UBC health economist Bob Evans famously called arguments that Medicare is unsustainable or that we therefore need privatization zombies: meaning that these ideas are constantly refuted by all the evidence, yet they keep being raised again and again. Of course, that is because there are powerful interests driving these ideas. Economist Hugh Mackenzie and health policy consultant Dr Michael Rachlis have done an excellent analysis of how Medicare and a universal health system is sustainable and how the real answers to the pressures facing the system are better policy and management. They highlight that this debate is essentially political; that the fiscal pressures on health and other sectors come from government decisions to cut taxes and services, as opposed to inherent trends within the health system. They point the way forward: improved planning and management of care will control costs; service and organizational reforms can drive better quality care; enhanced primary care, health promotion and prevention can keep people well; and seeing all this as part of a comprehensive and integrated Second Stage of Medicare will underlie a vision of good health and well-being for all.