By Robert Pear
The New York Times, December 29, 2018
More and more Democrats, fed up with private health insurance companies, are endorsing the goal of a government-run, single-payer system like Medicare for all Americans. But they have discovered a problem. More than one-third of Medicare beneficiaries are in Medicare Advantage plans, run not by the government but by private insurers.
Whether to allow younger Americans to enroll in such private Medicare plans has become a hotly debated political question as Democrats look to 2020.
When liberal Democrats started advocating “Medicare for all” more than 25 years ago, Medicare was the original fee-for-service program run by the government. Since then, it has changed in big ways. More than 20 million of the 60 million beneficiaries are in comprehensive Medicare Advantage plans sold by private insurers like UnitedHealth, Humana, Kaiser Permanente and Blue Cross and Blue Shield.
“Medicare for all” has become a rallying cry for progressive Democrats, though it means different things to different people. Supporters generally agree that it is a way to achieve universal coverage with a system of national health insurance in which a single public program would pay most of the bills, but care would still be delivered by private doctors and hospitals.
Billy Wynne, a health care lobbyist who used to work for Senate Democrats, said: “The literal meaning of ‘Medicare for all’ would include Medicare Advantage. But that is not what most supporters of Medicare for all have in mind.”
The champions of Medicare for all generally see insurance companies as part of the problem, not the solution.
“There are a lot of insurance companies and medical companies that are advocating for their own best interests, and those best interests are usually money, and not people’s health,” Representative-elect Deb Haaland, Democrat of New Mexico and a supporter of Medicare for all, said in an interview.
President Trump and other Republicans have mocked the idea of Medicare for all, saying it could ruin the program for older Americans and generate huge costs for the federal government. It would “come at a staggering cost to taxpayers,” said Alex M. Azar II, the secretary of health and human services.
Asked if his vision of Medicare for all included private Medicare Advantage plans, Adam Green, a founder of the Progressive Change Campaign Committee, an advocacy group, said: “No, absolutely not. Why would it? Medicare for all, in the end, means fundamental systemic change. People would no longer be at the mercy of for-profit insurers that make money by denying people care.”
Mr. Sanders and Representative Pramila Jayapal, Democrat of Washington and a chairwoman of the Medicare for All Caucus in Congress, see no need for private Medicare Advantage plans.
Vedant Patel, a spokesman for Ms. Jayapal, said her vision of Medicare for all was the traditional Medicare program, not private plans. “The purpose of Medicare for all is defeated if there are other plans people can buy into,” he said.
Josh Miller Lewis, a spokesman for Mr. Sanders, said: “We would get rid of duplicative health insurance. Our version of Medicare would cover most procedures. There would be no need for a Medicare Advantage program.”
Other lawmakers support expanding Medicare, but do not want to disrupt coverage for consumers who like the insurance they have.
Josh Miller Lewis, a spokesman for Mr. Sanders, said: “We would get rid of duplicative health insurance. Our version of Medicare would cover most procedures. There would be no need for a Medicare Advantage program.”
Other lawmakers support expanding Medicare, but do not want to disrupt coverage for consumers who like the insurance they have.
“Millions of Americans who rely on employer-sponsored insurance and Medicare Advantage are satisfied with their coverage,” said Representative Rosa DeLauro, Democrat of Connecticut.
Some health policy experts have suggested building a national health insurance program on Medicare Advantage rather than on the traditional fee-for-service Medicare program.
“Medicare Advantage for all — that would be a much more politically feasible and a uniquely American spin on single payer,” said John K. Gorman, a former Medicare official who is a consultant to many insurers. “It would be Medicare paying all the bills, but it would be privately administered by heavily regulated plans that would effectively serve as utilities.”
Comment:
By Don McCanne, M.D.
As we move into the next year, we should be celebrating the fact that “Medicare for All” has gained traction and now has widespread support throughout the United States. But can we? Any celebration has to be tempered by the fact that a multitude of very powerful forces are hijacking the “Medicare for All” label and using it to advance their own agendas based on ideology and especially greed.
What has crept into the national dialogue more recently is an emphasis that Medicare is not just the traditional public program but it also includes the private Medicare Advantage plans. The latter are being promoted by those in the insurance industry camp as the ideal model for expanding the Medicare program, whether by reducing the eligibility age, or by offering Medicare Advantage as a ready-to-go “public option” (that is actually private), or by opening up the ACA exchanges to include private Medicare Advantage plans (as a devious route to premium support – using ACA subsidies to support privatized Medicare).
Whatever, it is clear that the private insurance industry is going to continue to do all it can to capture the present and future versions of the Medicare program, and they are doing it with the help not only of the conservatives but also the neoliberals who have infiltrated the progressive camp. We will likely be hearing much more about Medicare Advantage for All.
It is going to be a rough year.
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