During the campaign, Donald Trump
often promised to be a different kind of Republican, one who would
represent the interests of working-class voters who depend on major
government programs. “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid,” he declared, under the headline “Why Donald Trump Won’t Touch Your Entitlements.”
It was, of course, a lie. The transition team’s point man on Social Security is a longtime advocate of privatization, and all indications are that the incoming administration is getting ready to kill Medicare,
replacing it with vouchers that can be applied to the purchase of
private insurance. Oh, and it’s also likely to raise the age of Medicare
eligibility.
So it’s important not to let this bait-and-switch happen before the public realizes what’s going on.
Three points in particular need to be made as loudly as possible.
First, the attack on Medicare will be one of the most blatant violations of a campaign promise in history.
Some
readers may recall George W. Bush’s attempt to privatize Social
Security, in which he claimed a “mandate” from voters despite having run
a campaign entirely focused on other issues. That was bad, but this is
much worse — and not just because Mr. Trump lost the popular vote by a
significant margin, making any claim of a mandate bizarre.
Candidate
Trump ran on exactly the opposite position from the one President-elect
Trump seems to be embracing, claiming to be an economic populist
defending the (white) working class. Now he’s going to destroy a program
that is crucial to that class?
Which
brings me to the second point: While Medicare is an essential program
for a great majority of Americans, it’s especially important for the
white working-class voters who supported Mr. Trump most strongly. Partly
that’s because Medicare beneficiaries are considerably whiter than the
country as a whole, precisely because they’re older and reflect the
demography of an earlier era.
Beyond
that, think of what would happen if Medicare didn’t exist. Some older
Americans would probably be able to retain health coverage by staying at
jobs that come with such coverage. But this option would by and large
be available only to those with extensive education: Labor force participation
among seniors is strongly correlated with education, in part because
the highly educated are healthier than the less educated, and in part
because their jobs require less physical effort.
Working-class seniors
would be left stranded, unable to get the health care they needed.
Still,
doesn’t something have to be done about Medicare? No — which is my
third point. People like Paul Ryan, the speaker of the House, have often
managed to bamboozle the media into believing that their efforts to
dismantle Medicare and other programs are driven by valid economic
concerns. They aren’t.
It has been obvious for a long time that Medicare is actually more efficient
than private insurance, mainly because it doesn’t spend large sums on
overhead and marketing, and, of course, it needn’t make room for
profits.
What’s
not widely known is that the cost-saving measures included in the
Affordable Care Act, a.k.a. Obamacare, have been remarkably successful
in their efforts to “bend the curve” — to rein in the long-term rise
in Medicare expenses. In fact, since 2010 Medicare outlays per
beneficiary have risen only 1.4 percent a year, less than the inflation
rate. This success is one main reason long-term budget projections have dramatically improved.
So
why try to destroy this successful program, which is in important
respects doing better than ever? The main answer, from the point of view
of people like Mr. Ryan, is probably that Medicare is in the cross
hairs precisely because of its success: It would be very helpful for
opponents of government to do away with a program that clearly
demonstrates the power of government to improve people’s lives.
And
there’s an additional benefit to the right from Medicare privatization:
It would create a lot of opportunities for private profits, earned by
diverting dollars that could have been used to provide health care.
In
summary, then, privatizing Medicare would betray a central promise of
the Trump campaign, would specifically betray the interests of the voter
bloc that thought it had found a champion, and would be terrible
policy.
You
might think this would make the whole idea a non-starter. And this push
will, in fact, fail — just like Social Security privatization in 2005 —
if voters realize what’s happening.
What’s
crucial now is to make sure that voters do, in fact, realize what’s
going on. And this isn’t just a job for politicians. It’s also a chance
for the news media, which failed so badly during the campaign, to start
doing its job.
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