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Bait and Switch: No One Voted to Destroy Medicare

'Nobody voted to destroy Medicare,' writes Altman, but Republican Party leaders 'are determined to make it happen anyway.'

Donald Trump did not campaign on a promise to destroy Medicare. In fact, he promised not to touch Social Security, Medicare, and Medicaid. But now that the Republicans are in charge of the White House, the Senate, and the House of Representatives, destroying Medicare appears to be on the top of their agenda.

This is classic bait and switch. Trump and his fellow Republicans promised to repeal Obamacare.  Now, with the election in the rear-view mirror, House Speaker Paul Ryan has wasted no time in announcing his plan to end Medicare.

"Hostility to Social Security, Medicare, and Medicaid is the Republican establishment’s orthodoxy."

In order to get away with this bait and switch tactic, Ryan falsely claims that Obamacare hurt Medicare. WRONG! The Affordable Care Act left Medicare largely untouched.  The Medicare provisions it did include expanded benefits and strengthened the program’s financing.  Ryan further claims that they can’t repeal the ACA without dealing with Medicare. WRONG AGAIN!  The Medicare provisions can simply be left unchanged. And, finally, and most untruthfully, Ryan claims that he wants to save Medicare. But Medicare does not need saving. It works extremely well.

The truth is not hard to discern. Hostility to Social Security, Medicare, and Medicaid is the Republican establishment’s orthodoxy. Consistent with that orthodoxy, Ryan has been proposing to end Medicare as we know it for years. As Chair of the House Budget Committee, his annual budgets included a plan to turn Medicare into a voucher system – replacing the program’s guaranteed benefits with a fixed, and inadequate, payment to beneficiaries.

Under the Ryan scheme, seniors and people with disabilities would be forced to fend for themselves against private insurance companies. They would have to bear whatever the insurance companies chose to charge, or go without insurance if they couldn’t afford it. And, if Republicans succeed in repealing the ACA with its protection of people with pre-existing conditions, many seniors and people with disabilities now covered by Medicare would be unable to get any coverage whatsoever at any price. Ironically, after railing against Obamacare for years, Ryan and his fellow Republicans want to transform Medicare into Obamacare. The Affordable Care Act is much better than what existed before, but it is much inferior to Medicare.

Not surprisingly, Ryan’s plan to end Medicare has one big problem. The American people – Democrats, Republicans, and Independents – overwhelmingly support Medicare. Not only is the Ryan plan extremely poor policy, it is also incredibly unpopular. Consistent with the unpopularity of the Ryan plan, Republican primary voters rejected the candidates who embraced it – Jeb Bush, Ted Cruz, and Chris Christie, to name the most prominent of the primary’s losers.

Instead, Republican primary voters picked Donald Trump, who made a solemn promise to voters, differentiating himself from the others by declaring loudly and often that he would not cut Social Security, Medicare, or Medicaid. He specifically called out Ryan, saying “You know, Paul wants to knock Medicare way down. I’m not going to cut it, and I’m not going to raise ages, and I’m not going to do all of the things that they want to do.” 

Trump’s Medicare promise helped carry him to victory in the GOP primary, and again in November. Many advocates, including me, didn’t trust the promise - particularly after Trump picked as his running mate Mike Pence, a close Ryan ally who has pushed for Social Security and Medicare privatization for years. But despite that, Trump’s promise not to cut Social Security and Medicare (and the media’s willingness to believe it) kept them from being major issues in the campaign.


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Now that Trump is President, however, all signs are that he is planning to to betray his supporters and let Ryan and Pence run the show. Less than a week after the election, Ryan announced that Medicare was “part of our plan” going forward – clear code for implementing his privatization plan. To this disturbing announcement, Trump was uncharacteristically quiet.  Not a single tweet.

"Today, the Republican target is Medicare, Medicaid and Obamacare. Tomorrow it will be Social Security."

Even more recently, Trump spoke volumes about his view of Medicare and Medicaid when he announced that his nominee to head the Department of Health and Human Services was Representative Tom Price (R-Ga), another Ryan lieutenant and the current House Budget Committee Chair.

Just a few days before his nomination, Price announced that the Republicans planned to “address” Medicare in the first seven or eight months of the Trump administration. Trump’s action makes Price even more powerful in the upcoming battle over Social Security. There’s no question that if Price is confirmed, he will be the fox in charge of the Medicare hen house.

Nobody voted to destroy Medicare, but Paul Ryan, Mike Pence, and Tom Price are determined to make it happen anyway. Thus far, Trump seems entirely willing to be their Medicare cutting puppet or perhaps their quiet ally.

But supporters of Social Security, Medicare, and Medicaid are not going to surrender without a fight. In record time, over a million Americans have signed petitions demanding that the Republicans keep their hands off our Medicare. On Wednesday, boxes containing the more than a million petition signatures were on display at a press conference where

Democratic leaders Chuck Schumer, Nancy Pelosi and Bernie Sanders, together with Representatives Jan Schakowsky (D-IL), Ted Deutch (D-FL), and Tony Cardenas (D-CA), in the best tradition of the Democratic party, pledged to fight tooth and nail this Republican effort. Their message was that we should be expanding, not cutting, Social Security, Medicare, and Medicaid.

After the press conference, a group of seniors, nurses and other concerned citizens, led by Dr. Sanjeev Sriram (stage name, Dr. America), and Jon Bauman (Sha Na Na’s Bowzer) delivered the  petitions to Senate Majority Leader Mitch McConnell and House Speaker Paul Ryan.

This is just the first step. Medicare and Medicaid are over a half century old. Having worked on them for over four of those five decades, I know that this is the greatest threat they have ever faced. This is a time when all Americans who care about these vital programs must pay attention. 

Today, the Republican target is Medicare, Medicaid and Obamacare. Tomorrow it will be Social Security. For the economic security of all Americans, we must beat back this outrageous attack by the Republican establishment.

Nancy J. Altman

Nancy J. Altman

Nancy J. Altman is president of Social Security Works and chair of the Strengthen Social Security coalition. She has a 40-year background in the areas of Social Security and private pensions. Her latest book is "The Truth About Social Security: The Founders' Words Refute Revisionist History, Zombie Lies, and Common Misunderstandings" (2018). She is also the author of "The Battle for Social Security" (2005) and co-author of "Social Security Works!" (2015).

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