President Trump wrote a remarkable op-ed in USA Today on Wednesday, remarkable because one wouldn’t think it possible to pack so much dishonesty into such a small space, nor would one think a newspaper would willingly publish such a steaming pile of lies. As fact-checker Glenn Kessler wrote, “almost every sentence contained a misleading statement or a falsehood.”
But I’ll leave the fact-checking (mostly) to others on this score. What interests me for the moment is what Trump says about Medicare.
As Democrats have increasingly advocated for some kind of universal, government-guaranteed health insurance program (though there are multiple plans floating around with different features), Republicans have struggled to settle on the most effective rhetorical counter to the idea. “Big government takeover!” has gotten a little old. “Bureaucrats making decisions for you instead of your doctor!” rings false to anyone who has had to deal with the nightmare of insurance company bureaucracy. “It’ll cost trillions!” is less persuasive when they’re running up trillions in debt themselves for things like corporate tax cuts.
So what’s the alternative? Here are some selections from Trump’s op-ed:
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 … Democrats would gut Medicare with their planned government takeover of American 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. By eliminating Medicare as a program for seniors … Seniors would lose access to their favorite doctors … In practice, the Democratic Party’s so-called Medicare for All would really be Medicare for None. Under the Democrats’ plan, today’s Medicare would be forced to die.
Trump and the Republicans will defend Medicare from Democrats! If you believe that, you’ll hire an arsonist to protect your house from the fire department.
The strangeness of this argument highlights a fundamental problem Republicans can’t get away from: They hate Medicare, but the American public loves Medicare.
They hate it for two basic reasons. The first is ideological: It is indeed a big-government program and therefore an affront to their free-market beliefs. They have been horrified by the idea of the government providing health coverage ever since a future president and conservative icon tried to prevent the program from being enacted with the hit 1961 spoken-word album “Ronald Reagan Speaks Out Against Socialized Medicine.”
The second reason Republicans hate Medicare exists at the intersection of policy and politics. Because Medicare works extremely well and provides a valued benefit to tens of millions of politically potent citizens, it is impossible for them to unwind it as they would like to do. So every election, Democrats accuse them of wanting to destroy the program, which requires them to pretend that they actually love it and want to defend it.
There is a long history of Republicans enacting that charade, so it isn’t much of a surprise that they have just grafted the old argument on to a new health care debate. But it fits particularly awkwardly here.
Perhaps never before has the GOP had less credibility on health care than it does now, when it just failed to repeal the Affordable Care Act and is suing to eliminate the ACA’s protection for people with preexisting conditions. And while there is a certain get-off-my-lawn appeal to the argument that if we let the non-elderly have Medicare, then Medicare will be undermined, to buy it, you have to believe that the person making the argument doesn’t actually want Medicare to be undermined. There is only so far you can go insisting one moment that you despise government health insurance and claiming the next moment that you’ll protect seniors’ beloved government health insurance.
For the moment, though, almost every Republican seems on board with this strategy. Yes, there is an occasional note of dissent on the right. For instance, Philip Klein argues that “By perpetuating the idea that Medicare is a great program that needs to be protected at all costs (rather than an unsustainable entitlement) it only makes it easier for liberals to make the case for socialized medicine.”
But as a policy wonk, Klein has the luxury of thinking about the long term. Politicians, on the other hand, tend to be more concerned about what will work right now.
Klein is right that Republicans sowed the seeds for Medicare-for-all, but not just by praising Medicare. They also did it by attacking everything Democrats proposed on health care, even market-based reforms such as the ACA, as horrifying big-government socialism. Eventually, Democrats realized that if Republicans were going to call even something modeled on Mitt Romney’s plan “socialism,” they might as well not bother trimming their sails and just advocate something actually socialistic. And here we are.
If and when Democrats control both the presidency and Congress — perhaps in 2021 — we’ll have a real, sustained debate about Medicare-for-all or some version thereof. It would be foolish to imagine that we can predict exactly how that debate will go. It is entirely possible that “Giving more people Medicare will destroy Medicare!” will effectively mobilize seniors against universal coverage. It is also possible that the contradictions in their arguments will make Republicans unable to resist the appetite for a government guarantee of security that they helped reinforce.
One thing we can predict with some certainty, however, is that what they’ll say then will be just as dishonest as what they’re saying now.