What I would say is different is that seniors would be facing the exchanges with a much worse hand/stacked deck for "negotiation" than the general public.

(1)I am however, against any argument that exchanges do not work.  There is no evidence to support it.

There is evidence that public insurance programs are the most efficient in terms of cost and care. There is a reason you do not want to change Medicare. Public insurance is superior to exchanges. There is AMPLE evidence of this.

(2) Further, it assumes insurers are all out to scam people - which is simply not true.  The same issues that plague private insurance (payments, coverage, etc.) affect Medicare/Medicaid also.

Scam is a word I would not use. But it is undeniable that insurance companies seek to avoid paying out money. It is the nature of the beast. This tendency is less pronounced in public insurance programs because governments serve the people, not shareholders.

And even if they can enroll in an employer-sponsored plan, that doesn't solve the problem of affording care, nor does it guarantee that the providers one would like to use accept the insurance offered.

My firm has a CIGNA plan; I do not participate.  Premiums for a family run almost $1,000/month.  And aside from routine health screenings - pretty much the answer to everything is "no."  And trying to get to "yes" means spending hours and hours on the phone, never talking to the same person twice because they are in call centers all over the country.

Telling you about a co-worker's efforts to get Cigna to approve pretty much anything their adopted-from-China daughter has needed would fill a small book.  Oh, yes, she's "covered," but that doesn't mean they will pay.  And even when you do everything they tell you to do, even with pre-certifications, and treatment plans, they manage to find ways to say "no" after the fact - after the care has been delivered.

It's unconscionable that this is how people are treated in exchange for giving the insurance company upwards of $12,000/yr of hard-earned money.  She's been told by some providers that they have so much trouble getting paid by Cigna that they no longer participate in any Cigna plans.  It's gotten to the point where she just pays for things because it's so hard to get Cigna to approve anything.  Which no doubt cheers Cigna immensely - that is the whole point of "no:" some people will take that for an answer and just go away.

It's as I have said for a long time: insurance is less and less a path to care and more and more a barrier.