It appears that the Advantage plans eventually will be limited to lower incomes where it will be based on people on medicaid or dual eligible. It simply can't go to the way of having one area in the country offer it and not in others. Can this be unconstitutional? Insert from the congress blog:The candidates' positions on Medicare Advantage - The Hill's Congress Blog "Medicare Advantage plans are paid based on a legislative formula, and any payments they receive above what is necessary to provide the basic Medicare benefit must be provided to the beneficiaries of the plans in the form of expanded benefits, such as lower deductibles and copayments for services. Once the election is over and the artificial and temporary bump-up in payments is terminated, as it inevitably will be, the Medicare Advantage plans will be forced to pare back benefits, and enrollment in the plans will drop." "This should not be surprising. The traditional Medicare fee-for-service insurance is an extremely inefficient model. There is no incentive for either the providers or the enrollees (most of whom have supplemental coverage beyond Medicare) to control the use of services. Thus, the volume and intensity of service use rises dramatically each year. Moreover, there is no coordination among those providing medical services to the patients, which leads to fragmented and low-quality care in too many instances." Since traditional med sups are considered inefficient in controlling costs and the fact the president wants to cut spending on advantage plans it leaves a big gap of uncertainty of which way we go with medicare. I would hope we get rid of the political animal and try to come up with the most efficient way to run medicare for future generations to come as the country ages. What is your take?