The 'Advantage' in one 'Medicare for all' proposal

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.

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