The Washington PostDemocracy Dies in Darkness

The Health 202: GOP argument against 'Medicare for All' doesn't make sense


with Paulina Firozi


Late last week, Florida Gov. Rick Scott became the latest GOP politician to test out his party's new attack line.

"If you want to protect Medicare, vote Republican. If you want a socialist experiment with Medicare, by all means vote Democrat," he tweeted.

It's a line borrowed straight from President Trump's campaign-style rallies. “They want to raid Medicare to pay for socialism,” the president bellowed at an event in Indiana last month. "They're going to ruin your Medicare. Watch. They want to turn America into Venezuela. I don't think so," Trump told a crowd of supporters Friday in Montana. 

The GOP implication -- although the messaging is convoluted and not directly stated -- is designed, as many highly effective health-care attacks have been in campaigns past, to scare seniors: if more people are allowed to partake of Medicare benefits, current ones will suffer.

After nearly a decade of cornering the health-care messaging market, Republicans have largely ceded the issue to Democrats this election cycle. But the GOP sees an opening to seize back a little ground by going after Democrats who are pushing a more ambitious agenda, specifically the creation of a national "Medicare for All" health system.

Health-policy experts say there's a problem with the Republican argument: Medicare as it exists today -- a government-run service for all elderly Americans -- is the closest thing America has to socialized medicine. And there's nothing in Democratic proposals that indicate that expanding it would make the program less available for current recipients.

"I fail to see the logic in the argument," said David Lipschutz, senior policy attorney at the Center for Medicare Advocacy. "To me it is dripping in irony that when the Medicare program was being debated opponents accused it of being socialist medicine."

"Socialism was used as a boogie man to scare people away from the Medicare program, but now it’s so beloved people are trying to use it as a way to stop people from expanding health insurance," he said. 

Even as recently as the presidential election two years ago, most mainstream Democrats would have shied away from embracing "Medicare for All" for fear of this type of attack. But Democrats feel emboldened by an electorate that seems to want bold ideas and is, according to public polling, worried about access to affordable health coverage. 

Last week, progressive Democrats were elated when President Obama noted in a political speech that "Medicare for All" was one of the "good new ideas" that Democrats are running on:

What "Medicare for All" would do, in its most progressive of iterations, is create a universal health-care system using the Medicare model. Other proposals include making Medicare a public option in which people could choose to buy their insurance through the government rather than privately. In the version conceived by Sen. Bernie Sanders (I-Vt.), the current Medicare system would be subsumed by this new one.

There is a more legitimate counter-argument Republicans could make about the proposal, which Democratic candidates are increasingly championing, regarding the cost of such an undertaking: estimates show Sanders's plan would increase federal spending by $32 trillion over ten years, but lower national health spending by $2 trillion.

Paul Van de Water, an expert in Medicare policy at the Center on Budget and Policy Priorities, said there are serious unanswered questions around how such a program would work, most critically about how it would be funded. But calling it "socialism," he told me, "is a fairly incoherent comment."

"It’s going to be hard to have a thoughtful debate about this topic," he said. "There are very important issues that have not been specified, like how much people are willing to pay in new taxes. Supporters say it will be a major increase in federal spending, but a decrease in total health spending and savings in administrative costs. That basic argument makes sense, but there are a lot of details to be figured out. You’re not going to be able to do that just by taxing rich people."

Moreover, Sanders's "Medicare for All" proposal actually seeks to make the entitlement program more generous for all recipients -- so, Democrats say, it would make it better for everyone.

"People may have different views about 'Medicare for All' and what it will do, but it's hard to say they are robbing Medicare. They would expand benefits, eliminate premiums, reduce cost sharing. Seniors would get more direct coverage at a lower cost," Tricia Neuman, director of Medicare policy at the Kaiser Family Foundation, said. "They would replace the current Medicare program with this new program, that part is true, but it’s replaced with something more generous."

Republicans, as recently as this year, have supported cutting Medicare spending to balance the budget. They want to provide vouchers for seniors to purchase insurance privately, raising the age of eligibility, and make the program means-tested.   

Accusing the other party of threatening Medicare is a time-worn play used by both sides.

Back in 2011, in the aftermath of the passage of the Affordable Care Act, when Democrats were the ones on the health-care defensive, they were the ones  scaremongering on Medicare. Back then, Rep. Paul Ryan (R-Wis.), not yet speaker of the House, proposed a GOP budget to privatize Medicare. A liberal group ran an attack ad that showed a Ryan look-a-like pushing an elderly woman in a wheelchair and then shoving her off a cliff while 'America the Beautiful' played in the background. Ryan's budget never materialized, but it has served as a key benchmark for Republicans' vision of smaller government (that is, until Trump came into the picture).

"Medicare, or Mediscare, has been used as an attack in elections to scare older voters in one direction or another, so it’s not surprising that Medicare is again being used in a way that might scare older people – it’s more the norm than the exception for Medicare to be used as a wedge issue and to generate fear among older voters," Neuman said. 

And one of the reasons is because it works. Medicare is sacred to the over-65 demographic and any hint that it's being messed with is not popular in a demographic that tends to vote. 

In a piece about the Republican attacks on "Medicare for All,"  Vox's Matthew Yglesias, points us to a 2015 paper from the National Bureau of Economic Research that looked at attitudes toward redistributon of wealth in America, and used positions on universal health care in their analysis:

The most obvious candidate is that in the US, the government guarantees health insurance for only one immutable group: the elderly, whereas this coverage is universal in other developed countries. As Campbell (2003) has noted, the threat of Medicare cuts politically energizes U.S. seniors. We find evidence that this view may be driving elderly views on redistribution: seniors have grown increasingly opposed to extending the government guarantee of health coverage and controlling for this changing view explains nearly 40% of the elderly’s relative decline in redistributive support.

Seniors show a significant decline in their support on this question, moving (in the Republican direction) about one-third the partisan gap. In contrast, other adults have become significantly more favorable toward the idea that government bears some responsibility for covering medical costs. One might ask how, by the end of our sample period, seniors can be less supportive of the idea that government cover medical bills given that they, uniquely, are categorically entitled to this coverage.

These issues are nuanced ("Nobody knew that health care could be so complicated,” President Trump famously said) and it's quite easy to reduce attacks to a soundbite.

For Lipschutz, whose advocacy focuses on shoring up the existing Medicare program, the logic of the Republican argument that "Medicare for All' is socialism doesn't make sense. 

"The line of logic here is baffling. To me, expansions of coverage does not equal gutting of coverage," he said.  "Making more people eligible does not equate to taking away from someone who has it now."


AHH: Democrats knew they had to coax an admission out of Supreme Court nominee Brett M. Kavanaugh that he would roll back abortion rights in order to have any chance of blocking his nomination. But no such explicit admission was made during last week's confirmation hearings, Politico’s Adam Cancryn reports.

Instead, Trump’s pick for the high court was “tiptoeing carefully around the topic” and “managed to brush aside questions about his closely guarded views on abortion and emerged unscathed from the release of a leaked email that showed him arguing abortion rights weren't settled law.”

Our Post colleagues Seung Min Kim and Robert Barnes report following the hearings and reported that “some Democrats on the Senate Judiciary Committee seemed resigned to Kavanaugh’s confirmation.”

And Adam writes no one is any better informed after the week’s hearings whether the judge would vote down Roe v. Wade. “Legal experts said Kavanaugh’s testimony served to support his record as a conservative judge — and one who would be positioned to decide any of a slew of abortion rights cases that could soon reach the Supreme Court,” he says.

Meanwhile, the end of the hearings has turned the focus back to the critical votes Kavanaugh needs for his confirmation, such as from Sen. Susan Collins (R-Maine).

Collins has yet to voice explicitly where she stands on Kavanaugh despite saying she can't support a nominee who would overturn Roeas the Associated Press’s David Sharp writes. “Still, she’s sent signals that Kavanaugh cleared a hurdle by telling her that Roe v. Wade establishing abortion rights is settled law,” David writes. “A spokeswoman for Collins said Saturday that a recently released email from Kavanaugh — in which he disputed that all legal scholars see Roe as settled — didn’t contradict what he told the senator because he wasn’t expressing his personal views.”

Trump’s Supreme Court pick will likely be confirmed if Collins votes "yes," while she and Sen. Lisa Murkowski (R-Alaska) could sink the nomination if they both voted against Kavanaugh.

OOF: Agriculture Secretary Sonny Perdue said last week the department will look into reports that immigrant families are dropping out of a federal nutrition program for women and children over fears claiming the benefits would be detrimental to their ability to later receive green cards, Politico’s Helena Bottemiller Evich reports.

Perdue’s remarks that he would be “concerned” about such a drop and that he will “look into that further" follows a report from Helena that health providers are seeing a decrease of people on the rolls of EIC, a federal aid program that helps pregnant women, infants and children, over worries participating in such programs would affect their immigration status. 

"We do not want immigrants, particularly those who are coming undocumented or illegally into the country, to come in and take advantage of the programs that the taxpayers are providing there," Perdue said during an interview on C-SPAN's "Newsmakers. "But when it comes to women and children, I think we have to lean on the side of compassion.”

OUCH:  Colorado’s attorney general will become the latest to sue OxyContin creator Purdue Pharma for its “significant role in causing the opioid epidemic," just one of two pieces of recent news regarding the pharmaceutical giant, our Post colleague Lindsey Bever reports

The suit, Lindsey reports, “comes amid news that the company’s former chairman and president, Richard Sackler, has patented a new drug to help wean addicts from opioids.”

In a statement, the Colorado attorney general said the lawsuit claims Purdue Pharma “downplayed the risk of addiction associated with opioids,” “exaggerated the benefits” and “advised health care professionals that they were violating their Hippocratic Oath and failing their patients unless they treated pain symptoms with opioids,” — claims which the company “vigorously” denied in a statement to The Post.

“The state claims Purdue acted improperly by communicating with prescribers about scientific and medical information that FDA has expressly considered and continues to approve,” a Purdue Pharma spokesman said in the statement. “We believe it is inappropriate for the state to substitute its judgment for the judgment of the regulatory, scientific and medical experts at FDA.”

Meanwhile, according to a report from The Financial Times, Sackler has patented a new form of buprenorphine, which is a mild opioid used to ease withdrawal symptoms, Lindsey reports. But she notes “some are expressing outrage that the Sacklers, who have in essence profited from opioid addictions, may soon be profiting from the antidote.”


— In deeply conservative West Virginia, Democratic incumbent Sen. Joe Manchin III has made health care a top priority as he runs for reelection in the red state. Throughout his campaign, he has looked to defend protections for preexisting conditions under the ACA, or as the New York Times’s Trip Gabriel writes the “once-vilified law that has grown increasingly popular now that its benefits are woven deeply into a state with high poverty and poor health.”

Manchin won’t utter the term “Obamacare,” but he knows how important these protections are for his constituents, Trip writes, adding few Democrats are “using it to galvanize votes as aggressively as Mr. Manchin, whose state has epidemic levels of diabetes, heart disease and opioid addiction

“His TV ads star West Virginians with pre-existing conditions. He hosts round tables on the topic,” Trip continues. “Running on health care is designed to overcome his chief vulnerability: Mr. Trump’s 60 percent job approval here.”


 — In this dispatch from Ogden, Utah, the New York Times’s Robert Pear writes about a grassroots effort to expand Medicaid that’s seeing some momentum in the red state.

It’s one of three states that will vote on Medicaid expansion in November. In Utah, the measure would cover up to 150,000 more people under the ACA, and would join dozens of states that have expanded the program under the 2010 law. But Utah also represents a particular milestone for the push. “If it wins approval here, it could happen almost anywhere,” Robert writes, noting that the push in the state is five years in the making.

“Opinion polls suggest that 60 percent of Utah adults favor it. Advocates are energetic and well organized, knocking on doors and speaking frequently at public events,” he writes. “Opponents are lying low, but plan to make their case more forcefully before Election Day.”


— It’s been two years since the Drug Enforcement Administration began to accept applications to approve marijuana research. But the Wall Street Journal’s Sadie Gurman reports not a single application has yet been answered.

Two dozen requests are still pending. And it’s up to Jeff Sessions and the Justice Department to move the initiative forward.

“Mr. Sessions has stated publicly he is open to research on the drug but has offered no timeline for processing the applications” Sadie writes. “Republican and Democratic lawmakers have voiced frustration at the delays, saying Mr. Sessions has repeatedly avoided questions about the status of the applications. The inaction, they say, is stalling much-needed research into the potential health benefits of marijuana as society takes a more tolerant view of its use.”


— The Trump administration is considering a proposal from South Carolina to defund Planned Parenthood by cutting off abortion providers from the state’s Medicaid funding, The Hill’s Jessie Hellmann reports.

Texas and Tennessee have already made similar proposals that are under consideration by the Department of Health and Human Services. Under South Carolina’s proposal, Medicaid beneficiaries would not be able to use the program's benefits for coverage at facilities that offer abortions.

“While federal funds aren't permitted to go toward abortions, Republicans and anti-abortion groups argue that any money that goes to groups like Planned Parenthood indirectly supports the procedure,” Jessie writes. “While the Obama administration blocked states from cutting Planned Parenthood and abortion providers from Medicaid programs, the Trump administration has signaled a willingness to approve those proposals.”


— A federal judge ruled in favor of UnitedHealthcare in a challenge to a 2014 overpayment rule from the Centers for Medicare and Medicaid Services. The judge's ruling tossed out the rule, which the insurers claimed resulted in underpayment to Medicare Advantage insurers, Modern Healthcare’s Shelby Livingston reports.

"The rule required Medicare Advantage insurers to return overpayments to the government within 60 days of identifying them," Shelby explains. "The CMS hoped the rule would help curb Medicare fraud and upcoding, which may cost the government billions of dollars per year."

"The effect of the 2014 Overpayment Rule, without some kind of adjustment, is that Medicare Advantage insurers will be paid less to provide the same healthcare coverage to their beneficiaries than CMS itself pays for comparable patients," U.S. District Court Judge Rosemary Collyer wrote in the ruling issues on Friday.

“The decision is a huge win for Medicare Advantage companies,” Axios’s Bob Herman writes. “It could affect other pending overbilling cases and how the federal government audits the industry that has a track record of inflating patient medical codes.”

— And here are a few more good reads: 

Abortion Opposition Once Defined Marsha Blackburn. But Not in Senate Race. (New York Times)

SEC charges biotech billionaire Philip Frost with pump-and-dump fraud (Stat)

Can CEOs Get Away With Smoking Pot? (Wall Street Journal)

Doctors explore lifting barriers to living organ donation (Associated Press)


For new cancer treatments, less is more (Laurie McGinley)

Science Does Not Support Claims That Contraceptives Are ‘Abortion-Inducing’ (New York Times )

Ebola fight has new science but faces old hurdles in restive Congo (Reuters)


Coming Up

  • The Centers for Medicare and Medicaid Services holds a national training program workshop in Westminster, Colo. from Tuesday to Thursday.
  • The House Veterans Affairs Subcommittee on Health holds a legislative hearing on Thursday.
  • The House Energy and Commerce Subcommittee on Health holds a hearing on “Examining Barriers to Expanding Innovative, Value-Based Care in Medicine” on Thursday.
  • AHIP holds a webinar “Redesign your Payment Integrity Model to Achieve Savings” on Thursday.
  • The National Committee on Vital and Health Statistics holds a committee meeting on Thursday and Friday.

From investigative reporter and news anchor Angela Kennecke: 

Obama's rallying cry for the midterms - and against Trump:

Former president Barack Obama directly attacked President Trump and the GOP at a speech in Illinois on Sept. 7, and called on all Americans to vote this fall. (Video: Jenny Starrs/The Washington Post)