Jared Golden, a Democratic member of the Maine House of Representatives who is running for Congress, supports Medicare-for-All. As made obvious by the very phrase “Medicare-for-All,” Golden wants to extend Medicare-style health coverage to every American. If you currently have Medicare, Golden thinks you should keep Medicare. If you don’t currently have Medicare, Golden thinks you should be able to have Medicare.

Nonetheless, a new ad by Golden’s opponent, Rep. Bruce Poliquin (R-ME) paints a very dire picture of Golden’s stance on the government program. Polquin’s ad claims that Golden “will end Medicare as we know it” and accuses Golden of wanting to impose “over $32 trillion in higher costs.” The climax of the ad features an image of a very stern older white lady shaking her head.

The implication is that seniors should be very, very afraid. If Golden is elected, things will happen to Medicare! And those things will be bad! For you!

This isn’t a new strategy. The GOP often appeals to older voters by suggesting that Democratic spending on some other demographic group necessarily implies fewer benefits for the Republican Party’s elderly base. In 2012, for example, Republican presidential candidate Mitt Romney ran an ad accusing President Obama of cutting Medicare to pay for “a massive new government program that’s not for YOU.”


Poliquin’s ad is an especially obnoxious example of this tactic because it deploys one of the most meaningless phrases in American politics — “end Medicare as we know it.” This is both literally true and intentionally misleading.

Yes, Golden wants to end Medicare as we know it. But that’s because Golden would transform Medicare from a program that only covers some Americans in one that covers all Americans. That’s hardly a reason for seniors to sternly shake their heads at him.

Rhetoric criticizing lawmakers for wanting to “end Medicare as we know it” is in fact a Democratic Party invention.

In 2011, then-House Budget Chairman Paul Ryan (R-WI) pushed a plan that would have gradually phased out the Medicare program in its entirety. Ryan would have repealed Medicare and replaced it with a voucher program — a move that, in and of itself, would have driven up seniors out-of pocket costs by nearly 40 percent.

But Ryan didn’t stop there. Under the 2011 version of this plan, Ryan’s vouchers would lose value every year because they did not keep up with the rate of health inflation. By 2080, according to the Congressional Budget Office, “Medicare would be cut 76 percent below its projected size under current policies.” And it would keep shrinking more and more after that.


At the time, many Democrats accurately described the Ryan plan as a proposal to “end Medicare.” In an act of journalistic malpractice, however, the “fact checking” cite PolitiFact labeled the characterization that the Ryan plan would end Medicare as a lie. Deferring to a news outlet which claimed to be a neutral factchecker, Democrats eventually modified their rhetoric to say that Ryan would “end Medicare as we know it.”

But the problem with this phrase is that it means nothing. Any scheme that alters Medicare in any way could be described as a plan to “end Medicare as we know it.” And now that this phrase carries negative connotations, thanks to Democrats’ decision to use it to describe the unpopular Ryan proposal, candidates like Poliquin can use it to make misleading attacks on Democrats who wish to expand Medicare.

Poliquin’s claim that Medicare-for-All would lead to “over $32 trillion in higher costs” is also worth unpacking. The source for this claim is a Koch Brothers-funded study that determined the specific Medicare-for-All plan pushed by Sen. Bernie Sanders (I-VT) would cause the government to spend $32.6 trillion on health care over a ten-year period.

That sure sounds like a lot! But if the United States does nothing — that is, if it leaves its current health care system in place — we will spend even more money than we would under a Medicare-for-All system. In 2016, America’s total health expenditures were $3.3 trillion a year, according to the Centers for Medicare and Medicaid Services, when you include both public and private spending. That means that, even before you account for inflation, the United States will spend $33 trillion over the next decade on health care if it stays its present course. And $33 trillion is, of course, more than $32.6 trillion.

The idea that the United States could save money by adopting a universal, single-payer health plan that guarantees coverage to all Americans may sound counter-intuitive, but it makes sense if you understand the economics of the health industry. Under Medicare-for-All, more people would receive quality care, but that care would cost a lot less.


Currently, Medicare pays significantly less for the same medical procedure than private insurers typically do. The reason for this is that seniors account for about a third of all health care costs in the United States, and Medicare provides health coverage to the vast bulk of these seniors. That gives Medicare tremendous power when it negotiates with health providers to lower costs.

If a particular health provider charges too much, Medicare can threaten to cut off that provider — and few providers can afford to lose so many older patients.

The entire premise of a single-payer system is that everyone (or, at least, nearly everyone) would be covered by the same government-run program. In this world, the government would have even more power to bargain down prices because hardly any health providers could afford to be cut off from Medicare-for-All patients.

For the moment, Medicare-for-All is also quite popular. A March poll by the Kaiser Family Foundation found that 59 percent of respondents support a universal, single-payer system. In the past, however, the most potent message a politician can bring into a health care debate is often “we should keep the status quo.”

This implicit message benefited Republicans seeking to kill Obamacare in 2009, and it benefited Democrats seeking to preserve Obamacare in 2017. Poliquin’s now hoping it will save him in 2018 — even if he is being completely dishonest.