Health Care

‘Medicare for All’ vs. ‘Medicare for Less’?

Bernie Sanders supporters during an event introducing the “Medicare for All Act of 2017” on Capitol Hill in Washington, D.C., September 13, 2017. (Yuri Gripas/Reuters)
The liberal talking point is inaccurate. But there’s a reason it resonates with the public.

The 2020 presidential race will pit the Democrats’ “Medicare for All” proposal against the Trump administration’s “Medicare for Less.”

At least that’s how the Washington Post and some Democratic political operatives suggest it will play out. According to the Post article, progressives are looking to make political hay out of the contrast between their dream of enlarging the Medicare program to cover all 327 million Americans and a Trump budget that proposes to reduce Medicare spending by $818 billion over the next decade.

“Free” medical care vs. pushing granny off the cliff. For progressives, it doesn’t get any better.

Or more misleading. On closer examination, most of the Medicare savings contained in the president’s budget would not adversely affect beneficiaries, and some would likely save them money. But Republicans are nevertheless vulnerable to the Medicare for All vs. Medicare for Less meme, because of their own reluctance to offer a credible alternative to the health-care status quo after losing the House in the 2018 elections.

As even the New York Times has observed, it’s misleading to claim that the Trump budget would harm Medicare beneficiaries. Consider hospital uncompensated care. Medicare currently makes payments to hospitals for uncompensated care they provide to non-Medicare patients. The administration proposes to remove this spending from Medicare and fund it instead through a separate program. That shift would save Medicare $183 billion over ten years.

The budget calls for a similar trade-off of $211 billion in spending on graduate medical education, moving financing out of Medicare and into a newly created program. These two transfers account for $394 billion of the $818 billion in Medicare “cuts.”

Another $271 billion in savings comes from eliminating Medicare payment disparities between procedures done in hospitals and those performed in physicians’ offices and other non-hospital settings. Typically, Medicare reimbursement rates are higher for hospital services. For example, Medicare can pay more than three times as much for cardiac imaging when it’s done in hospitals rather than physician offices, according to a study by Avalere, a health-care consultancy. Equalizing payments could provide significant savings to taxpayers and beneficiaries.

The administration estimates that its medical-malpractice-reform proposal would save Medicare $27 billion. Another $6.5 billion comes from policy changes designed to reduce waste, fraud, and abuse.

These policy initiatives collectively account for nearly $700 billion of the $818 billion in so-called Medicare “cuts.” Such proposals can be debated on their merits, but it is more than disingenuous to characterize them as “a massive transfer of wealth from the working class to the wealthiest people and the most profitable corporations in America,” as Senator Bernie Sanders (I., Vt.) tweeted last week.

That won’t stop the demagoguery. Voters trust Democrats more than Republicans on health care. Democratic candidates effectively exploited that credibility gap in the 2018 midterm elections, ousting Republican moderates in swing districts by accusing them of seeking to gut federal insurance regulations on preexisting conditions.

The charge wasn’t true, but it was believable, and so is the contention that Republicans would back Medicare cuts that would harm seniors — because Republicans have failed to table a health-care agenda that speaks to the concerns of voters.

President Trump seems to have grasped that. Under assault from congressional Democrats over a decision by the Justice Department not to contest a federal judge’s ruling to invalidate Obamacare in its entirety, Trump announced that he had a better idea. “If the Supreme Court rules that Obamacare is out,” he said, “we’ll have a plan that is far better than Obamacare.”

But the statement reportedly rattled congressional Republicans, who in fact are not currently advancing a plan that’s better than Obamacare, and who hope to prevail in 2020 without proposing one. Instead, they are spoiling for a fight against a presidential candidate who advocates Medicare for All. Always more comfortable faulting liberal ideas on health-care reform than with proffering their own, Republicans relish the prospect of running against a government takeover of health care.

That may prove more difficult than they imagine. The Kaiser Family Foundation, which has been tracking public opinion on single-payer health care for nearly two decades, finds that Americans favor the idea by a margin of 56–39 percent. In the early 2000s, the same poll yielded the opposite result.

It’s true that support for single payer declines as voters consider its cost and contemplate exchanging the insurance they have for something unfamiliar. The century-long quest for single payer has repeatedly foundered largely for that reason. Maybe 2020 will run true to form.

Still, Republicans are gambling by not advancing an alternative that enhances health-care choices and dampens rising health-care costs. They may come to regret allowing their opponents to caricature them as advocates of Medicare for Less and opponents of Medicare for All.

Doug Badger is a senior fellow at the Galen Institute and a visiting fellow at the Heritage Foundation

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