WASHINGTON -- Democrats, fed up with private health insurance companies, are increasingly 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.
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" 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, a Vermont independent who caucuses with Democrats, 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, D-N.M., 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 Republican-controlled 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.
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 Medicare for all 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 Campaign Committee, an advocacy group, said: "No, absolutely not. Why would it? Medicare for all, in the end, means fundamental systemic change."
A Section on 12/30/2018