The ‘cut spending’ conversation finally arrives at Medicare

Philip Bump, The Washington Post (c) 2024

In the wake of the killing of UnitedHealthcare CEO Brian Thompson in New York this week, the polling firm YouGov asked Americans a grimly related question: How satisfied were they with their health insurer?

The results were perhaps surprising. Overall, about 6 in 10 respondents said they were at least somewhat satisfied, with about half as many saying they were at least somewhat dissatisfied. (The rest either had no opinion or no insurance.)

Broken down by age, though, there was a big gap. Among those under the age of 65, about half said they were at least somewhat satisfied with their insurer, with fewer than 1 in 5 describing themselves as very satisfied. Once the age range hit 65 and up, though, enthusiasm spiked. A third of elderly respondents said they were very satisfied with their insurance, with more than 4 in 5 saying they were at least somewhat satisfied.

Why? Primarily for the same reason that so few people age 65 and over said they didn’t have insurance: They’re covered under the federal government’s Medicare program. It’s not perfect, obviously, but it’s robust and it’s affordable, if not free, both of which go a long way toward making it acceptable for American consumers.

It is also a central part of what the federal government spends money on. Data from the White House Office of Management and Budget indicates that about 12 percent of federal spending this year will be on Medicare, about 1 in 8 dollars the government disburses. Spending on Medicare is equivalent to 95 percent of the amount spent on national defense.

This means that those interested in cutting federal spending – like President-elect Donald Trump’s allies (and fellow billionaires) Elon Musk and Vivek Ramaswamy – were almost necessarily going to eventually arrive at the idea that the government should spend less on programs such as Medicare and Medicare specifically. They like to talk about how they will trim federal spending by targeting the federal workforce, but firing every single nonmilitary employee would eliminate only about 4 percent of the budget. If your plan is to cut a third of the budget (as Musk has said he wants to do)? You’ve got to aim higher than that.

On Thursday, as YouGov was asking people about their insurance coverage, Fox Business was reporting that such cuts were under consideration.

“Nothing is sacrosanct,” Rep. Ralph Norman (R-South Carolina) said after a meeting with Musk, Ramaswamy and Republican lawmakers. “Nothing. They’re going to put everything on the table” – which, the Fox host noted, included Social Security and Medicare.

During the campaign, YouGov asked voters to evaluate the importance of different health-care issues. Nearly three-quarters of those age 65 and over said that Medicare and Medicaid were among their most important issues. Those older voters were also more likely than younger ones to say that they trusted Trump on the issue – and were the only group to say they trusted Trump more than they trusted Vice President Kamala Harris.

Trump and Republicans have insisted for several years that, despite the party’s long-standing focus on cutting what they refer to as “entitlements,” they intended no such reductions. In early 2023, President Joe Biden picked up a proposal from Sen. Rick Scott (R-Florida) to require periodic reauthorization of federal programsto tell voters that Republicans wanted to cut Medicare and Social Security. Republicans cried foul, insisting that nothing could be further from the truth.

There’s an obvious political reason for this: Republicans are more reliant than Democrats on those older voters, a group that votes more heavily. In 2024, a larger percentage of Trump’s support came from elderly Americans than it did in 2020.

But Trump isn’t running again. He’s a lame duck president as of noon on Jan. 20, 2025. On the one hand, this frees him from the mundane political calculations that tempered Republican efforts in the past to cut programs such as Medicare (or the Affordable Care Act, for that matter). He can let Musk and Ramaswamy complain about whatever they want, recommend whatever cuts to whatever program, and Trump isn’t going to lose a single vote.

But there are a lot of Republican legislators, like Norman, who will need to go back to voters in 2026 or 2028, and the Billionaire Boys’ interest in submarining older Americans’ health-care program might be expected to turn up in a lot of campaign ads. Trump has never indicated much concern about the broader Republican Party; his second term in office is poised to put that indifference to the test.

Maybe there’s a way to effectively cut a substantial amount of Medicare spending without reducing coverage or access. Maybe Trump will be influenced by nonelectoral pressures from his loyal base of support. Maybe Musk and Ramaswamy will simply spend their time using their influence to kneecap their business competitors.

But there’s a reason that cutting these programs is referred to as a “third rail” in politics; that is, something that’s deadly to touch. If Musk says that they’re going to touch it and Trump shrugs at his doing so, it’s all the other Republicans who are going to get the shock.