurers add anything positive? Or are they simply parasites, skimming off money that could have been paying for care? The case for viewing insurers as parasites is strong. Many Medicare benefits are now delivered via Medicare Advantage, that is, plans paid for by the government but run through insurance companies. MedPAC, an independent advisory commission, estimates that last year Medicare Advantage plans were overpaid by $84 billion, thanks to practices such as “upcoding,” in which patients’ health problems are overstated to get larger sums from Medicare. Assessing the waste from employer-based insurance is harder, but most evidence suggests that private insurers have substantially higher administrative costs than Medicare does. Furthermore, the complexity of private insurance, with multiple payers all trying to deny care when they can, is a huge burden both on providers — doctors, nurses, and hospitals — and on patients. What do private insurers offer to compensate for these costs? One must go through intellectual contortions to avoid the conclusion that they are, in fact, parasites. Which brings me back to El-Sayed. In supporting Medicare for All, he’s basically calling for an end to the partial, parasitic privatization of a healthcare system that is already hugely dependent on public funding. When one looks at it that way, it’s not at all a radical proposal. Admittedly, the political lift requires overcoming the opposition to higher taxes to pay for Medicare for All. Political realism rather than economics was the reason I and many other progressives supported Obamacare, with all its complexities, rather than demanding an immediate move to Medicare for All. But the political calculus may very well have shifted since the 2000s, as Americans are fed up with a system of unaffordable premiums, rampant claim denials, and byzantine claim administration. Moreover, funding healthcare insurance through taxation would allow for a much more progressive distribution of the cost. That is, compared to the present system, middle-income households would pay less as high-income households would pay more. And the U.S. would stop wasting large sums on pointless administrative costs. So let’s be clear: El-Sayed’s healthcare platform is perfectly reasonable on the merits of cost, fairness and health efficacy. And with private insurers never more hated, while millions of Americans are losing their health insurance, 2026 may be its time. MUSICAL CODA
Sankey, SEC 'prepared to contest' judge's order in Louisiana
While the SEC said it will comply with an order that prohibits commissioner Greg Sankey from issuing punishment if they roster a player who returns from a pro contract, the league said, in a Sunday statement to ESPN, it will defend its rights in court.
Erie County receives small number of responses to biometric law disclosure
The law prohibits businesses from collecting, using or selling people's data.
Trump administration sues Minnesota for allowing trans athletes in girls’ sports
Justice department claims the state is violating Title IX – the federal law that prohibits sex-based discrimination
Parents argue new lawsuit against Ten Commandments in classrooms
The posters have already survived legal scrutiny under the Establishment Clause, but these parents are relying on a Texas law that prohibits the state from substantially burdening a person’s free exercise of religion.
Trump tells soldiers to vote GOP in campaign-style rally at Fort Bragg
Army policy prohibits partisan displays, and most service members refrained from cheering.
Bill banning Erie County businesses from using biometrics signed into law
The "Biometric Transparency and Privacy Act" prohibits the collection of biometric identifier information in commercial settings in Erie County.
Patel Suggests F.B.I. Agents May Be Sent to the Polls
Federal law prohibits armed federal officers or military personnel from being deployed to polling stations.
Health Care Providers Are Dropping a Common Anesthesia Drug That’s Also a Climate Super Pollutant
Limiting use of desflurane helps hospitals reduce their greenhouse gas emissions; the European Union now prohibits its use during most procedures.
This Jibber-Jabber Night in Acadiana prohibits jibber jabber. Here's why it works.
Learn how Acadiana Talent in Lafayette provides a platform for musicians of all ages to perform, experiment and connect, contributing to the city's diverse music scene.
Supreme Court allows Trump administration to use expanded database for potential voter purges
Critics have said the data could lead to U.S. citizens being kicked off the voter rolls, but the justices noted the law prohibits broad voter purges in the weeks leading up to an election.
Should California taxpayers chip in to fund political campaigns? Prop 4 lets you decide
Proposition 4 would lift a ban that prohibits state and most local candidates from using public funding for their political campaigns. Proponents argue the mechanism helps more candidates run for office, but opponents are skeptical.
Texas judge rejects push to let churches make political endorsements
A group of Texas churches and the IRS agreed to nix the Johnson Amendment, which prohibits nonprofits from endorsing candidates. A Trump-appointed judge said no.
Treasury plans to put Trump's signature on all new U.S. paper currency in break with tradition
The plans come in tandem with an ongoing effort to get Trump’s face on a coin, which has also drawn criticism since federal law prohibits the depiction of a living president on U.S. currency.
There’s more money in politics than ever. Here’s one way Rhode Island can fight back.
The Rhode Island Corporate Power Reset Act would also redefine corporations in a way that prohibits political spending.
Senate approves bill to protect business franchisees' religious beliefs, operating days
It prohibits a franchisor from requiring existing franchisees with sincerely held religious beliefs to operate on religious days. There are a few exceptions, including when an original franchise agreement required operation on a religious day.
Pulpit Politics: Johnson Amendment Rarely Enforced
The Johnson Amendment prohibits tax-exempt religious and charitable organizations from endorsing or opposing political candidates. Some Oklahoma churches have found a loophole: partnerships with other organizations let them reveal political alignments.
Political campaign & advertising signs not allowed on public highway rights of way, MnDOT says
With election season in full swing, the Minnesota Department of Transportation (MnDOT) is reminding campaigners that state law prohibits the placement of political signs, or any advertising on highway right-of-way.
Glyphosate: A story of science, risk, and nuance
In the summer of 2014, a California groundskeeper named Dewayne Johnson started noticing patches of raw, weeping skin spreading across his body. He had spent years applying Roundup, Monsanto’s glyphosate-based herbicide, for a school district, sometimes drenched in it when equipment malfunctioned. By 2014, he had a diagnosis: non-Hodgkin’s lymphoma. In 2018, a jury awarded him $289 million in damages, later reduced on appeal. Tens of thousands of lawsuits followed. The story hasn’t quieted down. It’s all over the internet, swinging between “this will kill you, buy organic” and “relax, you’re fear-mongering.” Some of that recent chatter stems from an Executive Order protecting glyphosate and its production, which set off intense infighting within the MAHA movement. Some of it reflects a deeper truth: Americans genuinely care about harmful chemicals in their environment (see poll below). And the conversation isn’t going anywhere, with a Supreme Court case involving Monsanto set for this April. Glyphosate (the active ingredient in Roundup) is one of the most widely used herbicides in the world. But does glyphosate cause cancer? And how much exposure is actually risky? With so much mistrust in institutions and corporations (and some genuine conflicts of interest), making sense of the actual scientific evidence is genuinely hard. Here is a translation of what the scientific evidence actually says. Does glyphosate cause harm? Glyphosate is an herbicide that kills most plants it contacts rather than targeting specific species. It works by blocking an enzyme pathway (EPSPS) that plants and many microorganisms need to produce essential amino acids. Without those amino acids, the plant can’t grow and dies. Glyphosate was first developed by Monsanto in the 1970s and became ubiquitous after the company introduced “Roundup Ready” crops in the 1990s. In 2024, Bayer removed glyphosate from residential Roundup-branded products due to litigation pressure. But today it is still the most widely used herbicide in the world. Farmers also discovered they could spray it directly on crops like oats, lentils, beans, and peas just before harvest to dry them out faster and make harvesting easier. Because of its widespread use, it’s obviously really important to understand if it’s harmful to humans. The key principle: The dose makes the poison The most important concept in toxicology is that “the dose makes the poison.” Sixteenth-century physician Paracelsus articulated what remains the foundational principle of toxicology: sola dosis facit venenum. Water will kill you if you drink enough of it. Aspirin saves lives at 81 milligrams and causes internal bleeding at higher chronic doses. So, at what dose is glyphosate poisonous? The LD50 in rats (the dose that kills half the test animals) is around 5,600 mg/kg body weight. Table salt is roughly 3,000 mg/kg. By that classic measure, glyphosate is less acutely toxic than salt. But some people are exposed to a lot of glyphosate through their work. And among the general public, there are many questions about low-dose, cumulative exposure from multiple sources over long periods. Does glyphosate cause health problems? Cancer Correlation maps are striking, with one analysis finding that 60% of counties that spray the most glyphosate have non-Hodgkin’s lymphoma rates above the national average. But correlation alone doesn’t establish cause, which is why animal and human studies matter. In animals: Rat studies are typically what most fear is rooted in, but most people don’t know the study details on the dosage given to rats. A pooled analysis of the 13 most rigorous rat studies found evidence that very high doses, around 55,000 times greater than typical food residue exposure, can cause certain cancers. In humans: One of the strongest studies followed 55,000 herbicide users over 20 years and found no overall increased cancer risk. There was one signal: among those with the highest use, rates of acute myeloid leukemia (AML) appeared elevated. A broader meta-analysis of 18 human studies also found no overall cancer risk, though a separate meta-analysis focused specifically on non-Hodgkin lymphoma found that people with high cumulative glyphosate exposure faced a 41% higher relative risk compared to those with low or no exposure. These human studies are observational studies (randomized controlled trials would be unethical), and meta-analyses are only as reliable as the studies they pool. But the story seems consistent: at very high exposure levels, there may be some cancer risk. But that’s about as far as the science currently takes us. Emerging research: gut and reproductive health Gut: Because glyphosate targets a pathway that exists in some gut bacteria, scientists have questioned whether it could affect the microbiome. In mice, a 2023 University of Iowa study found that glyphosate altered gut bacterial composition and raised markers of intestinal inflammation. A 2024 systematic review found similar patterns: disrupted gut bacteria and problems with the mucus layer that protects the intestinal wall in mice. Whether this translates to humans is an open question. The human gut is highly variable and resistant, and we don't yet have strong studies confirming the same effects in people. Reproductive health: Animal studies have found that glyphosate-based herbicides can interfere with reproductive hormones, including disrupting egg cell development in mice and reducing the number of eggs available in sheep’s ovaries. However, the doses used in these experiments were high, so it’s not yet clear whether the same effects would occur in humans. On the human side, a 2021 pilot study led by Mount Sinai researchers tested urine samples from pregnant women across the U.S. and found glyphosate in 95% of them. The study also found a possible connection between higher glyphosate exposure during pregnancy and a subtle physical difference measured in female newborns. That said, some connections weren’t statistically reliable and this was a small study. The researchers themselves said more and larger studies are needed before drawing firm conclusions. What do regulators say about glyphosate safety? In 2015, the International Agency for Research on Cancer (IARC), part of the World Health Organization, classified glyphosate as "probably carcinogenic to humans" (Group 2A). The classification is worth taking seriously. But, there’s an important distinction: IARC classifies hazard, meaning the potential to cause harm under some conditions. It does not assess risk, which accounts for actual exposure levels and the real-world probability of harm. The U.S. EPA, the European Food Safety Authority, Health Canada, and regulatory agencies in Australia and Japan have all concluded that glyphosate is “unlikely to be carcinogenic to humans” at realistic exposure levels. They’re asking a different question: given how much of this people actually encounter, what is the probability of harm? Your actual exposure is what determines your actual risk. What does glyphosate mean for your daily life? At the grocery store: Food residues are small. The EPA’s acceptable daily intake is 1.75 mg/kg of body weight per day. To hit that threshold from oatmeal alone, a 150-pound adult would need to eat roughly 50 pounds of oats every day. But this calculation addresses only one pathway (food), and we don’t yet have robust tools to measure people’s actual total exposure. If reducing exposure matters to you, organic certification prohibits synthetic herbicides, and organic oat products generally test at lower or undetectable levels. Either way, a diet rich in whole grains, conventional or organic, is far better for your health than one that omits them out of fear of residues. On the farm: Occupational exposure is orders of magnitude higher than consumer exposure. Farmers and farm workers who mix, load, and apply glyphosate-based herbicides, especially without protective equipment, face meaningfully different risk profiles. Proper PPE isn’t optional. Integrated weed management strategies that rotate chemical modes of action are also worth taking seriously, both for health and for long-term effectiveness. If you live near a farm: Spray drift is real. Concentrations near field edges can spike during and after application, particularly on windy days. This is an area where I think public health could really step up and empower rural communities with buffer zones, rather than placing the onus on individuals. But for now, knowing your local agricultural calendar and keeping windows closed during application are the first steps. Bottom line Dewayne Johnson was exposed to glyphosate at levels most people will never encounter, and a jury decided he deserved compensation. That outcome is not evidence that the oatmeal in your pantry is dangerous. But it is a reminder that the dose, the context, and the person doing the exposing all matter enormously. Glyphosate is a chemical tool with benefits, trade-offs, and genuine open scientific questions. Learning to hold that complexity without collapsing into panic or dismissal is, honestly, one of the most useful and hardest things to do in navigating modern health science. Love, YLE Your Local Epidemiologist (YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife, and mom of two little girls. Hannah Totte, MPH, is an epidemiologist and YLE Community Manager. YLE reaches more than 425,000 people in over 132 countries with one goal: “Translate” the ever-evolving public health science so that people will be well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below: Subscribe