THE BUDGET President Trump proposed this month is bad news for Medicare-for-all. That’s not so much because of what is in the plan, but rather because of the reactions it has provoked.
Democrats have attacked the president for allegedly proposing $850 billion in Medicare cuts. Actually, $270 billion of that total is not a cut at all — just an accounting quirk, and the result of moving pieces of current Medicare spending to a different part of the federal health-care budget. The remaining $500 billion to $600 billion or so in cuts sound scary, particularly when health-care interest groups say they would be “devastating” and “gut Medicare.” But they would not. The Committee for a Responsible Federal Budget notes that, “rather than coming from benefit reductions, these savings come largely from policies that would reduce the cost of care for the taxpayer and Medicare beneficiaries — and many of them build upon ideas originally proposed in President Obama’s budgets.”
This demagoguery should sound familiar: Republicans attacked Democrats in the same tricky way when similar cuts were used to finance the Affordable Care Act, also known as Obamacare. The line was unfair then, and it is unfair now.
So what does this have to do with Medicare-for-all? The national health-care plan Sen. Bernie Sanders (I-Vt.) and others favor foresees a breathtakingly generous program — more so than the national health-care plans of other nations that Mr. Sanders often invokes. On top of a wide array of health-care benefits, his would provide universal vision, hearing and dental care. Premiums and cost-sharing in the form of co-pays or other fees would be practically nonexistent.
This is not how universal health-care programs typically work. It would be astonishingly expensive to do what Mr. Sanders proposes. The only way the math gets close to adding up is if the government is able to wring money out of the current health-care system — not just by eliminating insurance company profits and overhead but also by aggressively crimping the payments doctors and hospitals get for their services, in the ways Mr. Trump and Mr. Obama before him proposed. The Post’s Fact Checker notes that the cuts envisioned in Medicare-for-all plans would be far deeper than what Mr. Trump included in his latest budget.
The reaction to Mr. Trump’s budget implies an all-too-likely scenario if Mr. Sanders got his way: Benefits would be extended, but politicians would shrink from imposing the necessary cost controls. The party out of power would take every opportunity to accuse those in power of heartlessly cutting everyone’s health care. Those in positions of responsibility would avoid the charge by running up the debt, endangering the program’s long-term stability, or both.
Those who favor Medicare-for-all must be clearheaded about the practical trade-offs. Miraculous levels of cost savings are neither obvious nor assumable, and basing a huge reform plan on the notion they will happen is irresponsible.