Ob­sta­cles lie in path of dream of ‘Medi­care for all’

Lexington Herald-Leader (Sunday) - - Nation - BY ROBERT PEAR

More and more Democrats, fed up with pri­vate health in­surance com­pa­nies, are en­dors­ing the goal of a gov­ern­men­trun, 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.

En­roll­ment in pri­vate Medi­care plans has shot up roughly 80 per­cent since 2010. Older Amer­i­cans are at­tracted by the prospect of ex­tra ben­e­fits, a limit on out-of-pocket costs and a doc­tor or nurse who can co­or­di­nate their care.

“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.

One-third of Se­nate Democrats and more than half of House Democrats who will serve in the new Congress have en­dorsed pro­pos­als to open Medi­care to all Amer­i­cans, re­gard­less of age.

A Medi­care-for-all bill drafted by Sen. Bernie San­ders, in­de­pen­dent of Ver­mont, has been en­dorsed by 15 Demo­cratic se­na­tors, in­clud­ing sev­eral po­ten­tial pres­i­den­tial can­di­dates: Cory Booker of New Jersey, Kirsten Gil­li­brand of New York, Ka­mala Har­ris of Cal­i­for­nia and El­iz­a­beth War­ren of Mas­sachusetts.

In the House, Medi­care for all is gain­ing new sup­port with the elec­tion of a num­ber of pro­gres­sive Democrats. They in­clude Sylvia Gar­cia of Texas, Ja­hana Hayes of Con­necti­cut, Joe Ne­guse of Colorado, Alexan­dria Oca­sio-Cortez of New York, Il­han Omar of Min­nesota, Katie Porter of Cal­i­for­nia, Ayanna Press­ley of Mas­sachusetts and Rashida Tlaib of Michi­gan.

Al­though Barack Obama shunned sin­gle-payer so­lu­tions as pres­i­dent, he praised Medi­care for all in a cam­paign-style speech in Septem­ber. “Democrats aren’t just run­ning on good old ideas like a higher min­i­mum wage,” he said. “They’re run­ning on good new ideas like Medi­care for all.”

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,” Rep.elect Deb Haa­land, DN.M., a sup­porter of Medi­care for all, said in an in­ter­view. “We need a na­tional pub­lic health care sys­tem, which would be more af­ford­able in the long run, and the out­comes might be bet­ter.”

Large ma­jori­ties of

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