A sudden switch to Medicare for All may seem appealing, but it risks overlooking critical systemic issues. Today, the U.S. healthcare system struggles with imbalances: some patients receive far more care than necessary, while others face significant barriers to accessing even basic services.
The Problem of Inequity in Healthcare
Studies consistently highlight disparities in care. For instance, a subset of “super-utilizers” often visits the hospital four or more times a year, usually through the emergency department (ED). This group, often uninsured or covered by Medicare or Medicaid, constitutes only 5% of patients but accounts for half of the nation’s healthcare spending. Alarmingly, 1% of these individuals drive 22% of costs, while the bottom 50% of patients represent just 2.9% of expenditures. These statistics underscore the inefficiency and inequity in resource allocation.
The Value of Primary Care
Research also points to the transformative power of primary care. A strong relationship with a primary care physician (PCP) leads to better health outcomes, reduced costs, and a significant decrease in mortality risk. My recent book, The Healing Connection: A Partnership for Your Health, delves deeper into the profound benefits of sustained patient-physician relationships.
However, Medicare for All, as currently envisioned, does not guarantee such relationships. The Centers for Medicare and Medicaid Services (CMS) often refer to patients as “consumers” and physicians as “providers,” reducing the human connection to transactional terms. Moreover, CMS frequently cuts physician payment rates as a primary cost-containment measure—a strategy that risks eroding trust and undermining care quality.
A Physician-Led Approach
Ken Terry’s 2020 book, Physician-Led Healthcare Reform: A New Approach to Medicare for All, offers an innovative solution. He presents a well-researched argument for a single-payer system that prioritizes revitalizing primary care. Terry emphasizes reducing waste—estimated at 30% of healthcare spending—while optimizing patient outcomes.
Primary care physicians are uniquely positioned to guide patients toward appropriate diagnostic testing, specialist consultations, and healthy lifestyle changes. They also play a pivotal role in addressing social determinants of health, which significantly impact illness and recovery. Despite this, PCPs remain overworked, underpaid, and increasingly scarce.
Transitioning to a Better System
Terry argues that transitioning to a single-payer model will take time—potentially up to a decade. Such a shift must be physician-led to ensure sustainability and effectiveness. His vision includes rewarding PCPs for creating savings, allowing them to maintain or improve their incomes while enhancing care quality.
While the current system’s inefficiencies make change inevitable, the outcome depends on careful planning. As Terry concludes, “Eventually, the current healthcare system will be swept away when it becomes unaffordable to enough people. The question is whether we’ll end up with something much better or something much worse.”
A Cautious Optimism
As an emergency physician, I find Terry’s approach both practical and inspiring. His cautious optimism resonates with healthcare professionals who understand the urgency of reform but recognize the complexities involved. By fostering societal consensus and empowering doctors to lead, we can build a system that balances cost, access, and quality.
The future of healthcare reform depends on bold yet measured actions. Medicare for All could succeed—but only if physicians guide the way forward.
Drew Remignanti is an emergency physician and an advocate for physician-led healthcare reform.
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