Two Birds With One Stone: Covering the Uninsured by Fixing Medicare

By Victor M. Sandler, MD

As a nation, we are in a heap of trouble. Our medical system is a disaster—overly expensive and ineffective. On average, we spend two to three times more per capita on health care than other developed countries. Yet on measures of quality, we rank 22nd out of 23 among those same countries, according to the World Health Organization. Not only that, Medicare, our national insurer for the elderly and disabled, is facing more than $30 trillion in unfunded liabilities over the next 40 years. We have 50 million people who are uninsured in this country and millions more who are underinsured because employers have shifted a larger percentage of premium costs to them and increased deductibles and coinsurance payments, causing some to forgo medical treatment because of the expense.

The bad news is that we are on a path that is much too costly and clearly not sustainable. The good news is we can get off that path by cutting medical costs dramatically without negatively affecting quality. The way to start is by acknowledging the fact that we don’t have the best health care in the world, as former President George W. Bush and others have touted.

What we have is the most health care in the world.

The Causes of Medical Waste
The factors that feed our obese medical system are manifold. But three are especially troublesome. First, there is an unfortunate ethos within American medicine and society at large called “heroic positivism.”¹ Essentially, it is the idea that the more we do to and for our patients, the more they gain.