Obstacles lie in path of ‘Medicare for all’
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.
AMedicare-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 Massachu-
setts 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.”
Wendy Kaplan, 53, of Evanston, Illinois, who has found family coverage under the Affordable Care Act rather expensive, said she liked the idea of Medicare for all.
“In principle,” said Kaplan, a Democrat, “I feel that health insurance should be available to everyone. Single payer is a great idea in principle. I don’t think health care should be a for-profit endeavor. My biggest reservation is whether our government could be competent at running something like that.”
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 25-year-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 Cam- paign 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.”
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.
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.”
Members of National Nurses United listen to a Sept. 13 speech by Sen. Bernie Sanders, an independent fromVermont, about health care on Capitol Hill in Washington. A Medicare-for-all bill drafted by Sanders is gaining support among Democrats.