How Abdul El-Sayed would build Medicare for All, from a wealth tax to a Fed-style governing board

Near the end of his victory speech in Detroit early Wednesday, Senator-elect Abdul El-Sayed returned to the line that carried his campaign: “It shouldn’t be this hard to see a doctor in the richest, most powerful country in the world.”

El-Sayed defeated Republican Mike Rogers in Michigan’s open Senate race on a night when Democrats captured both chambers of Congress. He arrives in Washington as one of the country’s most prominent advocates of Medicare for All, a public, universal, single-payer system, and as the co-author of a detailed plan for how it would work.

The issue resonated with voters in both parties. In the NBC News Exit Poll, which surveyed more than 79,000 voters, 85% said they were very or somewhat concerned about healthcare costs. Sixty-one percent said the federal government should play a bigger role in helping Americans get it.

Democrats campaigned on healthcare costs across the country, but the party is split on the fix. Many moderates want to strengthen the Affordable Care Act, which expanded coverage through Medicaid and subsidized private marketplaces. For El-Sayed and other progressives, Medicare for All remains the gold standard, and a single public payer would replace much of the private insurance business that sustains some of America’s largest companies.

UnitedHealth Group is No. 3 on the 2026 Fortune 500 and the biggest healthcare company on the list. CVS Health, which owns Aetna, ranks No. 6, and Elevance Health ranks No. 18. El-Sayed has singled out the industry before: in 2022, in written testimony to the Senate Budget Committee, he noted that UnitedHealth’s second-quarter profit in 2020 nearly doubled from a year earlier.

El-Sayed, 42, holds a medical degree and a doctorate, ran Detroit’s health department from 2015 to 2017, and later directed Wayne County’s Department of Health, Human and Veterans Services. He and co-author Micah Johnson laid out their vision in the 2021 book Medicare for All: A Citizen’s Guide, which offers the clearest picture of how the policy could take shape as progressives grow in Congress.

In the book, El-Sayed and Johnson describe Medicare for All as “an enhanced version of the traditional Medicare program that tens of millions of seniors rely on today,” one that would insure every American for life.

A “core tenet” of the policy, they write, is comprehensive coverage: physician visits, prescription drugs, and emergency services, potentially extending to long-term care, vision, and dental. Patients could see any participating provider, eliminating out-of-network charges.

El-Sayed has also pitched the system as more durable than employer-based coverage. “Turn 26, get a job, lose a job, get married, get divorced: none of these would cost you your health insurance under Medicare for All,” he wrote in the same Senate testimony.

One element has shifted. In a 2020 podcast, El-Sayed said Medicare for All “does away with the private insurance market,” Bridge Michigan reported. During this campaign, he said his version would not ban private plans offered through unions or employers, though his campaign website says Medicare for All “should make those choices redundant and unnecessary.”

He has also sketched how the system would be run. At a July roundtable with Michigan voters hosted by More Perfect Union, El-Sayed said its governance should sit “under, but separate from, the executive branch,” similar to the Federal Reserve, so the program couldn’t “change on a dime” with each new president. He added that Medicare would negotiate prescription drug prices as the buyer for the entire country.

El-Sayed and Johnson argue that individual Americans already fund the U.S. healthcare system through taxes, premiums, deductibles, and copayments. Under Medicare for All, they contend, money would flow through the public sector rather than private insurers.