The president on Thursday unveiled the “Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors,” a plan to, among other things, expand seniors’ options within Medicare Advantage, the popular program that allows the elderly to buy private health plans in lieu of receiving traditional Medicare.
There are several conversations we could have about this move. We could talk about the debate over Medicare Advantage itself, in which conservatives point out that it is far more cost-effective than traditional Medicare but skeptics say the savings aren’t passed through to taxpayers. Or we could talk about how this fits into the Trump administration’s broader efforts on health care, which have freed up many Americans to buy many plans that regulations previously took off the table. Or we could talk about the criticisms Trump made of the Democrats’ health-care plans, and whether those plans would really hurt seniors as he claimed, rather than holding seniors harmless and expanding benefits for everyone else.
But instead, let’s talk about why the president, facing a major controversy you no doubt have already read about elsewhere, would head to Florida to visit “the country’s largest retirement community” (as the New York Times observed) and make a big show of how much he supported Medicare. The reason is that seniors have a hugely disproportionate sway over this country’s politics and policy, and their power will only continue to grow even as it destroys our finances.
In 2016, 71 percent of those age 65 and up voted; so did 67 percent of those 45 to 64, the folks who will be retiring in the next two decades. Those 18 to 29 voted at a rate of 46 percent, those 30 to 44 at a rate of 59 percent. Put differently, those 45 and up outnumber those 18 to 44 about five to four among citizens — but nearly two to one among voters.
This longstanding gap in political involvement will only become more important as the Baby Boomers retire. Between 2020 and 2040, the senior population is expected to grow by 44 percent, while the 18–64 population grows by just 6 percent. That’s why seniors are and will continue to be such a key constituency — and it explains much about our fiscal crisis, too.
Social Security and Medicare are two of the most popular and least reformable government programs in this country. The former sends seniors checks every month; the latter provides them health care. As a result of these benefits, seniors are the most financially secure age group in the U.S. and enjoy the lowest poverty rates.
Seniors are told, and many fervently believe, that these programs simply give them back what they paid in, but this is a lie. The typical American gets much more out of these programs — in the case of Medicare, several times more — than he’s put in.
When the enormous Baby Boom generation was working, these programs nonetheless managed to build up a bit of a surplus, which was kept track of (though not actually saved) in the trust funds. As the Baby Boomers drain those balances, Medicare will run out of money in 2026, Social Security in 2034. We’re already running trillion-dollar deficits, and as entitlement costs mount further, we will have to either hike taxes — not just repeal the recent tax cuts, but seriously hike taxes — or trim benefits. Though whatever we choose will be painful, it will be less painful the sooner we act.
It used to be that some politicians would take this problem seriously and most would at least pretend to. But the Boomers have started to leave the work force, and fear of the political repercussions has prevailed. Trump won in part by stating flatly that he wouldn’t touch Social Security and Medicare; he reiterated at his Thursday event that “I made you a sacred pledge that I would strengthen, protect, and defend Medicare for all of our senior citizens. . . . It will never be taken away from you. We’re not letting anyone get close.” The Democrats, incredibly, have made noises about expanding Social Security.
If there’s any question about who’s in charge, know that Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, is quoted in the New York Times as saying that “proposals like Medicare for all, as well as the public option, they are morally wrong because they would demote American seniors to second-class status.” They’re bad ideas, yes. Unaffordable too. But this level of rhetorical catering — in which giving everyone else the taxpayer-funded health care that seniors already get “demotes” seniors, not to the same level as everyone else but to “second-class status” — is something to behold.
Democrats want to give everyone the socialism we already have for seniors. Republicans do not, and indeed they wouldn’t mind injecting some more free-market ideas into the entitlement system, as the new executive action shows. But no one, it seems, has any intent to address the fact that we can’t pay for all the spending we’ve already promised today’s and tomorrow’s elderly — at least until fiscal reality unmistakably forces them to.
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