In “What is implied by calls of ‘Medicare for all?’ ” (Aug. 2), Bryan Dowd used over-the-top rhetoric in suggesting that proponents of “Medicare for all” don’t understand Medicare. Medicare was conceived as a universal social insurance program providing health coverage to seniors regardless of income or health status, with all beneficiaries paying into the program through mandatory contributions from employees and employers. Prior to Medicare, half of seniors lacked health insurance and faced debt and poverty due to health care costs.

Unfortunately, in the last several years, the corporate health insurance lobby has tightened its grip on Medicare. Creeping privatization has made billions of dollars for the insurance industry while weakening the program.

Hefty contributions and constant lobbying on Capitol Hill by the insurance industry threatens one of the most efficient and popular universal public programs in our nation. For example, legislation passed in 2015 prohibits Medigap plans from covering Part B deductibles, forcing seniors to pay more for care, which we know tends to cause patients to delay or skip care until their illness is more serious and expensive to treat.

Another example is privatized Medicare (Medicare Advantage), which adds insurance companies as a middleman. Research has shown that Medicare Advantage costs taxpayers more than traditional Medicare and that it is less efficient.

More evidence that the Medicare system is needlessly convoluted to the advantage of the insurance companies: Kaiser Health News reported last week that health insurance companies are automatically enrolling members into their Medicare Advantage plans, rather than traditional Medicare, leaving many with surprise medical bills when they unknowingly go to out-of-network doctors and hospitals. When Dowd uses the words “turns out not to be very democratic” but rather “somewhat totalitarian,” he would be more accurately describing what is happening in Medicare Advantage than what supporters of universal health care seek. We support a system where people get to choose their doctors and medical providers, without interference from insurance companies.

Perhaps Prof. Dowd understands that we are pushing for something better than just an expansion of Medicare as it currently exists. The most efficient health care program would be a single national program, publicly financed and privately delivered, covering all Americans with one set of comprehensive benefits. No networks. No eligibility hoops or means tests. When advocates use the shorthand “Medicare for all,” that’s what we envision — not the distorted, semi-privatized, increasingly costly system seniors have to navigate today.

This is why the Minnesota Nurses Association advocates a system in which care is still provided by private providers but the government manages the finances. The current system is not sufficient: it is incredibly complex and wasteful, it is not controlling long-term health care costs, and it is not covering everyone. Your nurses think we can do better.

Rose Roach is executive director of the Minnesota Nurses Association.