The free market can't save American health care

First, do no harm" — a bedrock principle of medical care for millennia — won't work unless a nation's health insurance system is both universal and affordable.

Ours is neither.

It leaves 25 million uninsured; an additional 50 million cannot afford to use their insurance because of onerous out-of-pocket costs.

A majority of Americans worry about how they can afford medical care. In the wealthiest nation in history, nearly 70,000 Americans a year die prematurely because they cannot afford timely care.

Our health insurance system is doing harm.

The problems are structural — and built deeply into the system:

• The system is largely based on a politically powerful health insurance industry that is a nonessential middleman standing between patient and provider.

• For-profit health insurance companies have an obligation to their shareholders to be more concerned with the bottom line than with the nation's health — an irreconcilable conflict of interest when it involves your own health.

• To call the system overly complicated is an understatement: It takes a staggering number of health care dollars to administer it. We waste around $600 billion each year on needless bureaucratic costs — money that should be spent on patient care.

Despite our spending twice as much per person, American health care outcomes lag behind those of most other advanced nations — who years ago figured out how to give all their citizens affordable health care.

Some of our leaders have understood the need for a better system. Harry S. Truman unsuccessfully championed a national health insurance system; Lyndon B. Johnson established Medicare and Medicaid for some of the nation's most vulnerable; and Barack Obama passed the Affordable Care Act, or ACA. But no reform so far, including those in the recently passed Inflation Reduction Act, has been able to fix what's wrong with our health insurance system: Despite its huge costs, the system still fails to give everyone affordable care.

And the unnecessary deaths continue.

How, then, are we to "fix" health care? Not with the free market, where you can buy only what you can afford. When it comes to your health, a better idea is to get the care you need to get better. This is why great health insurance should be affordable for everyone.

Should we keep the current system, utilizing the ACA or adding a "public option"? These might give more people insurance but do nothing to eliminate all that built-in waste. They might eventually cover everyone, but given its costs, the system would remain unaffordable.

It's time for real reform: single-payer Medicare for All.

Such a program is now being considered in Congress. It would eliminate our current health insurance system — and replace it with a single government-funded plan (the "single payer") in which health care will still be largely privately delivered. Medicare for All saves so many of the dollars we currently waste — starting with that $600 billion the current system spends on building a bigger medical bureaucracy rather than on health care — that it is capable of not only covering everyone but also eliminating out-of-pocket costs at the time of service, paying 100% of all medically necessary care.

Those benefits are hard to beat.

Medicare for All, unlike the current system — and despite claims to the contrary by opponents — is affordable: for individuals, since contributions are based on income, not an arbitrary monthly premium; and for the nation, since it's so much cheaper to run, it could save hundreds of billions of dollars annually, even as we cover everyone.

We already have the dollars; we just don't spend them wisely. It also enjoys the broad support of the public (69%) and a large number of economists and industry professionals.

As a greatly improved version of current Medicare — no restricted provider networks or denials of care that boost bottom lines; no need for supplemental plans — it elegantly combines our excellent privately based delivery system with outstanding social insurance.

No one would want to start from scratch and end up with our current system. Its failings — astronomical costs, inadequate coverage, unnecessary deaths — are simply unacceptable.

Great health care for everyone should be a bipartisan goal, and anything less than the universal, affordable health care that Medicare for All represents means not just excess costs but more lives lost. Opponents will need to match its many benefits, or decide how much wasted money — and how many unnecessary deaths — they are willing to accept under any other system.

Remember, first, do no harm.

Dr. Jay D. Brock is past president of the Fredericksburg Area Medical Society and former chairman of the Department of Family Medicine at Mary Washington Hospital. Contact him at drbrockmfa@gmail.com.