By Elmore Rigamer, M.D. and Marc Lavietes, M.D.
State Affairs, Sept. 29, 2025
Some 377,000 Louisiana residents have no medical insurance. And while we do not have data for Louisiana, 40 percent of Americans have medical debt.
Residents of other industrialized Western countries donāt have medical debt because those countries have some form of a universal and regulated healthcare delivery system. Some, such as Germany or the Netherlands, use a regulated capitalistic format. Great Britain, on the other hand, uses a socialist model with government ownership of physiciansā practices and medical facilities.
The premise of a recent column, that competition would cure our doctor shortage, is flawed. If someone wishes to purchase a sofa or a refrigerator, he is an informed consumer. He is familiar with his available choices, and his need to replace these items is usually not immediately urgent.
On the other hand, when he awakens vomiting blood or feeling excruciating chest pain, he is not an informed consumer. He has no leisure time to investigate available services, and his ability to evaluate the pros and cons of commercially available healthcare plans is limited.
And with increasing consolidation within the hospital and pharmaceutical industries, competition becomes ineffective.
Expanding Medicare Advantage will not solve the problem. Medicare Advantage is private insurance, not Medicare, and the advantage goes to the insurance industry, not to the patient or physician.
If a person chooses an MA plan, the government pays a yearly lump sum from the Medicare trust fund to the private insurer, who then assumes all responsibility for that patientās health care. Any money not spent on the insureeās health becomes insurance industry profit.
Industry profits further by adding co-pays and by denying claims. For every 100 claims an insurance company denies, 15 would have been covered in full by traditional Medicare. This leaves the Medicare Advantage customer with considerable medical debt.
By this mechanism, insurance companies take billions of dollars yearly from the trust fund, diverting that money intended for medical care into corporate profit. Advantage plans are popular, until the insuree is stricken with illness and must use the plan.
Since we already have a viable Medicare system in place, Medicare for All is a reasonable choice for us. In a way, this would be a compromise between the Netherlands and Great Britain. The physician is free to practice as he chooses, while the patient is free to choose the physician of their choice. There are no networks, and there is only one payer: a national trust fund. Fees are determined by collective bargaining.
At present, our Medicare system is flawed. Dental, hearing and visual care are not included, nor is long term care.
What we need is not Medicare, but rather an improved Medicare for All.
Dr. Elmore Rigamer is medical director for Catholic Charities Archdiocese of New Orleans, while Dr. Marc Lavietes is an associate professor at Rutgers-New Jersey Medical School. Both are members of Physicians for a National Health Program.