White House Chronicle

News Analysis With a Sense of Humor

Medicare for All Is the Wrong Fix for the Healthcare Crisis

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As Charles Dickens might have said, “It is the best of times in medicine, it is the worst of times in healthcare.” It is a time of great medical discovery with artificial intelligence, it is a time of the poorest outcomes for the sick.

One of America’s most distinguished pediatric cardiologists says the nation is in desperate shape with the end of Medicaid subsidies and the 28 million people — or almost 10 percent of the population — who lack insurance. The number is growing as people trade off the cost of insurance and prescriptions against rent, food and electricity.

Cardiologist Dr. Arthur “Tim” Garson Jr., a clinical professor at the University of Houston, College of Medicine, is keen to head off those who think the answer is Medicare for All.

“It seems to me that politicians of either party, especially those who are new to healthcare, say, ‘Medicare for All’ when they mean ‘universal coverage,’” Garson said, adding, “Coverage for all people is essential, but Medicare for All is only one way — and a terrible way.”

Garson, who is a former University of Virginia provost and an elected member of the National Academy of Medicine, said: “Let me be clear: Traditional Medicare works beautifully for 34 million of us. It’s easy, actually too easy, with essentially no pre-approvals for care. But that won’t work for 338 million people — allowing anyone to have anything.”

According to Garson, analyses that say Medicare for All saves money have it wrong. “We know that with no guardrails, care can go up 25 percent to 30 percent. They showed that in South Texas.”

Particularly, he takes aim at the Medicare for All Act of 2025, which is still before Congress. It contains coverage of everything from elective surgery to dental, hearing and vision care without copays or any cost-sharing, and eliminates all insurance.

The answer for the uninsured, according to Garson, is basic, tax-supported healthcare for everyone. That may not be enough for some, so private insurance must be permitted — a system he calls the “single safety net.”

That system operates in most of the developed world.

Behind Garson’s concern for those who go without insurance and who can’t afford prescriptions is a close-to-home tragedy. He helped save a toddler’s life and watched her grow over the next 19 years. Then, when her Medicaid ran out, she died because she couldn’t afford her sustaining prescriptions and was too ashamed to ask for help.

Garson shared a draft paper with me that explains the ruinous cost of Medicare for All and the basic healthcare he believes is affordable and achievable.

It states: “We spend more than twice the average of other developed countries on healthcare per person, and waste about one-third of the $5.5 trillion that we spend on healthcare — that’s about $1.6 trillion wasted. Yet, other countries provide healthcare for everyone.”

Garson isn’t advocating for a more expensive system. He says getting rid of even a portion of the waste can pay for perfectly adequate care.

I know a bit about the healthcare systems in three countries: England, where I used to be a beneficiary of the National Health Service, and where members of my family have used it since it began in 1947; France, where I received extraordinary care after a bad fall in Paris two years ago; and Ireland, where the two-tier system is praised by friends.

If people across the developed world can have the security of illness without going into penury, and they get that for half of what we spend on healthcare, what are we waiting for?

Garson thinks it will take a long time to eliminate the waste before America can move toward coverage for all.

I am not so sure. I think the effect of tens of millions without medical insurance could be dramatic. They will clog the emergency rooms where the law says they must get treatment.

In education, Garson notes, we have public schools and private schools for those who want them, so why not at the doctors’ offices?

I say that if your house catches fire, you expect to see the fire brigade. All of you.

Time to hear the fire bell in medicine. Many wonderful things are on the way with AI medical research. Everyone should get the benefits.

Requiem for America’s Helping Hand in the World

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I have seen the U.S. Agency for International Development in action — in Bolivia, Botswana, Pakistan and in Eastern Europe — and I can say that it is sometimes ragged and sometimes wasteful, but overall it is a great value for the money.

It is the face of America in 100 countries and its work is independent of the State Department, which has been one of its strengths.

The purpose of State is to represent American policy abroad and all that it entails. The purpose of USAID is to extend a helping hand.

It is the agency which shows the world through its actions our goodness, our decency, our humanity. USAID makes a difference, whether it is fighting AIDS, Ebola and malaria in Africa or helping electrify the Americas.

I have chanced upon — and that is the word — USAID at work in my travels. In Bolivia, I saw a village enjoying the luxury of electricity for the first time. In Pakistan, I saw trucks of American grain going into an Afghan refugee camp — the only source of food for the inhabitants.

I have heard from my family about the work in Southern Africa, about the treatment of AIDS, malaria and other diseases, where it is most needed. My father suffered from malaria, and I have a special feeling for its ravages.

My wife, Linda Gasparello, has a special feeling for Egypt, where she has lived. She has noted the impact of USAID in Egypt, where it has helped build schools and train teachers, helped create jobs in agriculture and tourism, helped provide access to clean water, helped reduce child and maternal mortality, and helped eliminate polio.

USAID has probably convinced more people that the United States is the good guy in the world than most diplomatic efforts or even the reporting of the Voice of America, Radio Free Europe, and Radio Free Asia.

If the work of USAID ceases, as Elon Musk has engineered, or is subsumed into State, people will die and Russia and China will fill the vacuum. They won’t fill it with the same human touch, but they will be there and we will be gone — and our good works and influence with the departure.

I grew up in Zimbabwe and even before President John F. Kennedy created USAID, there was general hostility to the idea of foreign “do-gooders.” In those days, the do-gooders were volunteers and the churches. The white community worried about ideas of democracy and equality that would upset the balance of privilege in colonial society.

Later, in the countries I know best (Zimbabwe, Zambia, Botswana, Malawi and South Africa), that fear and resentment was transferred to the international aid community. The dethroned white ruling class spread the word that foreign aid was corrupt, wasteful, and ineffective. American conservatives signed on.

Did Musk — who is irrational and pathological in his hatred of USAID and wants it abolished, and has  gone a long way to achieving that aim — absorb these prejudices when he was growing up in South Africa?

Musk and President Donald Trump have presented no evidence, sought no information nor commissioned a study on USAID’s efficacy. Based just on hearsay and a paranoia that the world is out to cheat America, take its money and otherwise kick sand in its face, they are dismantling one of our pillars of statecraft.

It is an abiding myth among MAGA conservatives that foreign aid is a sinkhole, corrupt and indefensible. I have seen otherwise. But you can’t see if you don’t look.

Remember the Marshall Plan, the expensive but so worthwhile rebuilding of devastated Europe after World War II? It is cherished here and in Europe as an act of American magnanimity and statecraft that was unique in its scope and its preparedness to use American wealth for the good of others.

The plan paid off as one of the smartest investments we could have made as a country. It is an extreme example of the effectiveness of soft power.

It convinced Europe of the fundamental goodness of the American project and enabled more than 70 years of openness and sharing, convincing generations that America had certain values of human concern that would always prevail even when there were disputes.

In trashing USAID — and what mindless trashing it has taken! — the United States has opened the door to Russia and China to take on the good-guy mantle and to manipulate global opinion in their favor; and to make an always dangerous world into a more hostile one for the United States.

Without food and medicine, staples of the USAID efforts, the poorest and most wretched will suffer unspeakably. In Africa, where Musk and I grew up, people will die.

There is a ghastly irony that they will do so at the hand of the richest man in the world, acting for the richest nation in the world.