Franklin D. Roosevelt (FDR), arguably the most influential president the United States has ever had, ushered in a decades-long progressive era that lasted well into the 1960s. FDR is widely credited with saving the United States by lifting the country out of the Great Depression. He successfully implemented bold policies that reversed the extreme wealth inequality created by the oligarchs of his time—the very same oligarchs who caused the Great Depression in the first place. His legacy led to worker safety standards, high labor union participation, and Social Security—ensuring every American could retire with dignity.

His successors continued his progressive movement, paving the way for President Lyndon B. Johnson (LBJ) to take on the U.S. healthcare cartel. Medicare is a federal health insurance program created to provide affordable healthcare to individuals age 65 or over. Medicaid covers the health insurance needs of low-income families, pregnant women, and people with disabilities. At the time, Americans could raise a family of four with relative ease on a single income. This is no longer the case. Following the decline of the progressive reform era in the 1970s, the United States entered a forty-year period characterized by political stagnation and a lack of significant social legislation. While over 55 countries have completely eliminated healthcare cartels, the U.S. remains oppressed by one to this day.

For the sake of familiarity, I will be using Taiwan’s National Health Insurance (NHI) to compare and contrast with the bureaucratic healthcare mess in the U.S. It turns out that Taiwan’s NHI has been ranked number one globally by the Numbeo Health Care Index for eight consecutive years. According to the same source, the U.S. healthcare cartel managed to rank 40th globally in 2026. The problem in the U.S. is not the quality of care provided by highly skilled surgeons and knowledgeable nurses. Hospitals are not the problem; rather, the problem lies with greedy private insurance and pharmaceutical corporations. It is an undisputed fact that healthcare is a human right. Private health insurance systems should not exist, because their true intent is not to provide care, but rather to act as gatekeepers and make short-term profits.

Medicare serves retirees, while Medicaid assists low-income and disabled individuals. What about everyone else? In the U.S. today, children rely on the private health insurance their parents receive through their employers. After turning 26, non-disabled adults must secure their own private or employer-provided health insurance. The fact that healthcare is tied to employment means that middle-class and working-class individuals will lose their health insurance if they lose their jobs. Millions of Americans still subscribe to the notion that the U.S. is the land of the free, yet the reality is very different today. According to the West Health-Gallup Center, nearly a quarter of working individuals are trapped in jobs they hate, solely for fear of losing their employer-sponsored health insurance. This lack of mobility serves as a roadblock to true freedom.

On the other hand, it is unfair to expect employers—especially small and medium-sized companies—to bear the burden of providing health insurance for all employees. My parents have owned a family restaurant since I was a child. When I started helping out at age 15, I realized how lucky we were to be covered under Taiwan’s NHI. Thinking back, if my parents had needed to purchase private health insurance for themselves and our employees, we would have gone bankrupt. Fortunately, Taiwan’s decision to nationalize healthcare in 1995 instituted a single-payer system that prevents the wealthy elite from opting out. Why should the burden of health insurance be put on the shoulders of honest, hardworking individuals and family business owners? The U.S. healthcare system is not a true system, but a fragmented mess of bureaucracy, endless paperwork and complicated rules. It is a lose-lose situation for both employees and employers alike.

Medicare itself needs reform because the government only covers 80% of healthcare costs. This leaves a 20% gap—filled by Medigap—that allows the healthcare cartel to exploit elderly patients. This 20% gap may not sound like a lot, but for major surgeries or for patients on dialysis or chemotherapy, it can still be financially devastating. Let’s face the facts: middle-class and working-class Americans do not have $50,000 sitting happily in their bank accounts, ready to be used for medical emergencies. People have rent or mortgage payments to make, in addition to many other expenses. While purchasing private Medigap insurance effectively covers the 20% gap, doing so highlights a systemic issue. Beneficiaries should not have to rely on the healthcare cartel to avoid financial exploitation within the healthcare system. This is precisely why the United States needs to move towards true universal healthcare, something akin to Bernie Sanders’ Medicare for All.

The biggest problem is that a huge segment of the U.S. population between the ages of 26 and 65 will experience unemployment at some point. The out-of-touch Washington elitists will say that these people could sign up for the Affordable Care Act (ACA). While they aren’t wrong, they ignore the fact that the ACA is part of the healthcare cartel—working within the very system it’s trying to fix with a few band-aids. Since the ACA is often too expensive for those who become unemployed, approximately 18 to 20 million Americans are currently without health insurance. A bureaucratic, deeply segmented healthcare system cannot be reformed. Transitioning to a Medicare for All single-payer system would greatly benefit the entire U.S. population. The vision of Medicare for All is the necessary move the U.S. needs, as such a system is very similar to Taiwan’s NHI, with a few differences to best meet the needs of a different culture.

In Taiwan, 99.9% of the population is covered by our NHI from birth. The NHI is the sole healthcare system; private insurers are permitted only as a supplement and are prohibited from forming cartels to exploit people. Not only does that benefit society as a whole, but it also eliminates healthcare rationing based on class and age. Everyone has an NHI card to use at any hospital or clinic of their choice. Once inserted, the card allows doctors to access your medical history from the past three years through the NHI MediCloud system. This high-tech approach eliminates a lot of paperwork and is one of the main reasons why the NHI is so efficient.

American conservatives from both major parties will spread propaganda to scare people into thinking that Medicare for All will give patients less choice and slow treatment, which is a complete lie. In retrospect, under Taiwan’s NHI, patients who dislocate a shoulder or experience back pain can see a doctor on the same day. There are neither long wait times nor so-called “death panels.” Scheduling for necessary surgeries is also very quick and efficient—certainly much faster than what the healthcare cartel offers Americans. In fact, the U.S. healthcare cartel already subjects Americans to ‘death panels’ via bureaucratic paperwork, corporate middlemen, and fragmented rules. Whenever Americans see through the lies at home, they divert attention by pointing fingers at Canada, claiming that the Canadian healthcare system is too slow. I challenge them to compare their healthcare cartel to the fast and efficient systems in Taiwan, Germany, and Japan. Yes—shut the fuck up if you have nothing of substance to add.

Don’t even get me started on the drug prices Americans have to pay. What is often not talked about is how Americans are being ripped off by the pharmaceutical cartel. I remember picking up my father’s prescription medication. A half-year supply of Apixaban costs approximately $320 USD in Taiwan. In contrast, the same 6-month supply in the United States costs around $3,000 USD, even with Medicare coverage. Imagine how much that would cost for someone who is not yet eligible for Medicare. Under Taiwan’s NHI, patients receive the prescription drugs they need completely free in the first three months. Every drug in Taiwan has a price cap that pharmaceutical companies are allowed to charge patients. It is frustrating to see the U.S. praise the Biden administration for negotiating a list of a few dozen drugs with the pharmaceutical cartel, as though it were an act of goodwill. Only a healthcare cartel would milk every penny from patients’ savings accounts, knowing full well that they depend on these drugs to stay alive.

The goal of this article is not to argue how great Taiwan is and how bad the United States is. Certainly, every country has its strengths and weaknesses. Although Taiwan’s NHI is excellent, it is not perfect, and it will never be perfect. However, perfection was never the goal, as it is unattainable. The objective has always been continuous improvement. I am here to argue that the healthcare cartel has given Americans a corrupt system that is neither efficient nor affordable. The U.S. currently spends 20% of its $32 trillion GDP on a system that fails to insure millions of people, is highly bureaucratic, and results in poorer health outcomes compared to at least 39 other countries. Taiwan spends 3.5% of its $1 trillion GDP on its award-winning NHI, which covers all citizens regardless of age or income. 

So, how does the U.S. achieve Medicare for All when two-thirds of Congress will do anything in their power to prevent it from becoming law? The solution is something I cannot stress enough: the electorate must stand in solidarity during mid-term elections to elect progressive Democrats up and down the ballot. Once we secure a progressive majority and elect a progressive president, we will have the chance to eliminate Citizens United and the Electoral College. Furthermore, when politicians in power reject the healthcare cartel, Medicare for All will finally be taken seriously and implemented into law. The United States remains a democratic country despite its flaws and corruption. We must ask ourselves whether we want a country led by the likes of FDR and LBJ, or a country led by corporate puppets like Donald Trump and Bill Clinton.