I was recently asked to write an 800-word piece for American Family Physician about whether Medicare for All is a good idea. I said no. The article is currently available online and I won’t repeat all of it here.

But to give a brief summary, my argument boils down to 2 things. 1) Medicare for All will help the administrative cost problem a little on the front end, but it will not be a long-term solution, because Medicare has to cover anything that is shown to be beneficial, but it can’t consider costs in its coverage determinations. 2) Meaningful change will only come when there is solidarity of purpose for all parties: patients, doctors, hospitals, nursing homes, etc. Everyone must be willing to make a sacrifice for the greater good, which Medicare for All will never insist upon in its current form.

I give lots of examples of the difficult decisions European systems have to make to live within a budget. By implication, the patients who use these systems agree to live within limits.

I think the AFP magazine will have a printed version of the article in October. In the meantime, enjoy the online version.

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