By Jared Abbott
Jacobin, April 9, 2026

Medicare for All (M4A) is back. Juliana Stratton, who just won the Illinois Democratic Senate primary, pledged in her victory speech to “fight for Medicare for all.” Graham Platner, the populist veteran and oyster farmer running to unseat Susan Collins in Maine, has made universal health care a centerpiece of his platform. Abdul El-Sayed, running for Michigan’s open Senate seat, is one of the policy’s most prominent champions — he literally wrote the book on it. In California, single-payer has become a near-universal fixture of Democratic gubernatorial platforms, with Katie Porter, Tony Thurmond, Betty Yee, and Xavier Becerra all declaring support. And Rep. Pramila Jayapal has been presenting polling directly to House Democratic colleagues arguing the electoral merits of Medicare for All, even in battleground districts the party must win to flip the House.

But whether M4A is a winning issue or an electoral liability for progressives depends — particularly for those running in red and purple districts — on how the issue is framed to voters.

Polling data makes the framing problem clear. Depending on how you ask, Americans’ support for universal health coverage lands at anywhere between nearly 70 percent to just over 30 percent. When the question leads with outcomes, coverage, access, and affordability, large majorities say yes. Indeed, when you poll Americans on whether the federal government should make sure everyone has health care coverage, 66 percent say yes.

But how you talk about the mechanism government should use to guarantee universal coverage has an enormous impact on how favorably the idea is received.

Simply asking Americans if they favor or oppose Medicare for All tends to land between 55 and 60 percent support. Tell people that the plan would require voters or employers to pay more in taxes, and support drops into the 40s. Further highlight that a M4A model could entail a single national health care system that would not allow people to buy private insurance, and support declines to the 30s.

That swing is not a verdict on the policy idea itself. It is a warning about framing: When M4A sounds like a government handout or restraint on individuals’ freedom to choose, working-class voters tune out. When it sounds like something they’ve paid for, something they’ve earned and deserve, they don’t.

Working-class voters are not opposed to bold health policy. What our research at the Center for Working-Class Politics (CWCP) finds consistently, however, is that they are skeptical of programs that feel like government handouts rather than something they’ve earned.

Consider that Social Security regularly sits at 80 percent support or higher, despite the fact that it is a massive government redistribution program to help the elderly and those who can’t work. Workers don’t experience it that way. To them, it’s a program they’ve paid into, a benefit they’ve earned — it’s a return on decades of contributions. The moment a health care policy sounds like something the government is giving to people, rather than something people have already paid for and deserve, you’ve lost the working-class voters you need most.

By Richard Payerchin (fact checked by Keith A. Reynolds and AC Baltz)
Medical Economics, March 24, 2026

Key Takeaways

• Nearly half of physicians report insufficient time for optimal care, and over one-third face patient loads they view as unsafe, underscoring operational constraints with direct clinical quality implications.
• Many clinicians recommend evidence-based interventions despite anticipating access failures from insurer utilization management, systemic barriers or patient cost exposure, fostering repeated ethical distress.
• Moral injury is differentiated from burnout by etiology and phenotype, emphasizing guilt, shame and loss of meaning arising from externally imposed constraints rather than individual coping deficits.
• A substantial minority are considering leaving their jobs, suggesting workforce destabilization linked to persistent financial and administrative pressures that undermine professional obligations.
• Single-payer universal coverage is positioned as the principal corrective, though interpretation is tempered by nonrandom sampling through advocacy networks and potential underrepresentation of departed clinicians.

It’s not just burnout when patient numbers increase but doctors are not allowed adequate time and treatments for them.

The pursuit of profit, not patient health, is causing alarming levels of moral injury to physicians who want to treat patients but instead must deal with systemic constraints across U.S. health care, according to results of a new study.

Anti-burnout initiatives, such as wellness programs and resilience training, have helped some physicians cope with workplace stressors. But they don’t change the course of “health care financialization,” in which health systems and insurers prioritize income over patients’ and physicians’ health interests. Those programs also don’t address the moral injury that physicians feel when they want to guide patients toward better health but can’t due to insurance restrictions or systemic racism, according to Physicians for a National Health Program (PNHP).

“Our research shows that the system is failing both physicians and patients,” PNHP President Diljeet K. Singh, M.D., Dr.Ph., said in a news release. “Doctors enter medicine to care for people, but are increasingly forced to navigate barriers that delay or deny treatment to generate profit. When clinical judgment is overridden by financial priorities, patient care suffers.”

What the findings say

“Moral Injury in Medicine: The Human Costs of Practicing in a Profit-Driven System” is the new PNHP report based on two years of research among doctors and patients, including surveys and interviews with 1,207 physicians. The findings are grim, though perhaps not entirely unexpected for physicians fed up when the emphasis on making money supersedes needed patient care.

Among the key findings:

• 47% of surveyed physicians say they often or always lack enough time to provide optimal levels of care to their patients
• 35% say they are required to care for more patients than they can safely manage
• 44% say they often recommend treatments they know their patients will not be able to access because of systemic barriers, insurer practices or financial costs
• 41% report often feeling complicit in structural racism perpetuated by the health care system in which they work
• 35% say administrative and insurer pressures to reduce costs affect their ability to provide the best possible care
• 25% say they are considering leaving their job due to this distress

The report was funded by the Robert Wood Johnson Foundation, a national nonprofit devoted to improving health care and health equity.

“Across the country, physicians and patients are navigating a health care system increasingly shaped by the pursuit of profit rather than health,” Kelsy McIntosh, MPH, program associate at the Robert Wood Johnson Foundation, said in the news release. “Physicians want to deliver high-quality, evidence-based care that aligns with their values and expertise, but too often encounter barriers designed to generate profits. Shining a light on systemic pressures can support designing systems that prioritize patient health over corporate profit.”

What to do next?

The report stops short of prescribing incremental fixes, arguing that the health care industry has repeatedly demonstrated an ability to circumvent or undermine regulatory reforms. Its primary structural recommendation is the implementation of a publicly financed, single-payer universal health care program, a position consistent with the name and organizational mission of PNHP.

The report acknowledges this advocacy context as a study limitation, noting that its survey was distributed through non-random, non-probability-based sampling that included the organization’s own membership networks, which may have attracted physicians who already share its policy views.

PNHP cites factors in Oregon, a state that “has experienced rampant financialization of health care systems, with several high-profile health care buyouts by large corporate entities.” Among the players: Amazon; OneMedical, a membership-based primary care chain of five clinics; and UnitedHealth Group subsidiary Optum, which has an aggressive ownership and growth plan there.

Oregon also has enacted some of the nation’s strictest controls on corporate practice of medicine, and has been edging closer to establishing universal health care at the state level, the PNHP report said.

PNHP notes that the particulars of geography, specialty and practice setting may not be representative across the country. The sample of doctors may underrepresent those who have already left clinical practice, the report said.

Moral injury in health care

PNHP uses the term moral injury, which is borrowed from military psychiatry to describe the psychological harm that occurs when a person is forced to act against their deeply held values.

“Physician moral injury arises when physicians are prevented from delivering evidence-based, optimal patient care due to systemic constraints beyond their control — particularly those imposed by profit-driven goals of the health care industry,” the report said, citing the work of researchers Wendy Dean, M.D., and Simon Talbot, M.D., who first applied the moral injury framework to medicine in 2018.

The report argues that framing physician distress as burnout rather than moral injury has led to ineffective interventions and allowed underlying system failures to go unaddressed. PNHP distinguishes the two conditions on both cause and symptom. Burnout manifests as exhaustion, depersonalization, and diminished personal accomplishment. Moral injury produces guilt, shame, loss of meaning and erosion of professional identity. It stems not from overwork but from being systematically prevented from fulfilling one’s professional obligations.

Standard burnout frameworks locate the problem within the individual physician and prescribe individual-level fixes such as resilience training, mindfulness, reduced duty hours and wellness programs. These approaches, the report argues, have consistently failed to slow physician attrition precisely because they treat a systemic problem as a personal one.

“There’s no amount of yoga that will make me less distressed about how my patients are harmed,” one family medicine physician said in an interview quoted in the report. “My staff is harmed. I’m harmed by this system.”

https://medicaleconomics.com…

By Patsy Newitt
Becker’s ASC Review, March 19, 2026

Physicians across the United States are experiencing a deepening crisis of moral injury, and they believe profit-driven healthcare systems increasingly block them from delivering the care their patients need, according to a sweeping new study by Physicians for a National Health Program, an advocacy organization of more than 20,000 physicians, medical students and health professionals who support a universal, single-payer national health program.

The March 17 report, which surveyed more than 1,200 practicing physicians and included focus groups, found that nearly half of physicians often or always feel unable to provide their patients with the best possible care, with two-thirds reporting moderate or severe distress as a result.

The study draws a sharp distinction between burnout — which implies individual depletion and is typically addressed through wellness initiatives — and moral injury, which the authors define as the distress physicians experience when they know what their patients need but cannot provide it due to constraints outside their control.

Physicians in the study were pointed in their rejection of burnout framing; as one family medicine physician said, “When we talk about burnout, it makes it sound like it’s my fault or my colleagues’ fault. The term points to the person being affected. It’s a form of victim shaming.” Notably, 40% of surveyed physicians often or always felt frustrated by the wellness activities their employers offered, saying they simply didn’t help.

The survey was distributed through a non-random, multi-modal recruitment approach using PNHP’s professional networks, medical societies including the Society of General Internal Medicine and the American College of Physicians, listservs, social media, and snowball sampling. It adapted eight items from the validated Measure of Moral Distress for Health Care Professionals and added 14 new questions capturing system-level pressures, financial constraints and administrative burdens. The mean overall moral distress score was 143, compared to 96 in the 2019 benchmark study, suggesting a significant worsening over time. For 18 of 22 survey questions, the most common distress rating was “very distressing,” the maximum level possible.

Here are 10 key things to know from the survey:

1. Forty-seven percent of surveyed physicians indicated their employer often or always prioritized financial goals over best patient care, and 50% felt betrayed by a healthcare system that hindered their ability to provide good care.

2. Additionally, 62% experienced moderate to severe distress over cost-cutting pressures from administrators or insurers.

3. Of the surveyed physicians, 45% often or always felt unable to provide patients with the best possible care, and 68% experienced moderate or severe distress as a result. An additional 47% often or always felt unable to provide optimal care simply due to inadequate time.

4. Forty-four percent of physicians often or always felt that lack of insurance approval blocked medically necessary services, and 51% often or always experienced excessive documentation requirements that compromised patient care.

5. Of the surveyed physicians, 35% often or always felt required to care for more patients than they could safely handle, and 43% often or always felt required to overemphasize productivity metrics at the expense of patient care.

6. Forty-five percent often or always encountered lack of resources or bed capacity that compromised care, and 43% said leadership often or always failed to respond supportively when such failures occurred. Three in 5 physicians experienced moderate or severe distress contemplating these situations.

7. The mean overall moral distress score was 143, compared to 96 in the 2019 benchmark study, suggesting a significant worsening. For 18 of 22 survey questions, the most common distress rating was “very distressing,” the maximum level.

8. On attrition, 27% of physicians had already left a position due to moral distress, 25% are currently considering leaving for the same reason and 42% had previously considered leaving but chose to stay. The workforce consequences are tangible: physician departures have contributed to clinic closures, elimination of services, and dramatically longer patient wait times.

9. Fifty-seven percent of physicians reported moderate or severe distress from working in systems that failed to treat vulnerable patients with dignity, and 41% often or always felt complicit in the structural racism their systems perpetuated. Physicians described patterns of race-based misdiagnosis, discriminatory care based on insurance status, and the rationing of life-sustaining treatment for uninsured and undocumented patients.

10. Nearly half of practicing physicians reported often or always making diagnostic or treatment recommendations they knew their patients would not be able to pursue, due either to insurance barriers or financial toxicity, and for 7 in 10 of those physicians, this provoked moderate or severe distress.

https://beckersasc.com…