I believe that the mainstream position on healthcare reform - or more specifically healthcare financing reform - held by the membership (as opposed to the leadership) of the Democratic party is that the country should move to a "Medicare for All" type system.  In such as system, the Federal Government would function as both the sole payer, and also the sole administrator of the care financing system in a model that looks very much like Traditional Medicare does today.  The defining characteristic of the system is the elimination, or near elimination, of private insurers from the care financing system, and consequently the elimination of managed care, and the creation of a single broad, open access provider network.  I disagree with this position in one significant respect. 

While I agree with the premise that having the Federal Government function as the care financing systems sole payer is the most efficient solution (largest risk pool, greatest operating scale, etc.), I disagree with the premise that the Federal Government should function as the sole administrator of that system and that an open access provider network is desirable.  I am more in favor of a system I would characterize as, "Medicare Advantage for All".  In such a system the Federal Government would remain the sole payer, but would delegate administration of the system to private managed care entities in a model that looks very much like Medicare Advantage (aka Medicare Part C) does today.  I take this position because Medicare Advantage managed care providers have shown an ability to both reduce the cost, and increase the quality of, care delivered to members when compared to Traditional Medicare.  Unfortunately, today the majority of that cost savings is consumed by the marketing budgets of the managed care providers.  However, most of that marketing budget is currently spent marketing "against" Traditional Medicare, so I believe in a Medicare Advantage for all type system that marketing need would be eliminated and the cost savings could accrue to the Federal Government/taxpayers.

This position is still far to the left of the Republican position, as well as the ACA, but is to the right of say Senator Sanders position.  

3 Comments