In recent months, the people of Maine have witnessed activity by many different players in the health care system as Maine moves to implement the Affordable Care Act.

We’ve seen Gov. Paul LePage veto the expansion of MaineCare, which will leave 70,000 Mainers without access to health care. We’re watching MaineHealth and Anthem try to exclude local hospitals and providers in order to gain “market share” in the upcoming insurance exchange.

We’ve seen highly paid hospital lobbyists and executives successfully persuade Gov. LePage and the Legislature to repay the state’s hospital debt. We’ve learned that businesses are being granted a reprieve from the mandate to offer health insurance to their employees, although individuals remain subject to the mandate beginning in January 2014. Even with ACA subsidies, many of the individual insurance options in the marketplace will be either inadequate or unaffordable for many Mainers.

In the meantime, the problems in the health care system continue to grow. Patients are struggling. The costs of health care consume more than 20 percent of our state’s GDP.

In Maine, an estimated 1,800 individuals and families declared bankruptcy in 2012 due to medical costs. Although some of these people were insured, the majority had health insurance that was inadequate to cover the high costs of medical care. There are 130,000 Mainers who continue to have no health insurance at all; thousands more are under-insured.

When people are under-insured or have no insurance, they delay getting necessary health care and they don’t fill life-saving prescriptions due to cost. That leads to poor health outcomes. When people delay too long, the outcomes are catastrophic. In Maine, someone dies every three days because of lack of health insurance (over 130 deaths per year).

Despite these overwhelming problems in the health care system, there are some bright spots. Our own publicly-funded health care systems (Medicare and the Veterans Administration) remain highly popular and provide better care at lower cost to the most vulnerable patients.

Recently, Medicare passed its 48th birthday. Forty-eight years of experience demonstrates that Medicare, our cherished national public insurance system, could become the solution to the health care crisis in America.

On the occasion of the 48th anniversary of Medicare, I urge Congress to implement real health care reform by improving and extending Medicare to every person in the United States.

A single universal system would give everyone the same access to quality health care regardless of health, wealth, age or employment. It would allow patients to choose their physicians, rather than having insurance companies choose for them. It would spare people the specter of bankruptcy if any family member should have a serious accident or illness. It would help struggling families and small businesses by funding health care with progressive taxes rather than unaffordable insurance premiums. It would eliminate labor-management disputes over health care benefits.

An improved Medicare system would also allow the government to negotiate fair prices for pharmaceuticals, medical devices and health services, and would make it easier to identify and eliminate fraud. It would reduce costs of health care by eliminating the extraordinary and unnecessary administrative waste generated by the private health insurance industry and by the bureaucratic complexities of the Affordable Care Act.

America needs cost-effective universal health care as exists in every other industrialized country. No other nation uses our unique private insurance system which penalizes the sick by charging them more, by reducing their benefits, or by denying care altogether. None allow private insurance companies to place profit over coverage. All of them encourage health care by reducing or eliminating deductibles and co-pays. And all of them provide better care to more people for less money than we do.

Replacing the current health care system with an improved system of Medicare for all would improve this nation’s health. It would save lives and save money.

We must move beyond the bureaucratic, complex, expensive and limited reforms offered by the Affordable Care Act. Instead, let’s improve the popular Medicare program and expand it to cover everyone.

Dr. Julie Pease of Brunswick is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all.