Trump and his allies in Congress apply "Death of a Thousand Cuts"
Let’s compare the words of the two presidents:
LBJ:
No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents.
It’s not possible for us to take care of… Medicaid, Medicare, all these individual things. They can do it on a state basis. You can’t do it on a federal. We have to take care of one thing: military protection. We have to guard the country.
The comparison speaks volumes. One is a leader who
understood that the federal government has a crucial role in the protecting the
health and well-being of our most vulnerable citizens—including the poor,
disabled, and the elderly. The other is a president who claims to support
Medicare and then says that the federal government can’t afford it because
of his illegal war in Iran. So much for supporting Medicare.
But this goes deeper than Trump’s rhetoric. The Medicare
program, like Social
Security, is at a pivotal point in its history. The Part A hospital) trust fund must be fortified so that
it doesn’t run dry in the 2030s. (There are reasonable solutions that Congress
could enact without hurting seniors.) So far, though, we have heard no
constructive ideas from Trump.
More urgently, though, the Trump
administration is actively undermining the “traditional Medicare”
program that LBJ signed into law. The administration has begun a pilot program
to use AI bots to determine whether traditional Medicare
patients will be covered for procedures their doctors have ordered. This
appears to be an attempt to cut costs by erecting obstacles to medically
necessary care—with decisions made by bots instead of human beings.
It could be the first step in a scheme to corrupt traditional Medicare and make it more like the privatized Medicare Advantage program run by for-profit insurers, which is a glorified HMO (with frequent denials of care, limited provider networks, and surprise out-of-pocket costs for beneficiaries). Unfortunately, thanks to deceptive but pervasive advertising, Medicare Advantage has now captured more than 51% of the market, leaving traditional Medicare with a shrinking share of enrollees.
The problem is that Medicare Advantage (MA)
puts profits over patients. Participating insurance companies have been overbilling the federal government by billions of
dollars a year. Ironically, this privatized program was supposed to save taxpayers
money. Instead, Medicare Advantage plans cost the government an average
of 14% more per patient than traditional Medicare. That
translates into an additional $76 billion in federal spending this year alone.
The bottom line: Medicare Advantage puts taxpayers’ money into the hands of large insurance
companies while failing to deliver superior or more cost-effective
care. It is fair to say that this is not what LBJ had in mind when he created
the public Medicare program. (Medicare Advantage arrived—in nascent form—in
1997, after considerable pressure from the insurance industry.)
When we talk about the financial shortfall facing the
Medicare program, we must look at Medicare Advantage as an aggravating factor.
Reining-in MA would go a long way toward restoring the overall program to
fiscal health—along with other commonsense reforms. Unfortunately, the Trump
administration has been inconsistent on this issue, initially floating strict
curbs on MA overpayments but ultimately rewarding insurance companies with
higher payouts.
Traditional Medicare is far from perfect. It should have
caps on patients’ out-of-pocket medical costs. It should cover vision, dental, and hearing care. (President Joe Biden attempted
to expand coverage in the ill-fated Build Back Better Act.) These are
improvements that we have long urged Congress and the White House to
enact.
Medicare also faces compound financial challenges—including
the overall rise in healthcare costs
and soaring prescription drug prices. The Biden
administration and Democrats in Congress took a major step in the
right direction with the Inflation
Reduction Act, which empowered Medicare to negotiate drug prices with Big Pharma. This process
is expected to save the government more than $230 billion by 2031.
For the most part, the Trump administration has adhered to
the law and continued negotiating with drugmakers—but it also expanded the list
of cancer drugs that won’t be eligible for negotiations. The president has
largely relied on smoke and mirrors to make it appear that the administration
is “tough on Big Pharma,” using gimmicks like TrumpRx. Meanwhile, in a move that will make
medications less affordable for seniors, the Trump
administration has just announced it is ending Biden-era subsidies in the Medicare Part D
prescription drug program.
Of course, it’s also Medicaid’s 61st anniversary. The damage
that Trump and the Republicans have
done to Medicare’s sister program would take up another entire article. Suffice
it to say that more
than 3 million Americans have already lost health coverage since Trump
and the GOP enacted
their Big, Ugly Bill, which slashed nearly $1 trillion from
Medicaid. (This also hurts older people dually enrolled in both Medicare and
Medicaid.) It was correctly labeled the biggest cut in healthcare in US
history—to pay for tax
cuts largely benefiting the wealthy.
The political right has always been wary of the New Deal and
Great Society legacy programs that lifted people out of poverty and provided
older and lower-income Americans with basic retirement and health security.
Some on the right have outright committed themselves to dismantling these
programs, despite their distinguished histories. Trump and his allies in
Congress have not so much dismantled these programs yet as chipped away at them
under the guise of fighting “fraud and abuse.” If this movement continues
unabated, we may be left with the crumbling foundations of programs that were
built to last, for the good of the American people.
Max
Richtman is president and CEO of the National Committee to Preserve
Social Security and Medicare. He is former staff director at the United States
Senate Special Committee on Aging.