Republicans have a built-in contradiction at the core of their politics, and they’re not likely to resolve it anytime soon. On the one hand, they really, really want to do something to reduce the cost and scope of the big middle-class “entitlement” programs, Social Security and Medicare — if only to generate more dollars for tax cuts and defense. It’s why their chief fiscal engineer, Paul Ryan, was an early supporter of Social Security partial privatization, and included a Medicare overhaul (replacing defined benefits with “premium support,” or vouchers) in all those Ryan budgets. But Republicans are also afraid to go after these programs because (aside from the fact that they are wildly popular) the chief beneficiaries are seniors, who are the most pro-GOP age group (in part because over-65 voters are whiter than younger age cohorts).
This is why Republicans desperately want bipartisan cover for “entitlement reform” (it was the foundation for all those Grand Bargain negotiations with Barack Obama not that long ago). And it’s also why whenever they can’t get Medicare cuts, they’ll turn on a dime and pose as the stout defenders of the program against Democratic efforts to raid it to give health-care benefits to other people. That’s exactly what we are seeing in new attacks by Donald Trump and Rick Scott, among others, on Medicare for All as a threat to — Medicare!
Here’s Trump on the stump trying this out:
And here’s Scott — whose political career has been financed by a golden parachute from a hospital chain forced to pay the federal government billions for Medicare fraud — running for the Senate in senior-heavy Florida:
This is only marginally more cynical and audacious than previous Republican efforts to claim that Obamacare was a threat to Medicare. On the campaign trail in Florida in 2012, Paul Ryan, the nation’s chief enemy of traditional Medicare, stood by his mother and posed as Medicare’s great defender against Obama and those mean old Democrats who wanted to rob old folks’ benefits to give things to those people. But still, defending Medicare by attacking Medicare for All is a tough sell, even for sophisticated demagogues like Trump and Scott.
It is true, as I have argued myself, that single-payer proposals flying under the flag of Medicare for All aren’t a simple extension of Medicare as it exists today to the general population. But for the most part, single-payer (at least in the proposals of Bernie Sanders and other leading Democrats) would be a more generous, not less generous, version of Medicare, as Jonathan Cohn notes:
[P]art of their plan is to make Medicare more generous, by eliminating the program’s high out-of-pocket costs that lead many seniors to buy supplemental so-called Medigap plans or to enroll in private alternatives. Sanders and his allies like to talk about “Medicare for all,” but a more accurate moniker for their plans would be “better Medicare for all.”
Yes, Medicare for All would shut down the privately run Medicare Advantage plans that about a third of Medicare beneficiaries choose, though as Cohn says, many do so because they offer enhanced benefits that the government would provide in single-payer systems — along with many more benefits such as dental and even long-term care that Medicare does not provide at all. At a fundamental level, Medicare for All would make the inherent socialism of traditional Medicare more systematic, and then make eligibility universal.
If Republicans were strictly attacking Medicare for All because of the tax increases it will most definitely require (though they’ll be more than offset, say proponents, by savings in private health-insurance premiums, out-of-pocket expenses, and coverage denials), that would be one thing. There are other vulnerabilities as well, such as the impact of single-payer on health-care providers, many of whom dislike Medicare as it exists today.
But what Trump and Scott are doing is asking seniors to selfishly (or resentfully) oppose giving younger people the same kind of health coverage they enjoy because it might somehow put their own “socialist” benefits at risk. And as with the attacks on Obamacare, there is more than a bit of a whiff of racism involved, as Cohen observes:
[T]aken literally, Trump was saying that Democrats want to raid socialism to pay for socialism, which doesn’t make a whole lot of sense.
But Trump was probably making a clumsy version of the pitch that helped him get elected and that continues to keep his base loyal — namely, that Democrats want to shift money and status away from the kind of people who voted for him and give those things to others.
His message to supporters, in other words, was that Democrats want to raid your socialism to pay for theirs.
It’s not crazy to hear a racist dog whistle in there, given Trump’s history. It certainly wouldn’t be the first time that a Republican tried to rally white voters by telling them that Democrats were going to take their money and give it to nonwhite people.
You could argue that Republicans are simply appealing to the innate conservatism of old folks who fear change even if they would be helped very directly by that change. But the country could do without the lies told by those with bad intent toward Medicare posing as its champions.