WASHINGTON — Forget “Obamacare.” President Donald Trump has found a new target when it comes to ideas from the Democrats for the nation’s health care system.
Trying to fire up his base for the November midterm elections, Trump is going after “Medicare for All,” the rallying cry of Sen. Bernie Sanders. Trump is trying out attack lines echoed by other Republicans that a government-run system would wreck the existing and enormously popular Medicare program for seniors and disabled people.
There definitely are serious questions about “Medicare for All,” including the massive tax increases that would be needed to pay for it and longstanding differences in society about the proper function of government. But Trump omits any mention of improved benefits for seniors that Sanders and other Democrats promise. And he implies that Democrats are all lined up behind the idea, when they are not. A few recent examples:
TRUMP: “You know what they’re doing with Medicare? They’ll destroy it. The majority of House Democrats have co-sponsored a socialist takeover of health care that would obliterate Medicare. Their plan is called Medicare for All, except they have no money. But it’s really Medicare for none. Their plan would rob American seniors of the benefits they have paid — and they’ve paid these benefits and they’ve paid so much money for their entire lives and you take it away.” — Minnesota rally Thursday.
TRUMP: “Robbing our seniors of the benefits they paid into for their entire lives, giving it to people that don’t deserve it. Giving it, by the way, to illegal aliens who come in to our country. OK?” — West Virginia rally on Sept. 29.
THE FACTS: “Medicare for All” means different things to different Democrats. For Sanders, the Vermont independent, it’s a “single-payer” system in which the government substitutes for private insurers and employers, paying for almost all medical care with tax money instead of premiums.
But for others, “Medicare for All” means allowing people to buy into a new government plan modeled on Medicare. That would move toward the Democratic goal of coverage for all, while leaving private insurance in place.
Democrats are campaigning on health care in the midterms, but beyond defending legal protections for people with pre-existing conditions, they’re far from united. It’s expected the 2020 Democratic primaries will decide whether the party sets single-payer as its goal or steers another course toward coverage for all.
Trump is also wrong to say that Democrats would “obliterate” Medicare.
The options that allow younger people to buy into a Medicare-like plan don’t involve overhauling the current program,
The Sanders plan would be a fundamental change, expanding Medicare to cover almost everyone in the country. But current Medicare recipients would get improved benefits. Sanders would eliminate Medicare deductibles, limit copays, and provide coverage for dental and vision care, as well as hearing aids. A House single-payer bill calls for covering long-term care.
The issue is whether the U.S. can afford to convert to a new government-run health care system, not that older Americans would be left uncovered.
Trump is also stretching the facts when he implies that seniors’ taxes from their working years have paid for their Medicare benefits. While inpatient care is financed with dedicated payroll taxes, about 75 percent of the cost of outpatient (Medicare Part B) and prescription drug coverage (Medicare Part D) is paid for by general tax revenues.
Finally, it’s unclear where Trump gets his assertion that Democrats would give Medicare to “illegal aliens.”
The single-payer bills in Congress call for covering all U.S. “residents.” However, what qualifies as residency is not defined in the text but left to be worked out in regulations.
Sanders’ legislation calls for “inhibiting travel and immigration to the United States for the sole purpose of obtaining health care services.” The House bill calls for reimbursement arrangements with other countries or self-pay for foreigners scheduling surgeries at U.S. hospitals.