The Washington PostDemocracy Dies in Darkness

Giving everyone health care doesn’t make you a communist

Vladimir Lenin addresses supporters celebrating the first anniversary of the Bolshevik Revolution in October 1918. (TASS/AFP/Getty Images) (-/AFP/Getty Images)

One thing President Trump hasn’t changed about the GOP: Republicans still say any increase in government redistribution would be tantamount to communism.

That was the case in the 1930s when Republican leaders lambasted the New Deal as Bolshevism-lite. It was in the 1960s when Ronald Reagan warned that Medicare would lead to a socialist dystopia. And it is today when the Trump administration tries to scare voters about the supposed dangers of Medicare-for-all. The only difference is they’re now willing to be more offensive about how they put it.

What else can you say about a White House report that actually compares the rhetoric of Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) rhetoric about corporate abuses to what totalitarian dictators such as Vladimir Lenin and Mao Zedong used to say about their victims? (The only bit of nuance the report adds is that while “historical socialists such as Lenin, Mao, and [Cuba’s Fidel] Castro ran their countries without democracy or human rights,” it is true that “modern democratic socialists are different in these important ways”).

It’s insulting to everyone: to Sanders and Warren for being lumped in with some of history’s biggest butchers, to the victims of communism for having the crimes against them be so trivialized, and to the rest of us for being treated like we would fall for something so absurd. It’s not an attempt to convince anyone who doesn’t already agree with them but rather to troll everyone who doesn’t.

What makes it worse, though, is that it isn’t Republican politicians who are saying this. It’s Republican economists. Specifically, Trump’s Council of Economic Advisers, which is supposed to be a technocratic body that provides the president with the unbiased analysis he needs to make smart policy, not generate inflammatory talking points for him. But apparently they’re branching out now with their report on the failures of communism.

What does any of this have to do with whether we should expand Medicare, though? Well, at least according to the Council of Economic Advisers, the answer is that “although agriculture is not a large share of the U.S. economy, present-day socialists echo the historical socialists by arguing that healthcare, education, and other sectors are unfair and unproductive," so “it is worth acknowledging that socialist takeovers of agriculture have delivered the opposite of what was promised.” In other words, we can’t give everyone health care because Joseph Stalin and Mao starved people.

This isn’t exactly the strongest of arguments. Especially not when the rest of their report acknowledges that studies show Medicare has lower administrative costs than private insurance does in the United States, and that at least by one key measure it does a better job at covering older people than private insurance does overseas. Indeed, American seniors are less likely to have to wait a month to see a specialist than seniors anywhere else in the developed world. The fact that Medicare already works well, then, seems slightly more relevant than Stalin’s attempt to “liquidate” the kulaks — one time he didn’t bother resorting to euphemism — when we’re trying to figure out how feasible a Medicare-for-all system would be.

The White House has two responses to this, one fair and the other not. The fair point is that administration officials don’t think this tells us too much, since the specific Democratic bill they were responding to would cover everyone under a system that would be so much more generous than Medicare that wait times would probably be a lot longer.

Much less convincing, though, is that they also try not to give the government too much credit for Medicare’s successes. “Medicare isn’t socialized medicine” or even “a single-payer system,” a spokesman for the Council of Economic Advisers told me, because patients have to pay for some of their own costs and can choose to enroll in privately run Medicare Advantage plans.

The first part of that is true, but the second isn’t. Think of it as the No True Single-Payer fallacy: If a public system has any private elements in it, they say it isn’t really a public system at all. Which, of course, is ridiculous. Medicare uses tax dollars to pay for a lot — but not all — of older people’s health-care costs. Those exceptions, though, don’t change the fact it’s by and large a single-payer system. If it did, Reagan probably wouldn’t have said it was the literal road to serfdom, like he did in the 1960s.

This isn’t the debate the Trump White House wants to have. After all, once you admit that the government can do a good job covering some people, the question becomes whether it could do the same for everyone else. And, at that point, it’s less a philosophical discussion about whether the government should do this and more of a practical one about how it should — in particular, how we should pay for it, how much it should cover and how much the government should use its bargaining power to try to restrain runaway health-care costs. (Even Singapore, home to many conservatives' favorite health-care system in the world, does some of this).

Now, like everything else, all of these things have costs and benefits, but the Trump administration tries to skip over that calculus by talking only about the costs — and in the most hyperbolic terms possible, invoking the ghost of the gulag to argue against more redistribution. But that doesn’t change the fact that there are plenty of countries that have figured out how to do this without ending up in an Orwell novel.

When it comes to our seniors, we’re one of them.