The most interesting thing about the factually challenged screed Donald Trump published in USA Today on Wednesday—in which he attacked Democrats as Venezuelan-style “radical socialists” for supporting single-payer health insurance—may have been its intended audience. Democrats have turned health care into their single strongest policy issue, and Trump was evidently trying to turn it against them heading into the November midterms. But rather than make a case that all Americans would suffer under single payer, the president’s op-ed mostly attempts to scare the bejesus out of old folks. “Democrats would gut Medicare with their planned government takeover of American health care,” Trump (or more likely, his ghostwriter) explains.
It’s early days yet, but so far this is shaping up to be among the main Republican lines of attack on single payer. When Trump writes that “In practice, the Democratic Party’s so-called Medicare for All would really be Medicare for None,” he’s basically cribbing a line from his friend Lindsey Graham. At a CNN town hall debate last year in which he faced off against Bernie Sanders, the senator from South Carolina told the audience that, “Berniecare is socialism full-born. He’s a nice man, but if you want Medicare for all, you’re going to wind up with Medicare for nobody.” In January, the Wall Street Journal ran an op-ed by former Mike Pence staffer Chris Jacobs titled, “Sanders Proposes Medicare for None.”
These broadsides have very little to do with the actual legislation that Democrats have proposed. Sanders’ bill, for instance, would offer a program to all Americans that’s more generous than the current iteration of Medicare; it would cover more services while eliminating co-pays and deductibles, other than those on prescription drugs. Trump’s op-ed argues that government-run insurance “would inevitably lead to the massive rationing of health care. Doctors and hospitals would be put out of business. Seniors would lose access to their favorite doctors. There would be long wait lines for appointments and procedures. Previously covered care would effectively be denied.” Trump doesn’t precisely explain why any of this would happen, but that’s not really the point. Making grandma nervous is.
Seniors might not seem like the most obvious target for an anti–single payer campaign. They don’t exactly have the most to gain from a new federal insurance program. But given that they already enjoy government health care, they also don’t have a ton to lose (aside from the choice of enrolling in Medicare Advantage plans, which are privately run). Right now, most progressive policy wonks are worrying about how Democrats can sell single payer, or a version of it, to Americans who don’t want to give up their employer-based insurance or who don’t want to pay higher taxes. Trump’s op-ed barely bothers talking to those groups. It only nods a couple times to the fact that Sanders-style single payer would ban most private coverage, largely to underscore the idea that Democrats (who, it should be noted, haven’t all signed on to single payer) are Maduro-esque commies.
But terrifying loss-averse elderly voters over health care has worked for Republicans before, and there’s reason to think it could work again. Throughout 2009 and 2010, talk of death panels and cuts to Medicare (which, in fact, were mostly just reductions in excess insurer payments) helped mobilize resistance to Obamacare. “Keep your government hands off my Medicare” may have become a liberal punchline, but that didn’t make it any less of a real sentiment. Today, Americans over 65 have the dimmest view of socialism among any age group, and some polling suggests they’re the most likely to oppose single payer. (Other surveys have found otherwise.) There’s every reason to assume Republicans will at least attempt to frighten aging baby boomers into believing Democrats are about to sell them out, in order to provide free health care for Mexican immigrants. And I mean that literally. Taking a page from the European right, which regularly casts immigrants as a drain on the welfare state, Trump’s op-ed argues that Democrats want to end immigration enforcement, so that “millions more would cross our borders illegally and take advantage of health care paid for by American taxpayers.”
In other words, the Republican fight against single payer is going to sound very familiar. It will be “keep your government hands off my Medicare,” writ large.