Political challenges facing universal coverage

Major reforms intended to achieve universal health coverage in the United States need to consider numerous political and policy issues if they are to succeed. This discussion focuses on the proposed Medicare for All (M4A) universal healthcare model and suggests four essential political/policy issues that must be carefully considered if this model is to be adopted. Introduction of these issues provides frameworks to use when defining the issue and stakeholder identification strategies useful for any major health-related policy analysis. Understanding the position and scope of stakeholder investment in these issues is also necessary for any proposed healthcare payment strategy. The impact of the Federalist model of government on any healthcare policy proposal is introduced as an important contextual factor in the M4A proposal. Examples of concerns of three key stakeholders: the states, major philanthropic interest groups, and individuals are then offered for consideration and discussion.