Improved Medicare for All (IM4A) Explained

Photo by Elvert Barnes from Baltimore, Maryland, USA - A physician protests in 2017 in Baltimore for Medicare for All. Creative Commons.

by Ivan J. Miller, Ph.D., Executive Director

Just what is Improved Medicare for All (IM4A), the health care system promoted by progressives? It is a creation of a popular consensus that the best health care plan for the U.S. comes from using Medicare as the model, correcting the few problems, and adding benefits to cover the unmet needs.

Since July 30, 1965, Medicare has been tested as the single payer health care system for people over 65 and people with disabilities. Even though these are the highest need groups, for 55 years Medicare has passed the test and even exceeds employer sponsored insurance[1] for consumer satisfaction while costing less. It is natural that such a tested and successful program would be the model for building a health care for all system.

We, at the Colorado Foundation for Universal Health Care, are proposing a working definition, which describes the system that we would like adopted by the U.S. We believe that this definition pulls together the nine principle improvements that Medicare needs.

It is an aspirational definition that intends to be comprehensive and brief. Other groups may revise this definition. Together the advocates for IM4A definitions will provide criteria for evaluating legislation that is proposed under the name IM4A[2].

Working Definition of Improved Medicare for All (IM4A)

IM4A is a health care system that covers all people in the U. S. using the infrastructure of Medicare with the addition of the following benefits and/or modifications:

Medicare is improved in IMFA with the addition of these benefits[3],[4]

  • Include dental, vision, hearing, affordable drugs, durable medical equipment, long-term care, improved mental health services, all of the more comprehensive services that are part of Colorado Medicaid[5], and the popular Silver Sneakers program.
  • Eliminate the expensive middleman insurance companies that control Medicare Part D and Medicare Advantage.
  • Regulate the cost of drugs, devices, transport, and other services essential for life and health.
  • Make Medicare affordable by providing full benefits without deductibles, coinsurance, or copays, thus eliminating the need for supplemental or gap insurance.
  • Allow full choice of health care provider.
  • Cover the full range of reproductive health care including pregnancy, birth, contraceptives, and abortion services.
  • Negotiate with health care providers from each specialty for fair and equitable compensation that recognizes their experience, skills, and training.
  • Include public health services that prepare for pandemics; improve vulnerable, rural, and underserved community access; and focus on infectious disease and prevention.

What’s improved in improved Medicare for All?

Expansion of benefits and Inclusion of Medicaid benefits

This expansion of benefits is necessary so that IM4A covers the full range of health care needs.

Eliminate middleman

In Medicare Advantage and Medicare Part D, insurance companies serve as middlemen between Medicare funds and the patient/provider team. They have tripled the amount of administration costs, increased overall costs, and are turning Medicare into a typical insurance package that promises a lot but in practice has obscure limitations and restrictions and excessive preauthorization requirements that are not part of traditional Medicare.

Regulate pharmaceuticals as an essential public good

Pharmaceuticals are a matter of life and death. If a product is essential, there is no limit to the amount a supplier may charge. IM4A would regulate the cost of pharmaceuticals in the same manner as essential public utilities. This type of regulation would allow for incentives for new medications, research, and a reasonable profit, but not allow profiteering or charging more than people in other countries pay for the same medication.

Eliminate harmful financial barriers including deductibles, co-insurance, and copays

Medicare has co-pays, co-insurance, and deductibles that keep many seniors and others from being able to afford it.

Full choice of health care provider

Medicare’s history and reputation for full choice of provider has been sullied by Medicare Advantage plans that use narrow provider networks to cut costs. IM4A would restore full choice of provider.

Full reproductive services

A universal health care plan must ensure that every patient has the religious and personal freedom to choose the health care services they want and need, including reproductive services.

Fair provider compensation

IM4A needs a trustworthy mechanism for ensuring adequate provider compensation. In general, provider pay is not the cause of the out-of-control health care costs, and some specialties such as primary care and psychiatry are currently under-compensated. IM4A needs a trustworthy method and a Board that includes provider representatives for ensuring adequate provider compensation while controlling the payments to some specialists who are overcharging.

Public health services

As the pandemic has shown us, we are all in this together. A universal health care system needs a public health mindset. Preparation for pandemics and epidemics is crucial. Vulnerable, underserved, and rural communities may need extra consideration. Infectious disease is a concern for the general public as well as the individual. And prevention, of course, is a priority for maintaining public health.

We know exactly what improvements are needed to fix and expand Medicare. With this list, IM4A fixes what does not work well. After 55 years of trying to fix the multi-payer system, our country has only created the most complex and expensive system in the world, while still leaving millions uninsured and under-insured. Medicare has been proven over 55 years, and we know how to fix the few problems it has. It is time to give it to everyone.


IM4A builds on the system that is working best, Medicare. It also fixes the gaps and features that need improvement. It adds benefits and features to the Medicare model. The alternative choice for addressing the many problems in the multi-payer health care system is to keep the current patchwork of programs and add another, untested government program. As the Great American Health Care Experiment shows, we are better off with the Medicare model with a few improvements.

  1. At least one legislative proposal uses the phrase Improved Medicare for All — HR 676 in the 2017-2018 Congress is titled “Expanded and Improved Medicare for All Act.” It is anticipated that other legislation will also use this phrase. Legislation, however, is does not provide a useful definition because each legislative proposal could be different, and each proposal can be amended and modified so that it may not look like the original draft.

  2. There is no official list of improvements required in a IMFA plan, and others in the movement may create a different list. I believe that this is a list of the major points that most IMFA supporters want to see in IMFA.


  4. The Colorado Medicaid program is used here rather than a generic Medicaid program because it is one of the most comprehensive in the country.

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