Last week, at a huge and frightening retirement community in Florida known as The Villages, Donald Trump promised to protect seniors from two of the most menacing monsters lurking under their beds: Immigrants and socialism. You would think it might get boring, blaming everything on foreigners and commies, but its political utility is tried and true. Signing an executive order—which did not mention immigrants at all—before the assembled, Trump promised that he “will never allow these politicians to steal your health care and give it away to illegal aliens.” Democrats, he said, “want to raid Medicare to fund a thing called socialism.” Into this category he placed both single-payer health care alongside the “so-called public option.” Nevermind the fact that the latter policy bears as much relation to socialism as Trump does to a rose petal.

As hoary as the old-timey Red-baiting might seem, this executive order, and the rhetoric Trump deployed to promote it, is a distillation of his administration’s strategy to defeat the movement for single-payer. By pitting Americans against immigrants, and by telling seniors their Medicare would be under threat, Trump is banking on division and discord as a way to defeat a plan that would actually be beneficial for everyone except the very wealthiest. If Americans could realize the benefits of single-payer health care, and discover how different a life free from the worry of crippling health care debt could be, Republicans would not be able to persist in their promotion of the grim, race-to-the-bottom status quo. If this fight were fought on the merits and the facts, Trump would have no hope.



The executive order itself is a mish-mash of policy tweaks designed to further enhance the profitability of health care. Among the biggest winners are health insurers: The order instructs the Department of Health and Human Services to create rules promoting and expanding Medicare Advantage, the privatized part of Medicare under which insurers offer cheap plans that cover the benefits Medicare doesn’t. These ideas include encouraging “innovative [Medicare Advantage] benefit structures and plan designs”—“innovation” being the jollier term for privatization in the Trump era—and ensuring that the government doesn’t promote regular Medicare ahead of Medicare Advantage, which probably means directing the government to more fulsomely promote Medicare Advantage. The Trump administration already bumped up reimbursement for Medicare Advantage plans by 3.4 percent in 2018.



Hospitals and health care providers would also win big. The order directs HHS to study raising the prices paid by Medicare “to more closely reflect the prices paid for services in [Medicare Advantage] and the commercial insurance market,” which reimburses providers at a far higher rate than Medicare does. The goal is, according to the order, to “encourage more robust price competition, and otherwise to inject market pricing” into Medicare fees. It’s hardly worth noting the hypocrisy of a government that rails against the cost of socialized medicine proposing something that would cause government spending to skyrocket; this is the same bunch of crooks who pushed through a deficit-ballooning tax plan and claimed it would lower the deficit.



This particular proposal would be great for hospitals and other health care providers, who would stand to reap greater profits. It would be terrible for everyone else.

This particular proposal would be great for hospitals and other health care providers, who would stand to reap greater profits. It would be terrible for everyone else. Medicare premiums would have to rise to cover these costs. There is no sense to raising provider rates to reflect what private insurance pays, because those rates are stupidly inflated and, for that matter, deeply opaque: The public does not know what private insurance pays. (Last month, the Cleveland Clinic argued in a regulatory comment that it simply could not disclose all the prices it charges to insurers, because there are more than 210 million of them.) The market has not worked to constrain prices in the private market; it has sent them racing to unsustainable levels.

