With soaring health care costs and a plunge in coverage rates, there is growing interest in Medicare for All. Polls show that a large majority of the public now favors a universal Medicare system, with even a substantial share of Republicans now backing it.

A universal Medicare system has a huge amount to recommend it. Of course, the main point is to ensure that people can get the health care that they need, but it also eliminates a vast amount of waste in the national health care system.

In addition to the $300 billion a year that we spend directly on operating the nation’s health insurance system, another $1.6 trillion is spent on administrative costs running our health care system by providers like hospitals and doctors’ offices, according to analysis by David Himmelstein, Terry Campbell, and Steffie Woolhandler. These additional costs are all the office personnel and various navigators involved in assisting patients in dealing with insurers. They found that in the United States we spend roughly 31 percent of each dollar in health care spending on administrative costs, whereas under Canada’s universal Medicare system, the cost is just 16 percent of spending.

The difference would come to around $900 billion a year, or $6,700 per household. Even that may be an understatement. Even if the United States spent the same share of health care costs on insurers as Canada, it would still be spending far more per person on these costs, because our expenditures on drugs, medical equipment, and doctors are close to twice as high. In short, there is a huge amount to be saved by having a universal Medicare system.

But the other part of this picture is also enormously important. Much, perhaps most, of the insurance system is designed to keep people from getting care. That’s not a conspiracy; it’s just how insurers work. They make money by not paying claims.

Sometimes this takes the form of nickel-and-diming people on claims, adding deductibles that may not be appropriate, or raising co-pays as high as possible. But it often means making it difficult for people to get access to expensive drugs or medical equipment or high-priced medical tests. Given the current structure of these industries, that may actually be desirable.

To be specific, suppose a doctor recommends a new cancer drug with a price tag of $100,000 a year, when it’s possible that an older generic drug, available at 1-2 percent of this price, could be just as good. Wouldn’t we want someone to be asking questions before making such a large commitment of public money?

The same story applies to tests like an MRI. Hospitals can charge several thousand dollars for an MRI. Wouldn’t it be reasonable to ask if an X-Ray for a couple hundred dollars is just as good?

But drugs, medical equipment, and medical tests don’t actually have to cost huge amounts of money. They are expensive because the government grants the pharmaceutical industry and the medical equipment industry patent monopolies.

Without these government-granted monopolies, both drugs and medical equipment would be cheap. It’s rare that a drug is expensive to manufacture and distribute. In a free market, the vast majority of drugs would sell for $20 or $30 a prescription, and many for........

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