Daily Herald, The (Everett, WA) September 13,
2018
By Froma Harrop
A resurfaced Barack Obama has uttered those three little
words: "Medicare for all."
Does that mean that the Affordable Care Act, aka
Obamacare, was a bad idea? Not at all.
The ACA was a triumph in that it cut the number of
uninsured Americans by 20 million. And it hardened the idea that no American,
regardless of income or pre-existing conditions, should suffer or die for lack
of health coverage.
Does the ACA have flaws? It does. But it serves as an
important rung in the ladder toward less chaotic and universal health coverage.
"Medicare for all" is a fairly vague term that
could mean many things. Some see it leading to a Canadian-style single-payer
system. Canada's model has its virtues — simplicity being the chief one — but
it doesn't rank so high in international comparisons as others combining
government and private coverage.
How about Medicare Advantage for all? Medicare Advantage
refers to the managed-care plans run by private insurers. Medicare pays them a
monthly fee per enrollee to cover hospital care, visits to the doctor and other
services guaranteed under the original Medicare. Many offer extras, such as
eyeglasses and hearing aids. Sometimes they offer drug coverage and even gym
memberships.
About a third of Medicare beneficiaries now choose them
over the traditional fee-for-service program. Studies show that the enrollees
are generally happy with their plans and the care is high-quality.
Like other managed-care plans, these require using an
insurer's network of providers. The rules vary, however. People can buy more
expensive plans if they like — or they can opt for a plan with virtually no
out-of-pocket expenses. There's even a system for low-income subsidies.
Standardized and listed on an online marketplace, the Medicare Advantage plans
are easy for beneficiaries to figure out.
And there is some value added to private coverage,
certainly at the point of delivery. The cap on the plans' funding provides a
financial incentive to help people with chronic conditions navigate the health
care system. The plans do a decent job of making sure that patients follow
through on treatment.
As for the politics of it, Republicans have long been
boosters of the Medicare Advantage program. They like its reliance on private
insurers.
Medicare Advantage for all would steer conservative
theorists away from their "consumer-oriented" pipe dreams — those
tax-advantaged health savings accounts, health reimbursement accounts and the
like tied to catastrophic coverage. These schemes create an even more complex
bureaucracy, all for the sake of some abstract notion of a "free
market."
Let's be blunt. The government must limit its spending by
fiat. Then we can let the market step in and sort out the details. Under
Medicare Advantage for all, the insurers would become, in effect, regulated
utilities.
As now, Medicare's overseers would have to keep an eagle
eye on how they reimburse the companies. There's a history of paying Medicare
Advantage insurers far more than they spend on medical care.
The good news embedded here is that the Medicare Advantage
plans can save money in ways the traditional fee-for-service program does not.
And it needs repeating that people are signing up for them by choice.
For younger Americans, the ACA is what they have at the
moment. Republicans intent on killing it are dealing with the unpleasant
reality that public opinion has swung from hostility to the reforms to support
for them. Too chicken to do an outright repeal, Republicans are engaging in
quiet sabotage, weakening its financial footing bolt by bolt. They're now
trying to end protections for those with pre-existing conditions while saying
they're not.
What to do now? Preserve the ACA and think Medicare for
all. And while thinking that, consider Medicare Advantage for all.
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