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July 26, 2023
David Burda
Economics Outcomes Policy

A Health Insurance Dream for All

A month ago, 4sight Health published a blog post in which I questioned the wisdom of blindly preferring to get health insurance from a commercial insurance carrier through your employer to getting coverage from a public insurance program like Medicare or Medicaid. As if getting your health insurance from the government was some sort of negative commentary on your work ethic, belief in capitalism or support for democracy.

That post elicited a thoughtful response from Denis Cortese, M.D., the former president and CEO of the Mayo Clinic who now directs and teaches at the Arizona State University Center for Healthcare Delivery and Policy. Dr. Cortese’s response, verbatim, is below.


Good article and interesting survey results. Actually, results are not too surprising given that in any one year about 70-80% of commercial insured do not actually use their coverage. Results of surveys of small samples depend on who is surveyed. I fully accept that there is high dissatisfaction when someone needs access in commercial insurance, Medicare, and Medicaid. I hear from people about problems with initial access and timely follow up almost daily.

The real test of your hypothesis will come when, or if, elected federal officials drop their commercial plan options available through the FEHBP (Federal Employees Health Benefits Program) and self-enroll into a true government plan such as Medicaid or Medicare as their only coverage. And then require all federal employees to do the same. After all, about 150 million U.S. citizens already are enrolled in those same commercial insurance “options” through their employers. Why are our public employees not enrolled in the same plans as those who employ them?

Of course, Medicare and Medicaid are not actually single insurance payers as both are merely government-regulated programs that farm out the administrative functions to commercial insurers. A bit circular really.

I think the only true government single payers would be the VA (U.S. Veterans Administration) and the U.S. military (U.S. Department of Defense), both of which own their own hospitals, doctors and nurses, operating much like the “Kaiser” model. 

The real question is why we are not all in the same scheme together from birth to death? Why can’t a president say to the public: “You get what we have”? Which one plan or program would be the most acceptable to the entire nation? Medicare for all? Medicaid for all? Medicare Advantage for all? The FEHBP program for all? And any one of these options could receive government-based means-tested premium-support.


Denis A. Cortese, M.D.

Hmmm. Let’s see. A government-run (not government-owned) health insurance program through which everyone could pick a health plan that best meets their needs from the same menu of plan options and through which commercial insurers would compete for business based on price, service and quality.

Makes sense to me. Customer-facing. Choice. Level playing field competition. Private-sector innovation.


Thank you, Dr. Cortese, and thanks to all for reading.

About the Author

David Burda

David Burda began covering healthcare in 1983 and hasn’t stopped since. Dave writes this monthly column “Burda on Healthcare,” contributes weekly blog posts, manages our weekly newsletter 4sight Friday, and hosts our weekly Roundup podcast. Dave believes that healthcare is a business like any other business, and customers — patients — are king. If you do what’s right for patients, good business results will follow.

Dave’s personnel experiences with the healthcare system both as a patient and family caregiver have shaped his point of view. It’s also been shaped by covering the industry for 40 years as a reporter and editor. He worked at Modern Healthcare for 25 years, the last 11 as editor.

Prior to Modern Healthcare, he did stints at the American Medical Record Association (now AHIMA) and the American Hospital Association. After Modern Healthcare, he wrote a monthly column for Twin Cities Business explaining healthcare trends to a business audience, and he developed and executed content marketing plans for leading healthcare corporations as the editorial director for healthcare strategies at MSP Communications.

When he’s not reading and writing about healthcare, Dave spends his time riding the trails of DuPage County, IL, on his bike, tending his vegetable garden and daydreaming about being a lobster fisherman in Maine. He lives in Wheaton, IL, with his lovely wife of 40 years and his three children, none of whom want to be journalists or lobster fishermen.

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