President Donald Trump and the Republicans would fight “Medicare-for-all” with distortion and hysteria, judging by an op-ed published Wednesday in USA Today.
Trump’s name is on the piece, and it has the same tropes as his stump speeches. There’s the lack of focus (Trump starts with health care and ends with immigration) and the nasty, hyperbolic attack on Democrats (he calls them “radical socialists who want to model America’s economy after Venezuela”).
And then there are the predictable boasts about what Trump has accomplished in office ― which, just as predictably, aren’t accurate.
First Trump claims he kept his promise to protect people with pre-existing conditions. In reality, he lobbied hard to pass legislation that would have repealed the Affordable Care Act. That legislation would have gutted regulations prohibiting insurers from charging more, withholding benefits or denying coverage to people with serious medical conditions.
The bill didn’t become law, but Trump has used his executive authority to undermine pre-existing protections in other ways ― by reversing regulations that kept cheap, skimpy plans off the insurance market, for example, and by asking the federal courts to deem the existing regulations unconstitutional.
Trump also takes credit for the fact that premiums for people buying coverage on their own are going to fall this year. But that’s because insurers increased premiums too much last year ― in no small part because Trump was trying (and is still trying) to sabotage the system and they were trying to anticipate the consequences.
But the main thrust of the article is an attack on Medicare-for-all ― in particular, the proposal from Sen. Bernie Sanders (I-Vt.) to create a government-run insurance program that would cover everybody.
The idea of creating a single-payer system has been around for decades, but it has gotten new attention in the last few years. That’s partly because people have become frustrated that so many Americans are still struggling to pay their medical bills, even with the Affordable Care Act in place. And it’s partly because Sanders made Medicare-for-all a centerpiece of his bid for the 2016 Democratic Party presidential nomination.
Whether the Sanders proposal qualifies as “radical” depends on your perspective. It would eliminate all private insurance, as Trump says, while eliminating nearly all out-of-pocket expenses and having the government set prices for everything from doctor visits to prescription drugs.
But similar systems exist in other countries, including Sweden and Taiwan ― where, notably, the government studied different models for universal coverage and decided such a “single-payer” scheme was not just the most equitable, but also the most efficient.
Polls show the idea is popular here in the U.S., even with Republicans, although it’s not clear how many people understand the concept fully.
In the op-ed, Trump warns that Medicare-for-all would mean “massive rationing of health care” and “long waits for appointments and procedures.” And it’s true that rationing in one form or another could happen in a single-payer system ― or, really, any system where government sets prices ― if the government sets payments too low.
Even some analysts sympathetic to single-payer have warned that the Sanders proposal, as written, would reimburse doctors and hospitals at rates they couldn’t easily accommodate, at least on a short timetable. Other experts have warned that having the government set pharmaceutical prices would ultimately limit innovation.
But not all analysts agree, and Medicare-for-all’s effect on providers and producers of medical care would ultimately depend on details Sanders hasn’t fully fleshed out. At the very least, it’s not difficult to imagine variations on the proposal that could avoid such painful consequences.
Many countries with government price-setting manage to spend less than the U.S. And they provide care that is just as good, if not better, and a heck of a lot more convenient. They also make sure everybody has comprehensive insurance ― so, unlike in the U.S., relatively few people struggle to pay for care.
Replicating those results here would not be easy. Medicare-for-all, like all big policy proposals, would require some very real tradeoffs ― among them, a massive increase in government spending. That would be about $32 trillion over 10 years for the Sanders plan, according to several independent estimates. Trump cites this figure in the op-ed, but he fails to mention that private spending would fall as public spending rose.
Exactly how many people would end up better or worse off financially is difficult to say right now. It would depend on several factors, like whether employers would increase pay once they no longer had to pay for insurance ― and whether those raises offset the higher taxes the Sanders plan would require. But both effects would matter.
Yet another attack ― that Medicare-for-all would hurt seniors, supposedly by taking money from the program ― in the op-ed is in the headline. “The Democrats’ plan means that after a life of hard work and sacrifice, seniors would no longer be able to depend on the benefits they were promised,” the piece reads.
This isn’t a new argument. Republicans, including Trump, have been using it for several weeks. It’s also not terribly accurate. The Sanders plan imagines strengthening Medicare by having it offer more comprehensive coverage than the program does today. And, in fact, it is the Republican Party that has repeatedly called for some combination of Medicare cuts and privatization.
None of this means reasonable people wouldn’t find Medicare-for-all objectionable. That’s especially true for people presently enrolled in private Medicare Advantage plans or employer-sponsored policies. They might not believe promises that coverage under the Sanders plan would be better ― and, given that final legislation would undoubtedly look different than the original proposal, it’s easy to understand why.
That’s one reason why many Democrats who have endorsed “Medicare for all” actually prefer less ambitious schemes, in which enrollment in the new public plan would be voluntary ― and in which, perhaps, the government would impose restrictions on prices more slowly. Still other Democrats seem content with more modest steps, like making the Affordable Care Act’s financial assistance more generous ― or having the government put more pressure on drugmakers, but without setting prices too aggressively.
But whether Democrats end up rallying behind the Sanders bill, less sweeping versions of Medicare-for-all, or an entirely different set of reforms, they should expect more arguments like the ones Trump made on Wednesday ― because, after all, they are nothing new.
Republicans have pilloried pretty much every major Democratic health care plan, from Harry Truman’s to Barack Obama’s, as radical, dangerous socialism. The attacks weren’t honest then and they aren’t honest now.