"Things are getting worse."

That's the message Harvard-trained economist Gerald Friedman delivered to an audience of University of Louisville medical students Wednesday — speaking in terms of health and life expectancy in the United States.

But it doesn't have to be that way, Friedman said, speaking at one of several appearances this week in Louisville to explain why he believes a national health insurance plan, or "Medicare for All," can work.

"The truth as I see it is that Medicare for All is possible and that's what we should do," said Friedman, a professor of economics at the University of Massachusetts at Amherst and author of a forthcoming book, "The Case for Medicare for All."

Friedman's visit comes as the debate is heating up among candidates running for president about how to fix the nation's health care system. Friedman said he saw the renewed debate about the subject when U.S. Sen. Bernie Sanders launched his 2016 presidential bid by promoting Medicare for All.

But it's not a new idea, he said, noting that various American presidents have proposed some form of universal health coverage dating back to Theodore Roosevelt.

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Friedman's visit to Louisville was sponsored by the Kentucky chapter of Physicians for a National Health Program and Kentuckians for a Single Payer Health Care.

He will give a free public lecture at 7 p.m. Thursday at the First Unitarian Church in Louisville, 809 S. Fourth St.

U of L Students for a National Health Plan hosted Friedman's medical school appearance Wednesday.

Sarah Riley Parker, president of the student group, said many of her fellow medical students are concerned about access to health care and support the idea of a national health plan.

"I haven't met anyone who thinks it's a terrible idea," Parker said.

Parker said her interest started as a child growing up in Murray, in a family without health coverage.

"My dad had a heart attack and it bankrupted our family," she said. "I don't want that to happen to anyone."

Erik Seroogy, a medical student and member of the group, said he's frustrated by a system in which people can't afford needed medical care or have to wait for an insurance company to approve care or medication.

"There are life-threatening situations in which people need certain medications fast," he said.

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Friedman, in his hourlong presentation to students, said an example of what's wrong with the system is the current crisis over the soaring cost of insulin, causing patients to skip required doses or go without it altogether.

"You know what we call patients who do do things like that?" he asked. "Dead."

In an interview, Friedman said he believes funding exists to create a system to give all Americans access to health care, taking into account the billions of dollars each year spent on health in the United States.

This country spends more than any other developed country on health care yet has poorer health outcomes and life expectancy than many others, he said.

"We're an outlier," Friedman said.

To support his claim that this country can afford a national health plan — offered in most all other economically advanced countries — Friedman offers these calculations:

The U.S. Centers for Medicare and Medicaid Services estimates the country will spend $46 trillion dollars over the next 10 years for health care. Friedman projects Medicare for All would cost about $37 trillion over the same period.

The government is projected to spend about $22 trillion over the next decade on government health programs, mainly Medicare, for older Americans, and Medicaid, for low-income and disabled adults and children.

That means the nation would need around $14 trillion to $15 trillion more to pay for a Medicare for All plan over the next 10 years, according to his estimates, Friedman said.

That money would have to come from somewhere, he acknowledged. But the benefits would include universal patient access to care in a nation with about 30 million people with no health coverage — about 9% of the population.

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It also would mean no commercial insurance premiums; few or no copayments and deductibles; and far less hassle and costs for doctors, hospitals and other providers in meeting demands of multiple private health insurers.

Meanwhile, consumers — whose commercial family health plans cost an average of $20,000 a year — would have more disposable income and far fewer medical costs not covered by insurance, Friedman said.

He acknowledged the obstacles are enormous, including the powerful lobby of the health industry — insurers, pharmaceutical companies and hospitals. And politicians can't agree, with some strongly opposed to the idea of a government sponsored plan, Friedman said.

But Friedman, who has been promoting the idea of a national health plan for nearly two decades, said he's seen a "sea change" in public opinion in recent years, particularly among young people unable to find health coverage they can afford.

He remains optimistic the United States eventually will move to a single plan if more individuals join the fight.

"That's how we got Medicare and Medicaid," he said. "I think that's how we will win this fight, from the bottom up."

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Reach Deborah Yetter at dyetter@courier-journal.com or 502-582-4228. Find her on Twitter at @d_yetter. Support strong local journalism by subscribing today: courier-journal.com/subscribe.