Health Care Reform

Medicare for All?

Maybe it’s sampling error, but I am seeing an increasing number of people who are being financially crushed by the US healthcare system.

One recent patient had a real rhythm problem, one that could or should be fixed with a procedure. But he could not afford it. He had insurance but could not afford to pay his allotted portion. I felt helpless–because although I could agree to do it for free, the hospital charges would be over $100,000.

Another patient suffers from stress-induced arrhythmia because her brother–whom she is close to– is hospitalized and she can’t be with him at the bedside. Why? Because of the fear of losing her job. If she loses her job, she loses her health insurance.

These are working people work. They saved money. They followed the rules of society. Then one unfortunate health crisis could drain their life’s savings. More and more of us are vulnerable. That’s not right.

We need to change this unfair system.

Take a look at this 2-minute video on the difference in two healthcare systems:

After listening, stop and think.


25 replies on “Medicare for All?”

I think Bernie is advocating for a straight 100% government program, based on the model of Medicare, but Medicare as it exists now also features substantial involvement by for-profit insurance companies.

I am on Medicare, and a Medicare Advantage policy provided by my former employer, but since I turned 65 I am also dunned constantly by other insurers to sign up for Medicare Advantage and/or Medicare Supplement plans. These plans must be a major profit center for private insurers, judging by the huge numbers of solicitations I receive every year during open enrollment period.

Why can’t this system work for universal coverage? It would be a win/win for individuals, and insurance companies, to have basic Medicare extended to all; with private supplemental plans to fill in the gaps, and provide insurance companies what I assume to be healthy profits.

Perhaps that arrangement would be the necessary incentive (carrot) to the insurance industry to accept Medicare for all.

The answer isn’t more government involvement in health insurance. That’s why the system got screwed up in the first place. Look at how the auto and home insurance industry operates. Those are the models – a FREE market.

I can fully insure my $400,000 house for just $1,500 a year with a $1,000 deductible. My vehicle is covered with a $500 deductible.

Government needs to get out of healthcare – period. The free market will work. Then and only then will costs come down. As long as their is a third payer involved – be it an insurance company or the government – costs will only go up and up.

Once costs come down after a free market system is established, you’ll be able to pay for routine visits, exams, procedures, etc. because they won’t bankrupt you.

Once “medicare for all” (i.e. single payer) is implemented, you can kiss your health good bye because then health care will need to be rationed one way or another. I talk to afibbers who live in Canada and guess where they go when they need an EXPERT ablation? The U.S. Why? Because in Canada they are put on a waiting list where they wait months to see an EP. Then IF an ablation is approved, they are forced to work with an EPs in their province. They can’t go to just any EP they want. If they want to choose their EP, they have to pay out of pocket and come to the U.S. Is that really better than what we have now?

Ultimately our healthcare system will crash as people simply won’t be able to afford the skyrocketing costs of premiums and deductibles. You can thank Obamacare for that but no doubt the government has mucked up the system for years before that. You get the government out of healthcare and let the free market work and you’ll see costs plummet and healthcare vastly improve. This is not rocket science. It works in the home and auto industry – heck – it even works in the animal industry (compare the costs of taking your dog to a vet vs. you going to a doctor). Why people refuse to believe a free market won’t work for healthcare is beyond me.




Why would any company in a truly ‘Free Market’ offer affordable policies to people with serious (or not so serious) pre-existing conditions? It is simply not profitable and profit after all is the sole motivation of any free market. Government on the other hand, should be motivated by what is in the best interest for society at large. Yes, it is hard to achieve in practice, but Medicare is a good example. Do you really think that the private healthcare industry would offer affordable care to seniors – a group of people with the most medical issues? Why would any businessman do that?

If you looked at this objectively, forgetting cliches about Government always being the ‘problem’, you might see there is a role for both Government provided care AND the free market. Take a look at many other Western democracies – they offer basic Govt provided healthcare, in addition to having a private health insurance market for added care, your choice of doctor, rapid access to elective surgery etc.

Few claim that single payer systems could afford to provide unlimited care to all citizens – but it can protect against bankruptcy that arises from even routine medical procedures in this country. For ‘unlimited care’ people would need to supplement their Govt provided healthcare with private insurance, so there is still a place for capitalism.

Your analogy the household and car insurance simply does not apply to healthcare – when people get sick they will find healthcare, often too little too late, at emergency rooms. Who do you think pays for that?

We have government involvement in health care because the free market was not working. Why does a Medicare exist? Old people could not get health care. We see free enterprise in drug prices: high prices that many cannot afford, even among generics. Competition s not working to lower drug prices. Health insurance is not car insurance. You can live without a car. Everyone uses health care, few use car insurance; that is why car insurance works but the insurance model fails wth health care.
For any government law, regulation or program you don’t like, ask yourself why it exists. It exists because of a problem free enterprise did not solve.
If you are ok with old people and poor people not having health care then go down that free market road. It works for the wealthy, Mr. $400,000 House, but not for tens of millions of us.

John, I’m with you. I have medicare and it’s great. This libertarian streak in our society is bought and paid for by the likes of the Koach brothers. I think that Jane’s Mayer’s (impeccable investigative researcher/reporter) book “Dark Money” should be required reading by all to understand why we no longer have a goverment for and by the people. The real meaning of libertarianism is power to the oligarchy.

Dr. Mandrola,

There are misperceptions running rampant these days about Medicare, and falsehoods all over social media.

On Original Medicare, you pay an annual deductible and then Medicare covers 80% of what they deem to be covered (just like many private insurance plans) and the other 20% is up to the individual to cover.

Those on Medicare can take out supplemental insurance (Medigap) policies with private insurers, but those can be costly and out of reach for many on fixed incomes.

Instead of Original Medicare and a Medigap policy, you can opt for a Medicare Advantage plan with a private insurer, making you subject to the whims of what private payers may allow.

The main difference between being on Medicare and having private insurance is a lower total premium and a lower deductible; but, the deductibles and co-insurance are still there, making access to procedures prohibitive for many. It is not the solution that many think it is!

As a Canadian professor of history who lived and taught in the US for 3 yrs, I can confirm this dedicated physician’s view of the Cdn model. Healthcare is one of the reasons I returned to Canada. I loved my American students and colleagues, but the thought of growing old in the US for-profit system terrified me. I never had complaints about the level of care that I received in the US, it was only the model of healthcare deliver. Thank you Dr John M. for being not only an excellent communicator of new data/studies from the world of electrophysiology, but also for being a tireless advocate for your patients.

Come talk to us if you’re ever diagnosed with afib, cancer, etc. I have a feeling you’ll be quickly looking for care in the U.S.

Government run healthcare sounds great until you’re really ill and live under such a system.

It’s funny how people always say Canadian healthcare is great. They either don’t live in Canada or they do but they don’t have any serious illnesses.

Why do so many people let their emotions rule how they think when it comes to healthcare. This isn’t complex. Let the free markets work. It is the only way you’ll drive down costs and provide high quality healthcare.

Our system has been corrupted by government. Look how easy and affordable healthcare was before the 1960’s. There was very little government intrusion. As government got more and more involved what happened? Costs have increased every year and care has gone down. It’s a shame…but it’s even more of a shame that most people don’t see the obvious.


I have lived under both systems. In the past six years, I’ve had an MI, hyperparathyroidism (with parathyroidectomy), and 2 surgical removals of kidney stones. Two of the surgeries were emergent, 2 were elective/scheduled. I also currently have paroxysmal atrial fib and have been cardioverted a number of times (electrically and via drugs). I am so, so glad that I’m back in Canada. I have received first rate care and have absolutely no medical debt at all. My biggest outlay was parking at the hospital. I loathe the US for-profit system and returned to Canada at the first opportunity largely because of it. You have absolutely no idea what you’re talking about. I’ve lived both systems. I *know* which system is superior.

Oh, and I was once cardioverted under the NHS in the UK. Never received an invoice. They told me it wasn’t worth the red-tape to bill me.

Thank you Dr. Mandrola for saying this. I had afib for 32 years and had an ablation two years ago which ended it. Fortunately, at that time I was able to afford insurance which allowed me to have it done at one the top centers by Dr Natale. I really am concerned for the many who can’t get these things done without bankrupting themselves under our ludicrous system.

It’s the difference between a system that cares for all of its citizens reguardless of financial status and one that puts profit above people. Canada still has a semblance of democracy even though it’s under the same oligarchal pressures that seem to have swallowed the US. All advanced countries have universal healthcare except the US.
It reminds me of the story of the mother watching her son in a marching band and saying “oh look, everyone is marching in the wrong direction except my Jonny”.

And yet all those that can afford to get the *best* healthcare come to the U.S.

You don’t want universal healthcare. It’s great if you have strep throat, a broken bone, etc. but if you have anything serious like cancer, afib, etc. you’ll likely die in a universal healthcare system before you’ll be treated/cured.

Don’t let emotions cloud your judgement. Just ask patients with serious illnesses in these great “universal coverage” countries and they’ll tell you the hell it really is.


Travis, you state a myth. All of the responders to this post that have actual experience with universal health care say it is great. In this small sampling, we don’t have even one example of excessive wait times for treatment or complaints about quality of procedures. Don’t let emotions cloud your judgement.


Every day, we in the afib patient community hear from patients in single-payer systems experiencing problems getting the afib treatment their doctors have requested. Right now, afib ablations on the NHS (UK) have been stopped. I personally can point you to hundreds of afib patients who are not getting the treatment their doctors have ordered because of this freeze.

Healthcare rationing is a very real problem for afib patients in single-payer systems.

Yet as we all know, the reason the NHS is having difficulty is that the Conservative government of Theresa May is purposefully starving the system of funds (see the junior doctors’ strike, the introduction of private medical services provided by friends of Tory legislators). The Tories made the political decision to starve the NHS in the hopes of turning people against public medicine. They are the ideological cousins of the GOP in the US.

It’s bad enough to have insurance companies dictating what healthcare I get (at least my doctor can appeal); having my healthcare dictated by the whims of politicians is frightening because I have no control and no reasonable chance of appeal.

Being a patient is bad enough – we need some reasonable degree of control over our health.


Mellanie, I left the US largely because of the for-profit motive embedded in American medicine. The idea of insurers (who are responsible to shareholders not patients) making decisions is extremely unsettling to me. I would much rather have my doctor making medical decisions based on medical need (as is the case in Canada). Because he or she isn’t motivated by profit, he/she won’t be recommending unnecessary (but lucrative) procedures either. The Canadian system has saved my life twice (and my father’s life). There is no rationing of healthcare. There is however a kind of triage based on medical need. If I need a hip and there’s someone ahead of me in greater medical need, they go first. I accept that as part of living in a civil society in which we all care for one another. Emergencies always go to the front of the line. I’ve lived under both systems. I know how they both work. I will *never* move to the US again. I’ve seen friends lose their houses or go into deep, deep debt because of medical issues. It just doesn’t happen in the rest of the industrialized world.


Medical debt, or having to decide between medical insurance or a house payment, is a bad place to be. For many who have afib, that is a reality.

But, having to live with afib that takes over your life, making it impossible to work, and not having options to get your life back because of the whims of payers or politicians (as happens to many in our afib patient community) is also a very bad place to be. Perhaps Canadian afib patients don’t experience that (though I hear from many that do), but many patients around the globe do.

For many living with afib, it means losing jobs, cars, houses, even family, in addition to the physical and emotional toll it takes. Many with afib are between a rock and a hard place, regardless of where they live or the kind of medical coverage they have, because they are unable to get treatment to help them get their lives back.

Melanie, your fears are reasonable and understandable. I have a friend who had his a-fib ambulated 3 times to get it right and when I asked the cost he said he didn’t know. He is on medicare.
Universal health care can work for all the citizens of this country if we have the collective will. As David said, the conservatives in Britain are using the same tactics as conservative in this country concerning the ACA. Doing everything they can to cripple the law and then complain that it is imploding.
Remember this: the larger the pool of insured individuals, the lower the cost. Add to that, getting rid of the redundancies in the system will also make it more sustainable.
Since we know that in the US, it costs more per person to provide health care than any other industrialized country (twice as much as Britain) and we aren’t seeing that cost reflected in life span, something has to change.

Dr. M,
I’ve enjoyed reading your very informative posts, but in this one you are way, way off.

I’m assuming the patient is in Kentucky. 29% of adults in KY are smokers compared with about 15-16% nationwide and about 14% in my state, NYS. The KY cigarette taxes are 60 cents compared with $5.85 in New York City ($4.35 in NYS). The minimum purchase price for NYC cigarettes is $13 per pack. The minimal age for purchasing tobacco in NYC is 21.

Tobacco taxes contribute more than half the effect of getting people to quit or never start (MPOWER).

Since you are speaking of Canadian health care, they help to pay for the care with very high tobacco taxes that range from $6 to $8 per pack.

So, I wish you and your fellow KY Cardiologists would motivate the KY Medical Society and other allied KY groups and help to implement MPOWER which would include raising tobacco taxes, banning smoking in public places, and very scary, anti-tobacco advertising.

With the decreased healthcare costs of tobacco as more people quit, and with the additional tax revenues, KY can have a program that pays for these expensive procedures.

Finally, I close with this:

Cardiology Is Dead. Long Live Public Health

With all due respect, Travis, you are painting a very inaccurate picture of the Canadian health care system.

I am a 40 year old Canadian who has afib. I received an ablation 2 years ago which has worked well (keeping fingers crossed). I received fantastic, state-of-the-art, compassionate care.

With respect to some of your previous comments:

Canadians with afib are “put on a wait list and wait months to see an EP.”
– I waited less than 3 weeks after referral from my initial Cardiologist

“IF an ablation is approved…..”
– What are you talking about? If the Canadian EP thinks you would benefit from an ablation, then they recommend it. It is then up to me (the patient) to decide if I want to follow through and do it or not. There is no “approval” process.

“they are forced to work with an EP in their province…”
– well, lets put this in perspective. The population of Canada is much smaller than the U.S. There are probably more EP’s in the state of California alone than there are in our entire COUNTRY. That being said, to the best of my knowledge, there are no “dabblers” (as Dr. Mandrola calls them). Every center in Canada doing ablations for afib, is a center of excellence doing tons of these procedures. If it so happens that there is not one in your home province, your provincial government will pay for you to be treated in a Canadian center outside of your home province.

“As government got more and more involved what happened? Costs have increased every year and care has gone down.”
– This is a false flag argument. Healthcare costs have not increased SOLELY due to government involvement (although I grant you that it certainly has contributed). If that were the case, Canadians, with our current publicly funded healthcare system, should be paying vastly more per capita than those in the U.S. In fact, the OPPOSITE is true! I believe there are two primary reasons for increasing healthcare costs: 1.) delivery of healthcare has become EXPONENTIALLY more technologically driven and complex. Example: when they wheeled me into the EP lab for my ablation, I thought I was on the bridge of the U.S.S. Enterprise (computers, robotic arms, and monitors everywhere), not in an operating room. None of this stuff even EXISTED in the 50’s or 60’s! It wasn’t even a treatment option for those with afib, so the costs of care for those with afib were much lower. 2.) an aging population, thus creating more demand for top-notch, technologically -driven, complex healthcare and all the costs that go along with it.

Look, I am not a great “defender” of the Canadian healthcare system. It is certainly not without its warts (wait times for elective procedures, wait times for certain diagnostic or preventative procedures like colonoscopies). I think I agree with Joe McAuliffe that, ideally, there are roles for both government and the free market in health care delivery. As it stands now, when comparing the system in the U.S. to the system in Canada, I’d pick the Canadian system (I think most Canadians would as well). My reasoning is pretty simple: I have a choice between a.) dealing with government, who probably don’t give a crap about me but are at least in some way (elections) accountable to me, or b.) dealing with private insurance companies who, FOR SURE, don’t give a crap about me and, FOR SURE, are not accountable to me. I don’t understand why anyone would chose option b.), unless it is because they have been told throughout their entire lives that publicly funded healthcare is some sort of socialist boogeyman – which is isn’t.

Chris Mintern

Plowing through bills following procedures, or even routine Dr. visits, I am flabbergasted at the outrageous costs for the simplest things, like $30 tongue depressors or in one case, $75 for 3 generic medication pills that could be purchased for $15 for a 3 month supply outside of the hospital.

Perhaps instead of blaming it all on the insurance industry, we should instead start at the source. Granted, multiple layers between the provider and the patient don’t help either.

I have some serious questions concerning many of these commenters.

First — full disclosure: I’ve been on a Medicare Advantage plan for seven years that’s covered several procedures here in Massachusetts. Medicare came through me; the Advantage plan came through my wife’s teacher’s group. We’re both retired. We are fortunate enough to afford the monthly Medicare + the monthly Advantage + the various copays. It all comes to considerably less than the retail cost of my procedures. So, it works for us.
For now.

The above commenters have strongly held opinions on strongly divergent positions. I’m wondering what’s behind them. Full disclosure might shed some clarifying light on the impetus behind some of their strong views.
For instance — does the source of their bread and butter inform their stance?

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