If you were wondering whether Donald Trump would keep his promise to protect Medicare from cuts, you just got your answer. Trump’s choice for Secretary of Health and Human Services is none other than Rep. Tom Price (R-GA), one of the country’s leading advocates for turning Medicare upside down.
Over the course of his campaign, Donald Trump assured voters that he would not take an ax to Medicare. In May of last year, he made that particularly clear when he told the Daily Signal, “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.” That fits in well with Trump’s allegedly populist campaign message—in fact, it would fit even better if he pledged to expand Medicare and other social safety net programs.
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But with the election just three weeks in the rearview mirror, Trump is already wrapping his arms around various proposals to gut the social safety net that conservatives have long advocated for—including schemes to weaken Medicare. Price’s appointment is just the latest signal that the incoming administration is willing to put seniors’ health care on the chopping block.
Price has spent his career attacking Medicare. In 2009, he marked Medicare’s 44th anniversary by bashing it. “Nothing has had a greater negative effect on the delivery of health care than the federal government’s intrusion into medicine through Medicare,” Price wrote. Two years later, Price introduced a bill to shift more Medicare costs onto seniors by partially privatizing the program.
After Trump’s election, Price said that he hoped to have a Medicare overhaul “within the first six to eight months” of the Trump administration. He’s planning on using a process called budget reconciliation—which would allow conservatives to push through major policy changes without needing to secure a filibuster-proof, 60-vote majority in the Senate.
Privatizing Medicare has been on conservatives’ wish list for years—Speaker Ryan advocated for it as a way to cut the program’s costs as early as 2010. In a budget proposal that year, Ryan pushed the idea of “premium support,” which would effectively swap out the current Medicare system—where the government pays hospitals, doctors, and other healthcare providers—for one where every person essentially gets a check to buy their own insurance on a private market. Effectively, the plan takes power away from Medicare enrollees and puts it squarely into the hands of private insurers. Ryan’s most recent version of the plan would not eliminate traditional Medicare right away, but it would undermine the program and raise the eligibility age.
The devil is, as always, in the details, and so far Price and Ryan have declined to specify exactly what their Medicare overhaul would entail. But the consequences are potentially very grave: previous proposals would hollow out the current program and replace it with one that covers fewer people, offers its enrollees fewer benefits, and opens the door to charging much higher premiums to seniors facing the most significant challenges to their health.
Despite his campaign promises, it seems Trump is now falling in line . Price’s appointment follows a statement the president-elect put out on his transition website, where he pledges to “modernize Medicare, so that it will be ready for the challenges with the coming retirement of the Baby Boom generation—and beyond.” In the world of political parlance—especially after an election where Trump made a number of explicit attacks against many groups of Americans—this may not sound like much. But in fact, this phrasing strongly suggests that Trump is getting ready to join conservatives’ long-running effort to gut Medicare as we know it.
This is what makes Trump’s pivot on Medicare so disconcerting: It appears to be yet another example of how the populist rejection of establishment politics that defined his campaign’s narrative was just a ruse. Another broken promise originally made in bad faith.
My late grandfather, a New Deal Democrat who proudly cast his first vote for Franklin Delano Roosevelt’s third term in 1940, taught me many things: The airy pleasure of crooners Bing Crosby and Perry Como, how to handicap a horse race, the importance of being on time. (Incidentally, I’m still working on that last one.)
One lesson in particular is sticking out as we get more information on President-elect Trump’s plans for office. It went something like, “A person breaks a promise every single minute. If they’re acting in good faith, you give ‘em another chance. But if you know they aren’t, just go ahead and throw the first punch.”
If there’s a silver lining, it’s that the American people appear to be ready to throw a punch. They happen to like their Medicare the way it is, and fiercely oppose turning it into a premium support-based system. According to a June 2015 poll, only 26% of respondents support transitioning Medicare to a premium support model. In contrast, an overwhelming 70% of respondents said they preferred keeping Medicare structurally as it is.
There is no doubt Donald Trump was wise to the popularity of Medicare when he promised not to cut it a year and a half ago. Now that he seems likely to join in Speaker Ryan’s barrage of attacks on the social safety net, he may be surprised by how his supporters respond.