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.

On This Day in History — 1963

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.