Medicare one disease at a time

Expand Medicare selectively to cover specific high‑cost diseases (like Nixon’s 1972 end‑stage renal disease entitlement) regardless of patient age, using clinical diagnosis as a clean proxy for ‘‘expensive patient’’ status. Doing so would shift the costliest cases off commercial books, leverage Medicare bargaining to cut per‑patient costs, and potentially lower premiums for the remaining privately insured population. — Offers a politically plausible, fiscally targeted alternative to universal Medicare expansion that reshapes debates about who should be covered and how to stabilize insurance markets.