There is increasing public awareness that our present health care system costs more and often delivers less than that of any other country, and there is growing support for single-payer, universal health care. The best-known plan is Sen. Bernie Sanders’ Medicare for All Act.

Casey Johnston of Portland, left, and Julie Pitt of Arundel take part in a July 2021 rally at Lincoln Park in Portland as part of a national effort to demand improved and expanded Medicare for everyone. Ben McCanna/Staff Photographer, File

I recently participated in a signature-gathering campaign to put the question of universal health care before the Maine voters. While the campaign fell short, I learned some things. A healthy majority of those I met were supportive but had questions and concerns. I have gathered some of them here, along with my responses.

1. It’s Bernie’s idea, and I don’t like Bernie.

We may not embrace the senator’s entire agenda, but we should be willing to adopt the best ideas, whether from the left or the right, in making public policy. Slavish adherence to ideological imperatives closes minds and stifles creativity.

2. It is socialized medicine.

No, it isn’t. The whole delivery system – hospitals, physician practices, pharmacies, testing labs, etc. – remains under private ownership. It is just the social insurance function that the government performs and, as demonstrated with present Medicare, performs well.


3. It takes away our freedom to choose.

The only freedom we lose is that of struggling to choose from the confusing packages of benefits, prices, copays, deductibles and exclusions offered by private insurers. Those with employer-sponsored plans must accept what the employer offers. The freedom we care about most is choosing our providers, but private insurers have restrictive networks. Medicare doesn’t.

4. We should allow the invisible hand of the market to perform its magic to control costs, not the government.

I am a firm believer in free markets. For ordinary commerce, there is no better way to discover the price at which supply will meet demand. But when there is monopoly power and lack of transparency on the supply side, as is the case with health care, markets fail and government must intervene. And private insurers have a conflict of interest. They have interests in both profits and the health of their subscribers. When profits are down, we know what must be compromised. With ordinary goods and services, businesses can boost profits by cutting costs. Private insurers are tempted to do this by denying preapproval of tests and procedures or by rejecting claims after the fact.

5. We can’t afford it.

Many studies have demonstrated we can. One study, published in 2020 in The Lancet, a peer-reviewed medical journal, showed that the Sanders plan could guarantee coverage with generous benefits to everyone and still reduce the national health care expenditure by 13.1 percent, or $458 billion annually. It also showed that 68,500 American lives could be saved each year.


6. It will take jobs away from workers in the insurance industry.

Some proposals include plans for mitigating this, including funding for early retirement, retraining programs and relocation expenses. Any change in the economy that benefits society as a whole will inevitably displace some people. We must accept this but make provisions to assist them.

7. My taxes will go up.

It helps to think of deductions for health insurance premiums as taxes that we are already paying. These would be replaced by a tax/premium adjusted to the ability to pay. This would be instead of, not in addition to, what one is paying now.

A final thought: If I decided to oppose universal health care, I would have to identify the group of people to exclude. I could not do this and I don’t believe anyone could. Thus, we are all supporters of universal health care. Health care should be regarded as a public good, like fire protection, infrastructure, national defense, etc. We leave nobody out, not even those who, for whatever reason, don’t thrive in our highly competitive economy.

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