The promises of M4A

I support some form of M4A. It is the only and most efficient way to assure everyone American has coverage and access to health care.

Beyond that it gets real complicated and the wild claims of savings and better health care for all based on any number of questionable assumptions muddy the waters.

For example, we would save billions if we set drug prices at the same level of other countries. We would save billions when we reimburse all health care providers at current Medicare rates. Both have significant consequences possibly related to access to health care.

Proponents of M4A make unjustified and unrealistic statements such as “savings from negotiating care prices and drug prices.” Medicare does not negotiate prices, it dictates them, sometimes as a result of laws. Medicare reimburses 20-30% less than private insurers. Those who propose negotiating drug prices are not really talking about negotiating at all. They are thinking setting price limits with severe penalties for exceeding them.

Moving to something better than we have – for all Americans- is further complicated by misinformation- often promulgated by politicians. The cost problem is not the result of insurance companies, their profits or their CEOs pay. It’s not even pharmaceutical companies or the price of some drugs.

Then we have physician compensation. The US has the highest compensation in the world, in some cases nearly double. What will we do about that? Getting into the weeds we find the US has 42 CT scanners per million population, Canada has 14. More equipment means greater access which means greater use which means more convenience and most spending.

Oh yeah, America is the most obese country in the world and among the highest with chronic medical conditions. Think that has anything to do with what we spend?

We all know Americans want to spend less – of their money – on health care. What we don’t know is what changes they will accept to get it.


  1. If you google US healthcare spending, you will read that about 20% goes to “physician and clinical services”, and also the claim that 8% goes to physician salaries, implying that the broader former category includes overhead (salaries for nurses, assistants, clerks, receptionists, rent, etc.). Doctors in the US do indeed earn more than their international colleagues. But if these numbers are approximately true, and doctors worked for free, this would reduce total national healthcare spending by 8%. According to Elisabeth Rosenthal of KFF, hospital CEOs and administrators along with CEOs and senior executives of health insurance companies earn more than physicians. The system is indeed overpriced and bloated, but many more besides highly paid physicians are responsible.


  2. I don’t see how M4A can work across a whole population the size of the US. The population is growing by unlimited border crossings and that would only increase if people with health problems saw the US as an opportunity for treatment and not just a place to work.
    Give everyone a Mercedes at the price of a Chevy is a good way to upgrade the ride but how the heck will that work in the real world.
    I’m not saying good access to healthcare should be limited to us old geezers but it sure won’t be cheaper than now.


    1. Nobody said it would cover non citizens. But you know today illegal immigrants pay billions in SS taxes each year and never collect a penny in benefits. Besides to pay for M4A would still be a combination of payroll, income taxes and premiums. That’s the part people don’t want to discuss.


      1. So how will it work if everybody has M4A and an illegal walks into an emergency room for treatment? Will we still have charity care at hospitals? The answer will be of course, which goes back to trying to get people to buy into Obama care and they wouldn’t. In my area there are a lot of illegal farm and day laborers who work for cash. They are not paying into anything. Go to Home Depot when they open, you’ll see them there.


      2. Of course, just like today we wont deny emergency care to anyone. I hope But for citizens there would be no such thing as charity care. Regardless of the system, illegal residents are same problem.


  3. I too am not totally against M4A but it is important to note that the countries often shown as examples that people can still buy private insurance or supplemental insurance just like for Medicare in the US. You have to ask yourself why?

    Our government cannot efficiently run anything and for Healthcare I point to the VA where they have total control.

    As a side note on drugs, I would like to see a case study on the making of the Covid-19 vaccines. Without pointing out any faults of the vaccine and I agree that it was needed, let’s look at the cost and speed of the development to compare to other possible drugs for other diseases. Basically, money was thrown at the problem, helped financed by the government, covered a disease affecting the whole population, it was rushed, and it’s effectiveness is being evaluated every day compared to the years of study required by other drug development. The NIH and the drug companies are currently fighting over drug patents and the mRNA sequencing. Also, it is important to point out only a few countries had the money and biotechnology companies who could even develop any vaccine and these companies made millions of dollars in the process. Now what happens when the government negotiates drug prices down? Other countries depend on the USA for their drug R&D. What happens to research that is not government fund on diseases affecting only a few thousand people instead of billions of people?


    1. They can buy private insurance in some cases to gain quicker access and private care. That’s one of the problems in government run health care, but that’s not what Medicare is, it is insurance not health care. It’s kinds of disingenuous to say government can’t run anything efficiently as it’s been running Medicare for 60 years. VA is quite different, that’s providing health care.


      1. So is M4A going to be true insurance or is it really going to be providing healthcare since the government will be controlling all parts of it from doctors pay to where to go to drug pricing? You may be able to go to any doctor you want but the doctors will get paid what M4A is willing to pay. Since there will be very few private insurance plans left after M4A how will M4A be different than the UK’s NHS or the VA?

        Liked by 1 person

      2. If you think about what you say, is it any different than what private insurance does right now? Networks to use for full coverage, restricted coverage of Rx, determining what is covered or not and pet certification of some services.

        Liked by 1 person

      3. In the UK hospitals are run by the government and it sets budgets. Doctors are employed by the NHS who sets their salaries. Nothing like Medicare.

        Liked by 1 person

    2. I fully understand that Medicare is insurance. But you keep assuming that because M4A will also be insurance because it has the word Medicare in the title. I am willing to bet if M4A is successful unlike Obamacare by forced enrollment that employers will drop their private insurance plans to shift costs in a heartbeat and it will in fact become a national insurance program (my old union contracts dating back into the 1990 had language almost to that affect). Once that happens, since they will dictate payment to doctors and hospitals then the doctors might as well work directly for the government since there will be very little private insurance market left to cost shift healthcare costs onto the private market. When doctors start getting paid 20-30% for all their patents while still payback their student loans, no one will enter the profession and their will be a doctor shortage.

      If M4A is successful it will be a national healthcare and no longer “insurance” once the government controls every aspect of healthcare and delivery. It is healthcare.

      Liked by 1 person

      1. It only healthcare if we use a NHS model as in the UK. That’s not happening. By the way I’ve asked dozens of people in the UK about their system. They love it. Same for those I’ve asked the Spain, Germany and others. Of course, employers will drop coverage, but may offer the supplemental coverage. The bottom line is what is a better system that provides coverage available to all citizens.

        Liked by 1 person

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