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We now have multiple candidates for president plus congressional representatives speaking out for Medicare for All. However, under this rubric different things are meant by different people. Some — including Sen. Jeff Merkley — advocate simply allowing more people to buy into Medicare. Some think we can have “Medicare for All” while still leaving private insurance and employer-provided insurance as options. We cannot.

Or rather, this would be an untenable way to move toward Medicare for All. Any proceeding that leaves people outside the system will fail to achieve the huge savings we would have with Medicare for All. These are chiefly a) administrative savings and b) reining in runaway pharmaceutical prices. Medicare operates with only 2 percent administrative overhead compared with 20 to 30 percent for private insurance. Reining in pharmaceutical prices can only be done with the bargaining power of a large system. That’s how other countries do it. That’s how Veterans Affairs does it.

Allowing state-by-state changeovers to Medicare would be better, as it would give us a limited testing ground for Medicare for All. Only the fed can allow that and California, among several states, is seeking permission. California has the size to make a convincing test case.

Jumping into a half-baked Medicare for All that does not yield the administrative and pharmaceutical cost controls will only create an expensive, unsustainable situation that will discredit the project of Medicare for All for another generation.

Dianne Farrell

Corvallis (Feb. 1)

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