Donald Trump’s choice of GOP Rep. Tom Price as secretary of health and human services is being widely interpreted as a sign that he is likely to proceed with plans to repeal the Affordable Care Act and convert Medicare into a “premium support” scheme along the lines that Paul Ryan has long championed.
Trump did repeatedly promise to repeal Obamacare. But Medicare is a different matter. Trump promised countless times not to cut Medicare and repeatedly suggested he would leave the program as it is. The Post’s crack video team put together this video at my request:
Note that Trump repeatedly went well out of his way to contrast his own approach with that of the GOP writ large. “Many of these candidates want to cut it,” Trump said of his fellow GOP primary candidates in June of 2015. “Every Republican wants to do a big number” on Medicare, Trump said in April of 2015. All this was an obvious attempt to distinguish himself ideologically from the overall Republican approach to entitlements, which is to say, from Ryanism.
Trump also told audiences that had many younger people in them that he would not cut their Medicare. It’s reasonable to see these quotes as an effort to distinguish himself from Republicans such as Ryan who pledge not to cut the Medicare of current beneficiaries or people who are on the cusp of transitioning into the program.
Indeed, Trump also repeatedly suggested an intention to leave the program in its current form. “Medicare does work,” Trump said in December of 2015. On multiple occasions Trump said that the secret to “saving” Medicare is to bring back jobs and make the United States rich again — meaning that the way to ensure its long term solvency is not to transform the program in some fundamental way, but rather to boost the economy, causing tax revenue to rain down upon us.
As recently as early November, Trump accused Hillary Clinton of wanting to “cut” and “destroy” Medicare. He contrasted that with his own alleged plan to “protect” it.
But Thursday, Ryan confirmed at his weekly news conference that Medicare “reform” is once again on the table. “We are going to have to do things to preserve and shore up this program,” Ryan said, explicitly citing the reforms that House Republicans have been talking about “for many years.” As always, he predicted fiscal doom for the program if his reforms are not implemented: “it won’t be there for us if we stay on the current path.”
But critics have pointed out that Ryan’s proposed changes would fundamentally alter the program’s core mission by ending the Medicare “guarantee,” and would, in fact, “cut” people’s benefits. They argue that Ryan’s “premium support” plan would result in higher costs for seniors over time, as their fixed payment from the government falls behind rising health care costs. They also argue that Republicans overstate Medicare’s fiscal woes, which can be addressed without ending the guarantee or benefits cuts that harm lower-income beneficiaries.
We don’t know whether Trump will go along with this plan. Ryan insisted Thursday that the two men had not discussed the issue. But Trump’s selection of Price to lead HHS seems like a key tell. As The Post recently put it:
Price supports major changes to Medicaid and Medicare, health insurance pillars of the Great Society programs of the 1960s. Under his vision, both programs would cease to be entitlements that require them to provide coverage to every person who qualifies. . . .
For Medicare, Price favors another idea long pushed by conservatives, switching it from a “defined benefit” to a “defined contribution.” With that, the government would give older or disabled Americans financial help for them to buy private insurance policies.
If Trump does go along with congressional Republicans on this, everyone who covered this race will know full well that he will be flagrantly breaking a campaign promise — indeed, he’ll be breaking a core tenet of Trumpism, as many reporters and commentators defined it. Observers widely cited Trump’s declared refusal to touch entitlements as evidence that he is ideologically different from Republicans such as Ryan.
Trump himself repeatedly drew that distinction, as the video above shows. But if Trump does acquiesce to their designs, as seems very possible, it’ll show that in reality, he’s perfectly content to let them have their way when it comes to the big ideological questions about the future of social insurance in America.