Editor's Note:
What follows are some responses to an article by President Trump published on October 10 by USA Today, that I posted in my October 10 HCRA blog. His article is most likely a reaction to the growing popularity of Senator Sanders' "Medicare for All" legislation.
-SPC
Fact-checking President Trump’s USA Today op-ed on ‘Medicare-for-All’
by Glen Kessler - The Washington Post - October 10. 2018
October 10 at 11:21 AM
President Trump wrote an opinion article for USA Today on Oct. 10 regarding proposals to expand Medicare to all Americans — known as Medicare-for-All — in which almost every sentence contained a misleading statement or a falsehood.
Many of these are claims we have already debunked. Presumably, the president is aware of our fact checks — he even links to two — but chose to ignore the facts in service of a campaign-style op-ed. Medicare-for-All is a complex subject, and serious questions could be raised about the cost and how a transition from today’s health-care system would be financed. Trump correctly notes that studies have estimated that the program — under the version promoted by Sen. Bernie Sanders (I-Vt.) — would add $36 trillion in costs to the federal government over 10 years.
But this is not a serious effort to debate the issue. So as a reader service, we offer a guide through Trump’s rhetoric.
“Throughout the year, we have seen Democrats across the country uniting around a new legislative proposal that would end Medicare as we know it and take away benefits that seniors have paid for their entire lives.”
Sanders has unveiled a plan he calls “Medicare-for-all.” Essentially, it is a single-payer plan. That means all of the bills would be paid by one entity — the federal government — in contrast to the hodgepodge health-care system now in place. Medicare, the health care system for the elderly and disabled, is a federal single-payer plan, but people under 65 get insurance from employers, through the individual market (Obamacare) or through Medicaid, the federal-state health system for the poor. Private health insurance plans, such as those offered through employers, would be eliminated, according to the Congressional Research Service.
Sanders says he would first improve Medicare for seniors and the disabled by eliminating deductibles and covering dental, vision and hearing aids, which are not covered under current law. Then, over the course of four years, the eligibility age would be lowered in stages until every American was covered.
On paper at least, the Sanders plan would improve benefits for seniors, not take them away.
There are several other versions, including proposals more limited in scope (such as “Medicare-X”) that would simply offer a Medicare option as a buy-in. The Kaiser Family Foundation has a useful guide to the differences.
“As a candidate, I promised that we would protect coverage for patients with pre-existing conditions and create new health care insurance options that would lower premiums. I have kept that promise, and we are now seeing health insurance premiums coming down.”
Trump made this promise, but broke it. He supported Republican plans that would have weakened protections for individuals with preexisting conditions. His administration also has refused to defend the Affordable Care Act against a lawsuit that would undermine those protections. In effect, the Trump administration no longer supports a provision of the ACA, a.k.a. Obamacare, that makes it possible for people to buy insurance if they have preexisting health conditions. (We labeled this as a flip-flop.)
As for premiums, they have continued to increase on average, just at a lower rate than in the past. But experts say that without Trump’s moves to weaken the Affordable Care Act, premiums would be even lower in many states.
“I also made a solemn promise to our great seniors to protect Medicare. That is why I am fighting so hard against the Democrats' plan that would eviscerate Medicare.”
Under Trump, the date for when the Medicare Hospital Insurance (Part A) trust fund will be depleted keeps advancing. The current projection is 2026, three years earlier than the projection a year earlier.
Part A is financed mainly through payroll taxes of 1.45 percent on earnings paid both by workers and employers; self-employed people pay 2.9 percent. The money raised is then credited to a pay-as-you-go trust fund, which uses the revenue raised to pay the benefits of Medicare beneficiaries.
With the baby-boom generation retiring at a rate of 10,000 people per day, that puts pressure on the long-term financing of the program because fewer workers will be supporting more retirees. If the trust fund is depleted, that means the government would not be able to cover 100 percent of estimated expenses. Yet because of Trump’s tax cut, the budget deficit is soaring even as the economy is booming, in contrast to previous periods of under-4-percent unemployment. That leaves the government less prepared to deal with the consequences of baby-boom retirements.
“Democrats have already harmed seniors by slashing Medicare by more than $800 billion over 10 years to pay for Obamacare.”
Trump resurrects a misleading Republican talking point from the 2012 election.
The Affordable Care Act actually strengthened the near-term outlook of the Part A trust fund. The law includes a 0.9 percent payroll tax that hits the wages and self-employment income of wealthier Americans — above $250,000 per couple or $200,000 for a single taxpayer. That was estimated to raise an additional $63 billion for the Part A trust fund between 2010 and 2019. The law also was estimated to cut expenses, including $162 billion in productivity adjustments to provider payments and $86 billion in reduced payments to Medicare Advantage plans. The net result was that the “insolvency” date was extended by 12 years.
In other words, the savings that Trump complains about mostly were wrung from health-care providers, not Medicare beneficiaries — who, as a result of the health care law, ended up with new benefits for preventive care and prescription drugs.
Moreover, the $800 billion in Medicare reductions in the ACA that Trump complains about are the law of the land. In fact, Republicans in Congress and the Trump administration in their budget plans have pocketed virtually all those savings— and sought even more reductions in Medicare spending on top of that. Trump proposed $350 billion in net Medicare cuts in his budget — and there were about $540 billion in Medicare cuts assumed in the House GOP budget plan.
“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.”
As noted, the Sanders plan in theory would expand benefits for seniors.
“The Democratic plan would inevitably lead to the massive rationing of health care. Doctors and hospitals would be put out of business. Seniors would lose access to their favorite doctors. There would be long wait lines for appointments and procedures. Previously covered care would effectively be denied.”
This is a scare scenario. Obviously, a transition to single-payer health care would lead to upheaval and uncertainty since it would encompass the entire health care system, not just the small piece covered by Obamacare. But other countries appear to manage with single-payer systems, at lower costs than the United States. Trump’s vision of what would happen under single-payer echoes the fears evoked by opponents of Medicare in the 1960s and Obamacare in 2010. So there’s a Chicken-Little feel to this language.
Here, for instance, is Ronald Reagan in 1961, warning against the creation of Medicare.
“The Democrats' plan also would mean the end of choice for seniors over their own health-care decisions. Instead, Democrats would give total power and control over seniors’ health care decisions to the bureaucrats in Washington, D.C.”
Medicare is currently a government-run program, with hospital and doctor fees paid by the government, so this appears to be an absurd point.
“The new Democrats are radical socialists who want to model America’s economy after Venezuela.”
Venezuela is collapsing after years of near-dictatorship and squandering of oil wealth, but we are unaware of any Democratic leader who has pointed to Venezuela as an economic model.
“Some Democrats' absolute commitment to end enforcement of our immigration laws by abolishing Immigration and Customs Enforcement. That means millions more would cross our borders illegally and take advantage of health care paid for by American taxpayers.”
Some Democrats have been calling to abolish U.S. Immigration and Customs Enforcement, but it’s not a widely held position. Other Democrats say the agency should be reformed, not abolished. In any case, ICE is only one of several agencies tasked with immigration enforcement.
“Democrats will seek to slash budgets for seniors’ Medicare, Social Security and defense.”
Trump may have a point about defense spending, never a favorite among the left, but the president’s $1 trillion deficits will put pressure on all aspects of government, no matter who is in power. Democrats generally have pushed to expand Social Security benefits, not cut them.
“Republicans believe that a Medicare program that was created for seniors and paid for by seniors their entire lives should always be protected and preserved.”
As a technical matter, current retirees receive far more in benefits than they have paid into the system, according to the Urban Institute; younger workers are going to have subsidize the baby-boomers moving into retirement.
Meanwhile, for years, House Republicans led by Speaker Paul D. Ryan (R-Wis.) have pushed for a significant overhaul of Medicare. Retirees would get from the government what Ryan called “premium support” — a set payment adjusted to inflation; they would have used that money to pick from a range of plans offered by insurance companies through what is termed a Medicare exchange. But the Congressional Budget Office raised significant questions about whether the premium payment would be adequate over time.
The CBO analysis estimated that by 2030, the government would pay just 32 percent of the health care costs, less than half of what the federal plan currently pays. The other 68 percent of the plan would have to be shouldered by the retiree.
Ironically, Democrats successfully attacked the plan as ending “Medicare as we know it.”
Quote of the Day Comment by Don McCanne - October 11, 2018
The good news about this op-ed by President Donald Trump is that the Medicare for All concept has gained so much public support that the president feels that he must attack it in his own inimitable style, that is by being untruthful about it in an effort to reduce the political traction that it has been gaining. Although his misstatements and falsehoods are so obvious that we should not have to refute them, nevertheless it is very difficult to remain silent over his outrageous claims. Can't help but be compelled to respond to at least a few of them.
"a new legislative proposal that would end Medicare as we know it and take away benefits that seniors have paid for their entire lives"
Improving Medicare and expanding it to cover everyone does not end Medicare and it does not take away benefits from seniors. It expands benefits for seniors, and everyone else.
"Dishonestly called 'Medicare for All'"
It might be dishonest to merely add a public option to our fragmented, dysfunctional health care financing system and call that "Medicare for All," but that is not what the president is talking about. When the proposal would expand Medicare to cover everyone, just what is dishonest about calling that Medicare for All?
"I promised that we would protect coverage for patients with pre-existing conditions"
The Trump administration is supporting the lawsuit by Republican state attorneys general that asks for repeal of the entire Affordable Care Act which would repeal the requirement that insurers cover pre-existing conditions. How is that keeping his promise?
"I promised that we would... create new health care insurance options that would lower premiums"
The new products, such as association health plans, have lower premiums only because they do not provide adequate coverage. People who believed they were insured will be very disappointed when they find they will have to file for medical bankruptcy anyway, in spite of their insurance.
"we are now seeing health insurance premiums coming down"
Trump's effort to sabotage the Affordable Care Act by cancelling subsidies caused insurers to sharply increase their premiums. When the subsidies were reestablished, some of the insurers were able to reduce their premiums. There was no Trump magic that brought the premiums back down.
"I also made a solemn promise to our great seniors to protect Medicare"
The Republicans have repeatedly expressed their desire to implement premium support which is a scheme to privatize Medicare. Giving priority to private investors over patients is not protecting Medicare.
"That is why I am fighting so hard against the Democrats' plan that would eviscerate Medicare"
Expanding Medicare benefits can hardly be called an evisceration.
"Democrats would gut Medicare with their planned government takeover of American health care."
Under Medicare for All, health care delivery remains as it is now - mostly in the private sector - and health care decisions are made by patients in consultation with their health care professionals. That is not a government takeover of health care.
"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"
Seniors absolutely would be able to depend on the benefits they were promised, and even more.
"the Democratic plan would inevitably lead to the massive rationing of health care"
With the amount we are spending on health care, we have more than enough funds to ensure adequate capacity in the system.
"Seniors would lose access to their favorite doctors"
Private insurers limit patient access to provider networks, whereas patients would have free choice of their health care professionals under Medicare for All.
"There would be long wait lines for appointments and procedures"
Several nations have shown that resource planning and queue management can prevent excessive queues in the system.
"Previously covered care would effectively be denied"
Who is going to deny care? Donald Trump?
"the Democratic Party’s so-called Medicare for All would really be Medicare for None"
What an outrageous statement.
"The Democrats' plan also would mean the end of choice for seniors over their own health care decisions"
What a lie! (There, I said it.)
"Democrats would give total power and control over seniors’ health care decisions to the bureaucrats in Washington, D.C."
As mentioned before, health care decisions are the patients' own, made in consultation with their health care professionals.
"eliminate Medicare Advantage plans for about 20 million seniors as well as eliminate other private health plans that seniors currently use to supplement their Medicare coverage"
Medicare Advantage and Medigap plans waste funds through their administrative excesses. It would be of greater value to roll any extra benefits of those plans into an improved version of the more efficient traditional Medicare program.
"the Democrats would eliminate every American’s private and employer-based health plan."
Finally! Thank goodness.
"I am committed to resolutely defending Medicare and Social Security from the radical socialist plans of the Democrats."
What? Defending the social insurance programs of Medicare and Social Security from the people who created and support them? Besides, now that the Republicans have cut taxes for the rich they say that we need to cut our entitlement spending - Social Security and Medicare.
Lies and distortions. And when they are repeated at Trump's perpetual rallies, his forever loyal followers passionately cheer him on with total disregard for absence of a factual basis for his pronouncements. As a child, I remember newsreels of what seemed to me to be similar rallies held in a land far, far away. That did not turn out well. I have often wondered what caused the crowds to show such support. I still do.
Fact Check: Trump Is Dead Wrong on Medicare-for-All
by Robert Weissman - Common Dreams - October 10, 2018
Note: Today, USA Today published an op-ed by President Donald Trump that included several falsehoods about single-payer health care.
Lies and deceptions from Trump are nothing new. Lies and deceptions from Trump about Medicare-for All are new, so it’s worth correcting his USA Today column attacking such a system.
One reason his attacks on Medicare-for-All are new is that he probably has supported it in the past. But whatever, there’s no reason to think Trump particularly believed what he said then, or what he says now. On to the major lies and deceits:
One reason his attacks on Medicare-for-All are new is that he probably has supported it in the past. But whatever, there’s no reason to think Trump particularly believed what he said then, or what he says now. On to the major lies and deceits:
- Medicare-for-All would not “end Medicare as we know it and take away benefits that seniors have paid for all their lives.” The reason it’s called Medicare-for-All is because it would take the existing program and expand it to everyone. Seniors’ benefits would not be taken away – in fact, they would be improved, but everyone else would gain the benefits of Medicare, too.
- Medicare-for-All is not going to cost an “astonishing $32.6 trillion” over 10 years, because it will introduce major savings not adequately accounted for in the study Trump cites. Significant savings would come from eliminating vast amounts of paperwork and bureaucracy imposed by the current dysfunctional system, and steeply dropping costs for brand-name pharmaceuticals. But even if Medicare-for-All cost as much as Trump alleges, that amount would be LESS than projections for our current system, which also leaves tens of millions of Americans without coverage.
- Trump's claim to have kept his pledge to maintain coverage for people with pre-existing conditions and create new health insurance options is completely deceptive. First, the protections for pre-existing conditions remain in place only because Trump failed to repeal the Affordable Care Act (ACA.) Meanwhile, a Republican-led lawsuit is challenging the ACA, including guarantee for pre-existing conditions, and there’s a real worry that, especially with Brett Kavanaugh now on the Supreme Court, it might succeed. As for new junk health insurance options Trump has authorized, they offer only the illusion of care, because they permit insurers to skirt the requirement to cover pre-existing conditions.
- Medicare-for-All would not “lead to the massive rationing of health care.” It is the current system that rations care, based on the ability to pay. One-third of Americans say they had a problem accessing medical care because of cost in the last year. With Medicare-for-All, everyone will be able to see a doctor or access treatment, irrespective of how much money they have.
Why is support for Medicare-for-All skyrocketing? First, because Americans know from their own experience that the current system is a total mess. Health care is unaffordable, copays are a killer and doctors make you wait and don’t have time for you. The data backs up people’s impressions: We pay far more than other countries for health care, and we get far less – among rich countries, we alone
have massive coverage gaps, and our health care outcomes are by far inferior.
Medicare-for-All would take the best performing part of our health care system – Medicare – improve it, and then extend it to all Americans. That system alone will ensure coverage for all Americans, and, by wiping out the massive inefficiencies of the current corporate-dominated system, it will enable us to expand coverage and improve quality for no additional cost.
Medicare-for-All would take the best performing part of our health care system – Medicare – improve it, and then extend it to all Americans. That system alone will ensure coverage for all Americans, and, by wiping out the massive inefficiencies of the current corporate-dominated system, it will enable us to expand coverage and improve quality for no additional cost.
Mr. Trump, If You Love Medicare, Improve It and Expand It to All
by Dr. Carol Paris - Common Dreams - October 11, 2018
Well, now I’ve heard everything: Donald Trump wants to keep “the government” away from Medicare and protect seniors from attempts to improve it.
Huh?
Mr. President, take it from me—a newly-minted senior citizen and a doctor—you need to sit down and read the bill that single-payer supporters consider the gold standard for universal coverage: H.R. 676, the Expanded and Improved Medicare for All Act. Don’t worry, it’s a much easier read than the average commercial health insurance policy.
Here’s the deal: H.R. 676 would vastly upgrade Medicare for seniors by covering all medically necessary care, including dental, vision, hearing, mental health, and long-term care—none of which are currently covered. We learned very early on in medical school that, yes, the eyes, ears, mouth, and brain are all part of the human body and all those parts need care.
H.R. 676 would also provide tremendous financial relief for seniors by eliminating Part B and D premiums and doing away with all copays and deductibles. Doctors know copays and deductibles only discourage patients from seeking care, and nobody should have to choose between buying groceries and paying for doctor visits.
Today, Medicare beneficiaries’ average out-of-pocket health care spending was 41 percent of average Social Security income and 36 percent of those in traditional Medicare spent at least 20 percent of their income on out-of-pocket health care costs in 2013. H.R. 676 would provide the financial freedom that many seniors (and everyone else for that matter) need and deserve.
The seniors I talk to aren’t fooled by restrictive Medicare Advantage plans, either. They just want one, simple plan that gives them full choice of hospitals and doctors. Commercially administered Medicare Advantage plans don’t offer a full range of choices. Why? Because it would cut into their obscene, taxpayer-funded profits.
The argument that expanding Medicare’s coverage to younger Americans will somehow hurt seniors is preposterous. Mr. Trump, I know that you’re old enough to remember when Medicare was first signed into law in 1964. When 19 million seniors enrolled in Medicare in the first year, there was no significant increase in the total number of doctor visits in the U.S., no evidence of reduced clinical capacity, no waiting lists, and no “rationing” of care.
The same happy story repeated itself when we provided coverage to millions of children through the Children’s Health Insurance Program (CHIP) and low-income adults through Medicaid.
Our public health programs—especially Medicare—are an American success story, and an ideal foundation for a system that ensures high-quality care for everyone. The reason for that success is Medicare’s remarkable administrative efficiency: Traditional Medicare’s overhead is just over 3 percent, compared to private plans, including Medicare Advantage plans, whose overhead averages 30 percent.
Can the U.S. afford to expand Medicare to all? The real question is, can we afford not to? Moving to a streamlined, national single-payer program like H.R. 676 would save an estimated $617 billion annually by slashing the administrative waste of private health insurance and the paperwork imposed on hospitals and doctors ($504 billion), and by bargaining down drug prices ($113 billion). That would free up enough money for universal coverage without any net increase in U.S. health spending.
You try to frighten us with a $32 trillion price tag but fail to mention that if we maintain the status quo, we are on target to spend $50 trillion on health care over the next 10 years.
This desperate fear-mongering about Medicare for all is no surprise, given the surge in support for the idea, which is now favored by a majority of Americans (including a majority of Republicans!) and a majority of doctors like me.
If you love Medicare, fight to make it better and expand it to every one of your constituents.
Trump Lies About 'Medicare for All' and He's Made Health Care Worse
Medicare for All is popular because it would save people money and assure them the health care they need. Trump's only defense is to lie about my bill
by Bernie Sanders - Common Dreams - October 11, 2018
The American people have a very clear choice in the upcoming elections. On one side is Donald Trump and the Republican leadership in Congress, who made throwing 32 million Americans off of health insurance their number one priority in Washington. On the other side is my "Medicare for All" plan supported by 16 senators and 122 House members. It would guarantee everyone could get the health care they need without going into debt at far lower cost than the current dysfunctional system.
And Americans are very clear about which side they are on. In a poll last summer, 70 percent said they support expanding and improving Medicare to cover everyone in our country. They understand that there is something profoundly wrong when our current dysfunctional health care system is designed not to provide quality care to all, but to enable the private health insurance industry and drug companies to make billions in profits.
Despite spending almost twice as much per capita as any other country, 30 million Americans have no health insurance and many more are underinsured with high deductibles and co-payments. Further, the pharmaceutical industry charges us, by far, the highest prices in the world for prescription drugs. It is insane that today it costs an average of $28,000 a year to provide health insurance to a family of four. It is equally insane that one out of five Americans cannot afford the prescription drugs their doctors prescribe.
Donald Trump has only made health care worse.
Medicare is the most popular, successful and cost-effective health insurance program in the country. Today, only people 65 and older are eligible for it. Americans shouldn’t have to wait that long to get the high-quality health care they need and deserve.
As president, Trump has made our health care system worse. While we were able to defeat his budget which proposed a $1 trillion cut to Medicaid, a $500 billion cut to Medicare and a $72 billion cut to the Social Security disability fund, we were unable to stop other very harmful measures.
As a result of his efforts to sabotage the Affordable Care Act, 13 million more Americans will become uninsured over the next decade while millions more have seen their premiums rise. Further, his administration is working alongside 20 Republican state attorneys general to end the protection that the Affordable Care Act now guarantees to people with pre-existing conditions, such as cancer, heart disease and diabetes. No one can estimate how many thousands of those people will die if they can no longer purchase affordable insurance.
Medicare is the most popular, successful and cost-effective health insurance program in the country. Today, only people 65 and older are eligible for it. Americans shouldn’t have to wait that long to get the high-quality health care they need and deserve.
As president, Trump has made our health care system worse. While we were able to defeat his budget which proposed a $1 trillion cut to Medicaid, a $500 billion cut to Medicare and a $72 billion cut to the Social Security disability fund, we were unable to stop other very harmful measures.
As a result of his efforts to sabotage the Affordable Care Act, 13 million more Americans will become uninsured over the next decade while millions more have seen their premiums rise. Further, his administration is working alongside 20 Republican state attorneys general to end the protection that the Affordable Care Act now guarantees to people with pre-existing conditions, such as cancer, heart disease and diabetes. No one can estimate how many thousands of those people will die if they can no longer purchase affordable insurance.
We have a different idea: Expand Medicare to all. My bill would provide comprehensive and cost-effective health care for everyone — without out-of-pocket expenses.
Study after study shows that when we eliminate private insurance premiums, deductibles and co-payments, the average American will pay substantially less for health care than he or she currently pays. For example, a recent study by RAND found that moving to a Medicare for All system in New York would save a family with an income of $185,000 or less about $3,000 per person a year, on average. Even the projections from the conservative Mercatus Center suggest that the average American could save about $6,000 under Medicare for All over a 10-year period.
Medicare for All not only benefits individuals and families, it would also benefit the business community. Small and medium sized businesses would be free to focus on their core business goals instead of wasting precious energy and resources navigating an incredibly complex system to provide employee health insurance. Equally important, with universal health care, workers would not have to stay at jobs they dislike just because their employer provides decent health insurance.
Medicare for All is better for seniors
Given the president’s propensity to lie about almost everything, it is not surprising that Trump is grossly distorting what the Medicare for All legislation does.
Our proposal would not cut benefits for seniors on Medicare, as the president and his Republican allies claim. In fact, we expand benefits. Millions of seniors today cannot afford dental care, vision care or hearing aids because Medicare does not cover them. Our proposal does. In addition, Medicare for All would eliminatedeductibles and copays for seniors and significantly lower the cost of prescription drugs. Medicare for All allows seniors and all Americans to see the doctors they want, not the doctors in their insurance networks.
Trump claims that Medicare for All is not affordable. That is nonsense. What we cannot afford is to continue spending almost twice as much per capita on health care as any other country on Earth. We can’t afford the $28,000 it currently costs to provide health insurance for the average family of four. We can’t afford to have 30 million Americans with no health insurance and even more who are under-insured with high deductibles and high co-payments. We can’t afford to have millions of Americans get sicker than they should, and in some cases die, because they can’t afford to go to the doctor.
Here is the bottom line: If every major country on earth can guarantee health care to all and achieve better health outcomes, while spending substantially less per capita than we do, it is absurd for anyone to suggest that the United States of America cannot do the same.
Goodbye, Political Spin, Hello Blatant Lies
by Paul Krugman - NYT - October 11, 2018
Do you remember political spin? Politicians used to deceive voters by describing their policies in misleading ways. For example, the Bush administration was prone to things like claiming that tax breaks for the wealthy were really all about helping seniors — because extremely rich Americans tend to be quite old.
But Republicans no longer bother with deceptive presentations of facts. Instead, they just flat-out lie.
What do they lie about? Lots of things, from crowd sizes to immigrant crime, from steel plants to the Supreme Court. But right now the most intense, coordinated effort at deception involves health care — an issue where Republicans are lying nonstop about both their own position and that of Democrats.
The true Republican position on health care has been clear and consistent for decades: The party hates, just hates, the idea of government action to make essential health care available to all citizens, regardless of income or medical history.
This hatred very much includes hatred of Medicare. Way back in 1961, Ronald Reagan warned that enacting Medicare would destroy American freedom. Maybe it’s just me, but I don’t think that happened. Newt Gingrich shut down the government in an attempt to force Bill Clinton to slash Medicare funding. Paul Ryan proposed ending Medicare as we know it and replacing it with inadequate vouchers to be applied to the purchase of private insurance.
And the hatred obviously extends to the Affordable Care Act. Republicans don’t just hate the subsidies that help people buy insurance; they also hate the regulations that prevent insurers from discriminating against people with pre-existing conditions. Indeed, 20 Republican state attorneys general filed a lawsuit trying to eliminate protection for pre-existing conditions, and the Trump administration has declined to oppose the suit, in effect endorsing it.
So if you’re a voter who cares about health care, it shouldn’t be hard to figure out where the parties stand. If you believe that Medicare is a bad thing and the government shouldn’t protect people with pre-existing conditions, vote Republican. If you want to defend Medicare and ensure coverage even for those who have health problems, vote Democrat.
But Republicans have a problem here: The policies they hate, and Democrats love, are extremely popular. Medicare has overwhelming support. So does protection for pre-existing conditions, which is even supported by a large majority of Republicans.
Now, you might imagine that Republicans would respond to the manifest unpopularity of their health care position by, you know, actually changing their position. But that would be hopelessly old-fashioned. As I said, what they’ve chosen to do instead is lie, insisting that black is white and up is down.
Thus Josh Hawley, as Missouri’s attorney general, is part of that lawsuit against Obamacare’s regulation of insurers; but in his campaign for the Senate, he’s posing as a defender of Americans with pre-existing conditions. Dean Heller, running for re-election to the Senate in Nevada, voted for a bill that would have destroyed Obamacare, including all protection for pre-existing conditions; but he’s misrepresenting himself just like Hawley is.
And they aren’t just lying about their own position. They’re also lying about their opponents’. Incredibly, Republicans have spent the years since passage of the A.C.A. accusing Democrats of wanting to destroy Medicare.
All of which brings me to a remarkable op-ed article on health care in USA Today, which was published under Donald Trump’s name this week. (If he actually wrote it, I’ll eat my hairpiece — although, to be fair, it was rambling and incoherent, suggesting he may have played some role in its composition.)
Part of the article claimed that the Trump administration is defending health insurance for Americans with pre-existing conditions, when the reality is that it has tried to destroy that coverage. But mostly it was an attack on proposals for “Medicare for all,” a slogan that refers to a variety of proposals, from universal single-payer to some form of public option.
And what did “Trump” say Democrats would do? Why, that they would “eviscerate” the current Medicare program. Oh, and that they would turn America into Venezuela. Because that’s what has happened to countries that really do have single-payer, like Canada and Denmark.
Why do Republicans think they can get away with such blatant lies? Partly it’s because they expect their Fox-watching followers to believe anything they’re told.
But it’s also because they can still count on enablers in the mainstream news media. After all, why did USA Today approve this piece? Letting Trump express his opinion is one thing; giving him a platform for blatant lies is another. And as fact-checker Glenn Kessler of The Washington Post put it, “Almost every sentence contained a misleading statement or a falsehood.” Even the president of the United States isn’t entitled to his own facts.
So will the G.O.P.’s Big Lie on health care work? We’ll find out in a few weeks.
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