The false promise of free health care comes with an invoice for the middle class

“Money out of politics! Money in your pocket! Medicare for All!” That’s the rally chant of Abdul El-Sayed , who won Michigan’s Democratic Senate primary in August.

It’s catchy. So was “If you like your health care plan, you can keep it.” PolitiFact named that line its 2013 Lie of the Year , but only after roughly 4 million Americans received cancellation notices due to ObamaCare.

El-Sayed has company. Minnesota’s Senate nominee, Lt. Gov. Peggy Flanagan, is campaigning on Medicare for All , and 102 House members joined Rep. Pramila Jayapal (D-Wash.) as cosponsors of her bill . The pitch goes like this: free care, coverage for everyone living here regardless of immigration status, and the tax bill gets mailed to somebody else.

I have spent more than 30 years in private equity, private credit and family offices reading pro formas. A projection that only works if you ignore the expense line is a dud — the middle class always ends up writing the check.

Start with that last promise. President Barack Obama said his plan would cut a typical family’s premium “by up to $2,500 a year.” PolitiFact has since rated it “Promise Broken .” Premiums rose so far that Congress had to tack on “enhanced” subsidies to them during COVID — one subsidy added on top of the original subsidy, just to make premiums slightly less intolerable. When those credits expired at the end of 2025 , the average monthly net premium jumped by 58 percent and the average deductible hit a record $3,786. Sixteen years in, the Affordable Care Act still can’t live up to its own name.

Democrats want the temporary credits made permanent — a move the Congressional Budget Office priced at $350 billion over a decade . What would that mean? Hospitals would charge exactly what they charge now (with prices rising over time). Your premium statement would look friendlier each month. The difference would land on a Treasury already carrying more than $40.3 trillion in debt . That is called refinancing a bad loan with a bigger bad loan — a fiscal doubling down on stupid.

Then comes the main event. The Medicare for All Act of 2025 says that “every individual who is a resident of the United States” is entitled to benefits. It bars discrimination based on “citizenship status.” The same bill makes it unlawful for a private insurer to sell coverage that duplicates the government plan. So you can keep your plan, right up until it becomes contraband. Your solid benefits package — perhaps even negotiated by your union in lieu of higher pay — would become illegal.

The price of Medicare for All runs into the trillions each year. The Congressional Budget Office studied five illustrative single-payer designs and found federal health subsidies would rise by $1.5 trillion to $3 trillion in 2030 alone . Its follow-up work found that paying for it with income or payroll taxes would leave GDP between 1 percent and 10 percent lower by 2030. It also warned that demand would outrun supply and produce “increased congestion.” After all, nobody conjures an extra hospital bed or a night-shift nurse by printing “free” on an insurance card.

Candidates insist the rich will pay. But the top 1 percent already paid 38.4 percent of federal income taxes in 2023 while earning only 20.6 percent of adjusted gross income; the bottom half paid 3.3 percent. Sen. Chris Van Hollen’s (D-Md.) millionaires surtax would raise no more than $1.5 trillion over ten years .

Sen. Bernie Sanders’ billionaire wealth tax scores between $2.3 trillion and $4.4 trillion over a decade, and he has already spent every dime on paper — on $3,000 checks, a rollback of last year’s Medicaid and ACA changes and new Medicare dental coverage. Even if Sanders tore up his wish list, both bills together might cover two years of single-payer health care at the Congressional Budget Office’s high estimate. After that, the tax collector comes for payroll. Margaret Thatcher saw it in 1976: Socialist governments “ always run out of other people’s money .”

California offers a preview of Medicare for All. Sacramento extended full Medi-Cal (the state’s Medicaid program) to adults regardless of immigration status, then discovered it was spending about $8.5 billion a year from the general fund on that population, with costs running $2.7 billion over projections. The state then froze new enrollments for most non-citizen adults on Jan. 1, 2026 and announced it will be scaling back coverage for those already on the program. Routine dental was cut in July, and $30 monthly premiums will be required starting in 2027.

Gov. Gavin Newsom (D) is hardly a deficit hawk. When he slams the brakes on a program, you know it is unsustainable. It means that candidates promising the national version of this debacle are just selling oceanfront property in Arizona.

Currently, only 49 percent of adults rate as “cost secure” in the West Health-Gallup index , the lowest reading since it began in 2021. That is the proponents’ strongest argument. But a price problem calls for more supply and more competition, something Medicare for All cannot do.

Congress already made bronze and catastrophic marketplace plans eligible for Health Savings Accounts this year, opening tax-free accounts to about 7.3 million new enrollees. That’s the place to start. Next, raise the contribution limits. Enforce hospital price transparency with penalties that sting. Fund more residency slots, since the American Association of Medical Colleges projects a shortfall of up to 86,000 physicians by 2036 . Drive prices down, and coverage gets cheaper for everyone.

Before you vote on Nov. 3, you should put three questions to every candidate who supports Medicare for All. First, what tax rate hits my paycheck? Second, who is eligible? Third, how long will I wait for a specialist?

Channel your inner Jerry Maguire and make them show you the money. A candidate cannot answer those questions is handing you a pitch deck with no financials — a huge red flag that has prompted me to walk away from much better deals than this one.

Jay Rogers is a financial professional with more than 30 years of experience in private equity, private credit, hedge funds, and wealth management.