Our nation has entered a new political season, and a vocal group of elected officials and presidential candidates are promoting a single-payer health care system, or Medicare for All.

Hospitals in Maryland, and nationwide, support universal coverage. And we cannot deny that our current system has flaws. Though, as David Brooks explained in plain language recently, moving to a single-payer system run by the federal government is impractical.

For one thing, half of Americans today have employer-provided health benefits that they like. Plus, Medicare nationally is not a generous payer so, as an AHA/FAH-commissioned report found, hospital income would drop dramatically. Added costs to taxpayers, intense politicization of health care decisions, and consumers’ loss of choice also are concerning.

I led a team that came to similar conclusions in 2013 when appraising Vermont’s first-in-the-nation proposal for single-payer health care on behalf of a group of health care providers and purchasers. The state’s legislature walked away from that plan as a result.

Would a national shift to Medicare for All suit Maryland? We do still have an uninsured population – about 1 out of every 20 people. And, at least under today’s model contract, Medicare is just about as good a payer – for regulated hospital services – as others.

Maryland’s foundation of all-payer rates and our progress in transforming care could ease the change. Though Medicare for All may not yield enough total income for all services to meet the health needs of all Marylanders. And the additional concerns of how a single-payer system operates would remain.