I am responding to columnist Dr. Jay Fleitman’s July column dismissing Medicare for All.

Fleitman states that 91 percent of Americans are insured, but neglects to point out that more than one-third of those insured are enrolled in public programs such as Medicare and Medicaid, or that, according to the Commonwealth Fund, 45 percent of Americans between ages 19 and 64 are not adequately insured.

If insured, their out-of-pocket costs put routine care out of reach. Fleitman blames Americans’ habits for the U.S.’s poor health outcomes and lower life expectancy compared to other countries. Helping patients with drug addiction, smoking and obesity are part of primary/preventative care, where they are less expensive to treat than to leave untreated.

In his previous column on Medicare for All, Fleitman urged doctors not to worry about insurance companies’ frequent denials of treatments and medications. Just call them up and explain, he advises. Who is not alarmed that doctors must base their treatment plans on what the patient’s insurance will cover and even then may have to spend time on the phone pleading with the insurance company to approve the treatment?

Private insurers are in business to make money, not to treat patients, and they make money by charging more and covering less care. Fleitman warns that the Bernie Sanders Medicare for All program will not reimburse doctors like himself or hospitals adequately, but neglects to point out that U.S. doctors currently spend, on average, $88,000 annually on insurance-related overhead. Many hospitals have as many bill coders as beds for the same reason.

Medicare for All would substantially reduce administrative costs for providers, hospitals and insurance companies, and it would also save hospitals the cost of treating uninsured patients who cannot pay, freeing up more money for universal health care.

In contrast to the unaccountable system of private insurance, the proposed Massachusetts Medicare for All bill, if passed, provides for accountability and transparency through a representative board of trustees that will determine what is covered and reimbursement rates. I urge readers to read the bill (S683, H1194).

NANCY TALANIAN

West Whately