September 14, 2018 10:23:43 AM
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.
Froma Harrop, a syndicated columnist, writes for the Providence (Rhode Island) Journal. Her e-mail address is [email protected]
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