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Medicare for All: Fair, Frugal, and Inclusive

For 30 years I’ve been teaching young doctors how to practice primary care medicine at a center-city clinic in Toledo. Every day we witness heart-wrenching scenes right out of a Charles Dickens novel -- scenes that illustrate the cruelty, arbitrariness and absurdity of our health care “system.”

Imagine for a moment a 64-year-old, low-income and uninsured man whose condition requires hospitalization and specialty care. Due to the likely cost of his treatment, he and his family could soon be facing bankruptcy. As if the physical suffering were not enough, he’s now grappling with a terrible financial crisis.

Right next to him is another patient with the same condition and of similarly modest means. However, because he’s 65 and enrolled in Medicare, he’s able to get dignified and relatively hassle-free care, without the worry of a financial shipwreck. He can go to the doctor and hospital of his choice, get treated and not face overwhelming medical bills.

Two patients, two very different stories -- all because one person just happened to have been born a year earlier than the other.

Medicare, whose 46th anniversary will be observed July 30, has been a lifesaver for millions of elderly and severely disabled Americans. It’s been a major pillar of financial security for our nation’s families. And yet there are those in Congress today who would weaken or even dismantle it in the name of “fiscal responsibility."

The Medicare program has many virtues. It has created incentives for hospitals and doctors to improve the quality of care. It has produced better cost control than the private sector, despite giving patients freedom to see any doctor and go to any hospital.

The cost of administering the program is in the 1.3 percent to 3 percent range, much less than the 12-14 percent range typical of big employer-based private plans, and the 25-30 percent overhead associated with individual plans.
Given these strengths, Medicare should have been the model for health reform. Instead, in passing the Affordable Care Act, Congress added a third floor to house with a crumbling foundation. That crumbling foundation is our inefficient, wasteful private-insurance-based system of financing health care.

Private insurers make money by screening out the sick, denying claims and raising premiums. They cause us to waste enormous amounts of money on excess paperwork and bureaucracy — their own paperwork and the paperwork they inflict on hospitals, patients and doctors like me. An estimated 31 cents of every health care dollar goes toward administration in U.S. health care, at least half of it unnecessary.

It doesn’t have to be this way. Our nation needs to enact a single-payer national health insurance program, an improved Medicare for all.

Instead of the being saddled with the mean-spirited, wasteful and exclusionary insurance arrangements we have now, an improved Medicare for all program would be fair, frugal and inclusive.

By replacing the private insurers with a single, streamlined, publicly financed system that handled all bills, we’d recapture about $400 billion annually that’s currently spent on unnecessary paperwork -- enough to provide comprehensive coverage to all the uninsured and to improve coverage for the rest of us.

Such a system could negotiate pharmaceutical prices like the Veterans Administration does, lowering drug costs by about 40 percent. The same principle would apply to other supplies and services, helping us rein in costs.

The burden of rising health care costs on businesses would be sharply reduced, thereby enhancing the competitiveness of U.S. products overseas. Lowering out-of-pocket health cost would leave more money for discretionary spending that stimulates the economy.

Alarmingly, the budget deficit is prompting some in Washington to talk about cutting Medicare or delaying eligibility to age 67. That would be exactly the wrong direction in which to go. Medicare is the victim of rising health costs, not its cause.

It’s not too late to do the right thing. We should celebrate Medicare’s birthday by improving it and expanding it to all. The new system will save lives, save money and will place our nation on a path to become one of the best health systems in the world -- something of which we can all be proud.

Johnathon Ross

Johnathon Ross, M.D., M.P.H., is past president of Physicians for a National Health Program and an executive committee member of the Single Payer Action Network in Ohio (

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