In this issue of the magazine, we celebrate our Union’s successful efforts to protect the Affordable Care Act and defend Medicaid.

We know how crucial this fight is, because all of us have somebody in our lives—a family member or another loved one, a close friend or co-worker—who has a serious medical condition. It may be heart disease, cancer, diabetes, multiple sclerosis, or something equally threatening.

Perhaps they were in a bad traffic accident or a fire and continue to suffer from the after-affects. And of course, we help provide care every day to our patients, residents and clients who are facing these challenges.

Their stories remind us that defending our current system is not enough. We have to keep fighting to make it better. While our Union fights for – and often wins -- very low-cost, high quality health insurance for our members, healthcare costs are still beyond the means of many working people.

Just the cost of medications for ordinary chronic conditions, e.g. asthma or glaucoma or migraines, can put those without insurance in debt. And even with insurance premiums, deductibles, co-pays, may force a choice between paying the rent or mortgage and paying the medical bills.

This is not the situation in much of the rest of the world. In Tunisia or Costa Rica or Thailand or virtually anywhere in Europe, like dozens of countries, there are no doctor’s bills. If you break your leg in Italy or develop tonsillitis in Singapore, you are taken to the hospital, receive the required care to make you well, and sent on your way. You don’t even have to travel so far. Cuba is 90 miles off the coast of Florida and Canada is on our northern border. Both have universal health care, national health insurance, single-payer programs, or whatever you want to call it.

But here in the United States, the wealthiest and the highest technologically- developed country in the world, patients come out on the short end in every way. Americans pay more for healthcare and outcomes are worse than in most advanced countries.

For example, in 2012, the average cost of coronary bypass surgery was more than $73,000 in the United States but less than $23,000 in France (not that the French patients had any out-of-pocket expenses). This is because governments are able to negotiate much more favorable terms with drug and device companies and other providers, and because there is no insurance company adding an additional cost. As for outcomes, the United States ranks a shameful 31st in the world in life expectancy.

Actually, we already have national health insurance or single-payer for two sectors of our population: Veterans have the VA, and seniors have Medicare. So why not Medicare for All? It’s not impossible. After all, Medicare is (along with Social Security) the most popular government program in the country.

For years, Rep. John Conyers of Michigan, the dean of the Congressional Black Caucus, has been a leading proponent of Medicare for All. His bill, HR676, has 112 co-sponsors in the current House of Representatives. Senator Bernie Sanders (I-VT) is now introducing a companion bill in the Senate that already has the support of Senators Kirsten Gillibrand (D-NY) Elizabeth Warren (D-MA).

Given the current stranglehold of Republicans on the federal government right now and the challenges of restructuring a sixth of our economy, this will not be a short struggle. But a new Congress will be elected next year, and again in 2020, so it’s not too early to start advocating for it. States are also exploring the possibility of state-based universal healthcare systemsand Medicare for All bills have been introduced in 11 state legislatures.

For the past seven years, the Republican leadership engaged in a never-ending campaign to defeat the Affordable Care Act (or Obamacare).

But even with control of the White House and both houses of Congress, they have been unable to do so. Because whatever its flaws, the Affordable Care Act gave healthcare coverage to more than 20 million people who previously went without. And they don’t want to give it up, nor should they.

Obamacare is a huge achievement in covering tens of millions of uninsured Americans. But it does have shortcomings: some 20 million more still have no coverage; and being based on for -profit insurance markets guarantees that the costs are beyond what they could be. We should view the Affordable Care Act as an important first step toward universal healthcare.

As a candidate, Donald Trump promised to give healthcare “to everybody” and make it “cheaper than ever”. But each of the several versions of Trumpcare had two common elements— loss of coverage for more than 20 million people, and the transfer of nearly a trillion dollars in Medicaid money to the already Super Wealthy. They have yet to offer an actual healthcare bill.

“Healthcare for everybody”?

“Cheaper than ever”? We agree. Isn’t it time to start imagining our joining every other advanced society with Medicare for All?