Republicans have been dreaming for decades of privatizing Medicare. The idea, of course is so unpopular that they’ve never come close to achieving it. In fact, public opinion has been trending in exactly the opposite direction with growing interest in the idea of Medicare For All. Republicans hate that. So, while everyone has been pre-occupied with the furor over impeachment, Trump has issued an order that serves as a kind of Privatization Lite.
While the executive order spells out few details, it calls for the removal of "unnecessary barriers" to private contracting, which allows patients and doctors to negotiate their own deals outside of Medicare. It's an approach long supported by some conservatives, but critics fear it would lead to higher costs for patients.
Under the current system, Medicare sets the rate. Doctors are paid the set amount and are basically not allowed to charge the patient more. A lot of doctors complain that the rate is too low, but most participate anyway.
With private contracts, the doctor and patient can theoretically negotiate their own deal. But what it really means is that doctors can charge as much as they want. We all know how the system works. When you start with a new doctor, they give you forms to fill out and sign. There’s no negotiation. You either take it or leave it. Even worse, a lot of patients may not realize what they’re signing, and they could be hit with surprise medical bills.
The supposed benefit of all this is to make it easier to find a new doctor. Typical of conservative thinking, the idea is to create free market incentives to encourage doctors to take on new patients. Of course, what this really means is that doctors can change more and will accept patients who are willing and able to pay more. As usual Republican policies, this can be good for people who are financially well-off, but it will likely hurt people with lower incomes.
Another possible effect of this would be to drive more people to sign up for Medicare Advantage plans rather than sticking with traditional Medicare. Medicare Advantage plans are run by private insurance companies.
The order also lets beneficiaries opt out of Medicare Part A, which covers hospitalization. I don’t know why people might want to do that, but I guess the idea is that they’ll buy private insurance instead. If they can afford it.
This order is basically a Trump temper tantrum over the growing popularity of Democratic proposals for universal health care. If there’s any question about that, take a look at the order itself. It’s right there in the very first paragraph:
Section 1. Purpose. The proposed Medicare for All Act of 2019, as introduced in the Senate (“Medicare for All”) would destroy our current Medicare program, which enables our Nation’s seniors and other vulnerable Americans to receive affordable, high-quality care from providers of their choice. Rather than upend Medicare as we know it, my Administration will protect and improve it.
Trump probably wrote the first half of the first sentence before handing the whole thing off to someone literate.
The rules under this order still need to be drafted, so there’s always the chance that things won’t turn out as badly as they could. But there’s plenty of reason to be apprehensive.
"Unless these policies are thought through very carefully, the potential for really bad unintended consequences is front and center," says economist Stephen Zuckerman, vice president for health policy at the Urban Institute.
Avoiding harm would require a competent administration operating in good faith. Does anyone here trust Team Trump to do that? Me, neither.