President Trump’s new executive order on Medicare, the government health insurance program for seniors, will provide seniors with more options and more savings and help make the program fiscally solvent for future years.
This direction is a stark contrast to the Democrats’ healthcare agenda of “Medicare-for-all.” While Democrats want to replace the private health insurance market with Medicare for everyone, President Trump wants to reserve Medicare for seniors only. In fact, he wants to make Medicare more like the private market, and, as demonstrated by his other actions on health care, he wants to make the private market more functional, competitive and affordable for patients of all ages.
Medicare-for-all is packaged in the politically attractive concepts of equality and assurance for every person. No American wants to see a neighbor or friend face high medical bills or the uncertainty of going uninsured. Medicare-for-all falsely promises to protect people financially while giving equal access to healthcare services.
But the U.S. has long had safety-net programs in health care designed to protect vulnerable populations. Since the 1965 Great Society agenda became law, Medicare has covered virtually all of the nation’s seniors, and Medicaid has covered people with low-incomes. Even before these programs, the U.S. provided medical care for veterans.
President Trump’s approach to health care focuses on strengthening existing government healthcare programs. He seems to understand that expanding these programs beyond their original scope will only weaken them for the populations for whom they were designed.
He’s right. The Medicaid expansion in the Affordable Care Act (ACA), or Obamacare, shows what happens when a safety net program is stretched too thin. Both now and before the ACA, all 50 states offered coverage to low-income pregnant women, children, parents, people with disabilities, and the elderly (“dual-eligible” for Medicare). But the ACA offered states an incentive to expand coverage to able-bodied childless adults up to 138 percent of the federal poverty line. Thirty-five states opted in.
The incentive was federal money. Specifically, the Medicaid expansion offered an enhanced federal matching rate for newly eligible enrollees. This amounted to the federal government paying states more to cover able-bodied childless people than to cover the traditional Medicaid population, which is generally more vulnerable. Talk about upside-down priorities.
Medicaid already faced inferior health outcomes and access. More enrollees only worsened this problem.
Any expansion of Medicare — whether it’s Medicare-for-all or a slower-paced “Medicare Buy-In” — will have a similar effect, to the harm of Medicare’s current population of senior citizens. Today we have a government program designed to serve seniors. If Medicare were open to all Americans, we would no longer have a program specifically designed to benefit seniors.
And all of this is not even to mention the fiscal side of the equation. Medicare’s Trustees presently project that the program will be solvent only until 2026. And it’s a wonder Medicare has made it this far without going bankrupt, considering that the average senior takes out $3 in benefits for every $1 he paid in.
This isn’t sustainable for the 60 million seniors currently in Medicare, much less for the 327 million lives in the United States.
By committing to preserve Medicare for seniors, President Trump is committing first and foremost to not expanding the program.
He’s also committing to improving Medicare: Consistent with his other actions on health care to expand choices for the general population (such as short-term and Association health plans, as well as the expansion of Health Reimbursement Accounts), President Trump is instructing his administration to expand plan options for Medicare patients, to expand choices for where and how they consume care, and to capitalize on the success of the Medicare Advantage model, wherein seniors use Medicare dollars to enroll in private health plans.
Importantly, this order would remove the near coercion into Medicare that seniors face: It unlinks Medicare from Social Security, providing seniors, for the first time, the ability to completely opt out of Medicare and keep their retirement benefits.
Americans are rightly fed up with the status quo in healthcare, which represents neither a fully socialized system nor a free and competitive private marketplace. With this latest executive order, President Trump has demonstrated that he will advocate for the latter, even as his Democratic opponents move toward the former.
At the very least, Americans now see two contrasting visions shaping up: Do we want Medicare-for-all, which would offer only one coverage option for all patients, or do we want a robust marketplace alongside a strong safety net reserved for only the truly vulnerable?