Newt Gingrich and Dr. Joel Zinberg Examine Medicare for All, Medicaid Reform, and Healthcare Fraud
Medicare for All is gaining popularity, but do Americans understand what the proposal would actually change? As the 2026 midterm elections approach, Newt Gingrich welcomes Dr. Joel Zinberg, director of the Public Health and American Wellbeing Initiative at the Paragon Health Institute and former White House health policy advisor, to examine the promises and potential consequences of a government-run healthcare system. Drawing on his recent Wall Street Journal op-ed, Zinberg explains why he believes Medicare for All could eliminate existing insurance choices, increase taxes, reduce access to medical care, and undermine the Medicare program seniors depend on today. Their conversation explores why public support declines when voters learn more about the proposal and what Americans can learn from healthcare systems in Britain and Canada.
The discussion also turns to the future of Medicaid and the growing challenge of healthcare fraud. Zinberg offers an inside perspective on the Trump administration's Medicaid reforms in the One Big Beautiful Bill, including work requirements, restrictions on provider taxes, and stronger eligibility verification. Gingrich and Zinberg examine how improper payments, questionable enrollment practices, and financial incentives within federal healthcare programs are placing additional pressure on taxpayers. With healthcare costs rising and major policy decisions ahead, their conversation raises a fundamental question: How can America protect access to quality healthcare while ensuring taxpayer dollars reach the people who genuinely need assistance?
Listen to their conversation below, or scroll down for an edited transcript.
Edited Transcript
This conversation has been condensed and lightly edited for clarity.
Newt Gingrich
I’m pleased to welcome Dr. Joel Zinberg, director of the Public Health and American Wellbeing Initiative at the Paragon Health Institute. Joel recently spent 19 months in the White House advising President Trump on healthcare and deregulation. He’s also a board-certified surgeon, lawyer, and former senior economist at the Council of Economic Advisers.
We’re going to discuss his recent Wall Street Journal op-ed, “Medicare for All Isn’t Medicare as We Know It,” along with Medicaid reforms, the sustainability of federal healthcare programs, and the fraud costing taxpayers billions of dollars.
Joel, welcome to Newt’s World.
Dr. Joel Zinberg
Great to be here. Thanks for having me.
Newt Gingrich
Bernie Sanders first introduced Medicare for All in 2017, and despite repeated reintroductions, the legislation has never received a floor vote in either chamber. Yet it’s become a progressive rallying cry this election cycle.
In your op-ed, you warn that voters should be careful what they wish for. Why?
Dr. Joel Zinberg
The problem is that Medicare for All is a very catchy title. It sounds wonderful, but most people don’t understand what’s actually in the bill.
It would eliminate the current public-private insurance system, including employer-sponsored plans that cover more than half the country. It would also eliminate the choices people currently have in Medicare, whether that’s traditional Medicare, Medicare Advantage, or privately administered Part D prescription drug plans.
All of those choices would be replaced with a single government plan.
I also believe it would decrease access to care, require enormous increases in government spending, and make significant tax increases inevitable. Once people understand those consequences, support for the proposal drops dramatically.
Newt Gingrich
When Medicare for All was reintroduced in 2025, it had 104 original House co-sponsors and 16 in the Senate. Why are so many Democrats embracing this slogan?
Dr. Joel Zinberg
I think it’s part of the broader movement toward democratic socialism within the Democratic Party. It’s an appealing political slogan, but it doesn’t accurately communicate the consequences of the policy.
It sounds good until people understand what it would actually mean for their healthcare.
Newt Gingrich
What strikes me is that Medicare for All has become a slogan without a clear understanding of the policy.
Americans are understandably frustrated by healthcare costs. Could that frustration lead people to accept a system similar to Britain’s National Health Service or Canada’s single-payer system?
Dr. Joel Zinberg
Americans should look at what’s happened in countries that have adopted these systems.
In Britain, satisfaction with the National Health Service is extremely low. In Canada, patients face significant waiting periods for medical care, and some travel to the United States to receive treatment.
The problem is that when you eliminate cost-sharing, demand for healthcare increases. But the supply of medical services doesn’t automatically increase with it.
You can end up with longer waits and a situation where people with less urgent needs displace those requiring more immediate treatment.
Newt Gingrich
You cite polling showing how support for Medicare for All changes when people learn more about it.
When respondents learn that private insurance would be eliminated, support falls to 52 percent. When told it could threaten the existing Medicare program, support drops to 38 percent. When higher taxes are mentioned, it falls to 35 percent. And when people learn it could delay medical tests and treatments, support drops to just 24 percent.
Doesn’t that suggest the public’s support is relatively shallow?
Dr. Joel Zinberg
Absolutely. The initial support comes from the appealing name and the promise of universal coverage.
But once people understand the potential effects on their insurance, taxes, and access to physicians, their views change.
Proponents also claim the system would save money by eliminating inefficiencies. I don’t think there’s good reason to assume a government-run system would necessarily be more efficient.
There are important questions about administrative costs, incentives, and fraud prevention that often get overlooked.
Newt Gingrich
Isn’t Medicare Advantage, in some ways, an example of moving away from a purely bureaucratic government system?
Dr. Joel Zinberg
Medicare Advantage gives people choices. They can compare plans and select the one they believe works best for them.
Nobody is required to enroll in Medicare Advantage. Traditional Medicare remains an option.
That flexibility is important. Many beneficiaries find they can save money or receive additional benefits through Medicare Advantage.
Under the Medicare for All proposal we’re discussing, those choices would disappear.
Newt Gingrich
You also cite estimates suggesting that physician access could fall dramatically for people currently covered by employer insurance, while medical productivity could decline.
Why would that happen?
Dr. Joel Zinberg
The proposal would lower reimbursement rates, potentially to Medicare levels or below.
When providers receive lower reimbursement, the supply of medical services can decline. At the same time, eliminating patient cost-sharing increases demand.
That combination of reduced supply and increased demand means longer waiting times and less access to care.
There are also consequences for medical innovation. If government-imposed price controls reduce the financial rewards for developing new treatments and technologies, innovation could suffer.
The United States has been a world leader in medical innovation, and we shouldn’t take that for granted.
Newt Gingrich
Let’s turn to Medicaid reform and the One Big Beautiful Bill, which passed while you were serving in the White House.
What was President Trump trying to accomplish with those reforms?
Dr. Joel Zinberg
Medicaid spending has been growing enormously, and we needed to get that under control.
Our objective was to make sure taxpayer dollars were going to the people the program was intended to help, rather than being lost to fraud, waste, and abuse.
The legislation included Medicaid work requirements, restrictions on provider taxes, more frequent eligibility determinations, and efforts to eliminate duplicate enrollments.
Provider taxes were particularly important. States could tax healthcare providers and use those funds to draw down substantial federal matching payments.
In Medicaid expansion states, the federal government covers 90 percent of certain costs. That creates powerful financial incentives for states to maximize federal funding.
The reforms were designed to limit those practices while also providing $50 billion for rural healthcare transformation.
Newt Gingrich
The Congressional Budget Office estimated that the work requirements alone would save $326 billion over 10 years.
When we passed welfare reform while I was speaker, there was overwhelming public support for the principle that able-bodied adults should work.
The provider tax arrangements are also remarkable. States could essentially create taxes that generated additional federal subsidies without necessarily contributing meaningful new resources of their own.
Dr. Joel Zinberg
That’s right. Medicaid is a federal-state partnership, and states receive matching funds from Washington.
For expansion populations, a state can receive nine federal dollars for every dollar it contributes.
Provider tax arrangements allowed states to take advantage of that financing structure. The One Big Beautiful Bill places new restrictions on those arrangements and phases out certain practices.
The larger goal is to protect federal resources and make sure the money is used appropriately.
Newt Gingrich
Medicaid and the Children’s Health Insurance Program now cover roughly a third of Americans, and spending is approaching $1 trillion annually.
How much reform will be necessary to make these programs sustainable?
Dr. Joel Zinberg
We have seen a tremendous expansion in Medicaid enrollment and spending, particularly following the Affordable Care Act’s Medicaid expansion.
It’s critical that we eliminate fraud and improper enrollment.
One issue my colleagues at Paragon have examined is the problem of phantom enrollees, including individuals who are enrolled in subsidized insurance programs but may not actually qualify or may not even be aware they have coverage.
We also need to strengthen eligibility verification and ensure that people who have moved, obtained other coverage, or are otherwise ineligible are removed from the rolls appropriately.
Newt Gingrich
How much of this is simply administrative error, and how much is deliberate fraud?
Dr. Joel Zinberg
There are financial incentives that encourage states to maximize enrollment and expand the range of services covered under Medicaid.
That can include services such as transportation, nutrition, and housing, because states can receive additional federal matching funds.
Those incentives can encourage practices that increase spending without necessarily improving the delivery of medical care.
Newt Gingrich
Minnesota has become a particularly striking example.
A federal prosecutor suggested that as much as half of the $18 billion in Medicaid payments in Minnesota could involve fraud. That’s an extraordinary potential figure.
We also saw a national healthcare fraud enforcement action in June involving 455 defendants and $6.5 billion in alleged fraud.
This is a very large problem.
Dr. Joel Zinberg
It is. And the important thing for the public to understand is that money isn’t unlimited.
We cannot continue increasing spending on Medicaid, the Affordable Care Act, and healthcare generally without considering the consequences for other national priorities.
We have to refocus these programs so the money goes to the people who genuinely need help rather than being diverted through fraud and abuse.
Newt Gingrich
The administration has also been identifying unauthorized Obamacare enrollments.
You mentioned that Paragon estimated approximately six million phantom enrollees on the exchanges. How did your colleagues reach that conclusion?
Dr. Joel Zinberg
They examined enrollment patterns after enhanced subsidies made zero-premium coverage available to people within certain income ranges.
In some states, the number of people claiming incomes within those ranges was two or three times higher than Census Bureau estimates suggested.
They also observed unusually large numbers of enrollees who never filed medical claims.
Those patterns raised concerns about improper enrollment.
CMS developed criteria to identify potentially questionable enrollments, including missing or unverifiable information, no medical claims, and enrollment through brokers who receive commissions.
Insurers were instructed to attempt contact using two different methods. Individuals who did not respond within 30 days could be disenrolled.
The objective was to verify eligibility and address improper enrollment.
Newt Gingrich
If Democrats gain control of Congress after the midterms, do you believe they’ll attempt to reverse these reforms?
Dr. Joel Zinberg
I’m certain they’ll try. They may not be able to reverse everything in one package, but I expect they’ll attempt to chip away at various provisions.
Newt Gingrich
Joel, thank you for joining me.
Your work raises important questions about healthcare costs, patient choice, and the sustainability of federal programs.
Listeners can read your Wall Street Journal op-ed, “Medicare for All Isn’t Medicare as We Know It,” and explore your research at the Paragon Health Institute.
I’m grateful you could share your insights with us.
Dr. Joel Zinberg
Thank you. It’s been a real pleasure.
About the Guest
Dr. Joel Zinberg is director of the Public Health and American Wellbeing Initiative at the Paragon Health Institute. He previously served as special assistant to the president for economic policy at the White House National Economic Council, advising President Donald Trump on healthcare policy and deregulation. During the first Trump administration, he served as general counsel and senior economist at the Council of Economic Advisers.
A board-certified surgeon and attorney, Dr. Zinberg practiced general and oncologic surgery at Mount Sinai Hospital in New York for nearly 30 years. He is also an associate clinical professor of surgery at the Icahn School of Medicine at Mount Sinai.
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