Ob­sta­cles lie in path of ‘Medi­care for all’

The Idaho Statesman (Sunday) - - NEWS - BY ROBERT PEAR New York Times WASHINGTON

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.

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 Oca­siocortez 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 Medi­care ben­e­fi­cia­ries say in sur­veys that they are sat­is­fied with their cov­er­age.

With a Repub­li­can pres­i­dent and a Repub­li­can­con­trolled Se­nate, pro­pos­als for a ma­jor new health care en­ti­tle­ment have no chance of be­com­ing law in the next two years. But they show how an idea long rel­e­gated to the side­lines is edg­ing back into fa­vor with some Democrats and could be em­braced by the party’s nom­i­nee in the next pres­i­den­tial elec­tion.

Pres­i­dent Don­ald 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 Azar, the sec­re­tary of health and hu­man ser­vices.

Christine Vilord, an Idaho school­teacher who de­scribed her­self as a mod­er­ate Repub­li­can, said she could sup­port a Medi­care-for-all pro­gram of na­tional health in­surance even if it meant a small in­crease in taxes. She said she re­al­ized the need for such a pro­gram in Oc­to­ber when her 25year-old daugh­ter was in a se­vere auto ac­ci­dent that left her un­able to walk for two months.

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 for­profit in­sur­ers that make money by deny­ing peo­ple care.”

San­ders and Rep. Pramila Jaya­pal, D-wash., a chair­woman of the Medi­care for All Cau­cus in Congress, see no need for pri­vate Medi­care Ad­van­tage plans.

Vedant Pa­tel, a spokesman for 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 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.”

TOM BREN­NER NYT

Mem­bers of Na­tional Nurses United lis­ten on Capi­tol Hill on Sept. 13 as Sen. Bernie San­ders, an in­de­pen­dent from Ver­mont, speaks about health care.

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