By Dr. Kat Lindley (originally published on X)
I’m a physician, and I’m a patient. I’m against Medicare for All.
That’s not because I think our current system works. It doesn’t. I left it in 2017. I’ve watched families pay more every year for insurance and still face deductibles, copays, prior authorizations, and a rushed visit with a doctor who’s staring at a screen. They aren’t paying for care. They’re paying for the middlemen.
But the fix for too many middlemen isn’t one giant middleman. Putting one payer in charge doesn’t fix medicine. It gives you one bureaucracy instead of many, plus waiting lists.
COVERAGE IS NOT CARE
This is the part the slogans skip. Health coverage is not medical care. A card in your wallet doesn’t put a doctor in the room. It doesn’t open an operating room or read your MRI. It’s a promise to pay. When a government makes that promise to everyone and the supply of doctors, nurses, and appointments doesn’t grow to match, the result is a line.
We don’t have to guess what that line looks like. We can look at the countries that already run their health care through the government.
Canada runs single-payer systems province by province. Every year the Fraser Institute surveys Canadian specialists. Its 2025 report found a median wait of 28.6 weeks from a family doctor’s referral to actual treatment. That’s the second longest wait it has ever recorded, after 30 weeks in 2024. In 1993 the wait was 9.3 weeks. Patients waited a median of 18 weeks for an MRI. For orthopedic surgery the wait was about 49 weeks, and for neurosurgery it was close to 50. The report estimated Canadians were waiting for 1.4 million procedures.
To be fair, Canada does better on some things. Radiation and medical oncology waits were under five weeks. But if you need a new hip, a back operation, or a scan to find out what’s wrong, you wait.
England’s NHS is government-run care. At the end of August 2026, NHS England reported 7.4 million treatment pathways on its waiting list, about 6.2 million people. More than 113,000 of them had been waiting over a year. Only about 65% were seen within 18 weeks, against a standard of 92%.
Those are the government’s own numbers. Waiting isn’t a glitch in these systems. It’s how they control cost. When the price at the door is zero, the line becomes the price.
What the Medicare for All bill actually says
Supporters often describe Medicare for All as “adding a choice.” Read the bill. The current Senate and House versions, S.1506 and H.R.3069, were introduced in April 2025. Section 107 is titled “Prohibition against duplicating coverage.” It makes it unlawful for a private insurer to sell coverage that duplicates the program’s benefits, and unlawful for an employer to provide such benefits. Private insurance could only cover extras the government plan doesn’t.
So this isn’t a public option sitting next to your current plan. If the government plan covers it, that’s the plan. If the line is long, you can’t buy your way into a different one for those services.
Who pays, and how much
The cost estimates come from across the spectrum, and they’re all enormous. The Mercatus Center at George Mason University estimated that the 2017 Sanders bill would add about $32.6 trillion to federal spending over its first ten years. The author called that a lower bound, and his more likely range was $32.6 to $38.8 trillion. The left-of-center Urban Institute estimated a similar single-payer plan would raise federal spending by about $34 trillion over ten years.
To be fair, a big part of that is money families and employers already spend, moved onto the federal books. But Mercatus noted something every doctor should read twice. Even its lower estimate assumes hospitals and doctors get paid Medicare rates, more than 40% less than private insurance pays today. Doubling every federal individual and corporate income tax would still not cover the added cost. That assumption is where the waiting list starts.
Medicare rates don’t create more doctors
Medicare already pays less than private insurance. A KFF review of the research found private insurers pay physicians about 143% of Medicare rates on average, and hospitals about 199%. Meanwhile, the AMA calculates that Medicare physician pay has fallen 33% since 2001 once you adjust for the cost of running a practice. Paying every doctor in America that way won’t produce more doctors. It will produce more early retirements, more closed independent practices, and more physicians sold to hospital systems.
And we’re already short. The Association of American Medical Colleges projects a shortage of up to 86,000 physicians by 2036. Part of that is self-inflicted. Since the Balanced Budget Act of 1997, Medicare has capped the residency slots it funds at each teaching hospital at roughly 1996 levels. Our own medical graduates can’t become practicing doctors without a residency. Washington’s answer has too often been more visas. I’d rather we stop needing visas altogether and train our own students.
Promise everyone unlimited “free” care, cut what you pay the people who deliver it, and keep the training pipeline capped. You don’t get more care. You get rationed care.
One payer means one set of rules
Even with the waits aside, there’s a deeper problem. Whoever pays decides. I’ve seen what that looks like with the payers we already have. Standardized protocols, CMS quality measures, coding and billing rules, and pay based on RVUs have done more to kill the practice of medicine than any disease.
Now imagine that payer is the only payer. Every patient, every doctor, one rulebook. If Washington decides a test, a drug, or a conversation isn’t worth paying for, there’s nowhere else to go.
Medicine works best when a patient and a physician sit in a room together and make decisions. Not a corporate protocol. Not an insurer’s algorithm. Not a mandate from someone who has never met that patient.
Informed consent, personal autonomy, and parental authority are what health care is supposed to be. A single government payer is the opposite of all three.
What would actually work
The answer isn’t more government between you and your doctor. It’s less of anyone between you and your doctor. Here’s what I’d do.
Put patients in charge of their health care dollars. Open competition through direct primary and direct specialty care, or other independent models, plus a health savings account and catastrophic coverage for the big, rare events. It’s not complicated. The money should follow the patient, not the insurer.
Break the health insurance monopolies. Insurers don’t have a monopoly because the market failed. They have one because Washington built it. Tie coverage to employers, write rules only giants can follow, and let the same companies own the insurer, the PBM and the clinic, and you get a few gatekeepers sitting between every patient and every doctor. Breaking it doesn’t take another government program. It takes getting out of the way: Let people buy coverage across state lines. Give individuals the same tax break employers get, so the plan belongs to the patient, not the job. Expand HSAs and pair them with real catastrophic coverage. Make direct primary care/independent models work with HSAs and stop treating it as insurance. Break up insurer-owned PBMs and clinics. Require real, upfront prices. When patients control the money, insurers have to compete for them. Insurance should cover catastrophes, not your sore throat.
Real price transparency. Every hospital and clinic should post a real price you can see before you walk in. Transparency in pricing helps patients choose how and where to spend their health care dollars, and competition does the rest.
Train more American doctors. Lift the 1997 cap and fund more residency slots, especially in primary care and rural areas. We have qualified American graduates. Let’s train them.
Cut the administrative bloat. Getting rid of most prior authorizations would be a game changer for patients and physicians. So would reining in pharmacy benefit managers and the paperwork that keeps doctors at keyboards instead of with patients.
Stop the fraud. DOGE the system. Every dollar stolen from Medicare and Medicaid is taken from a real patient, and real patients are the ones left waiting.
Get rid of the PBMs (pharmacy benefit managers). Expand the Trump Rx. Make the medications affordable for all especially the seniors.
Medicine used to be a calling. Somewhere along the way it became a bureaucracy, and the relationship between doctor and patient was the first thing the process ran out of room for. Medicare for All wouldn’t fix that. It would finish the job.
Let’s give medicine back to patients and their doctors.
Omnia Pro Aegroto.
— Dr. Kat Lindley is a Board Certified Family Physician and Director of the Fellowship Program at the Independent Medical Alliance
