Despite the horror show of the attempted insurrection he fomented on the national Capitol on January 6, a recent CNN/SSRS poll found that former President Trump’s approval among self-described Republicans remains at 80 percent. Trump is finally gone, but his base is here to stay. And like it or not, the structure of our democracy means that they continue to have a large stake in it. Rather than ignoring Trump’s base in this new chapter of American government, to get our democracy working again we must directly confront the discontents underneath the veneer of Trumpism.
One place to start is with health care. We believe that the most important thing we can do to address the profound insecurity that so many in Trump’s America face every day is to pass Medicare for All.
Before we deal with the “but socialism!” elephant in the room, let’s discuss the indisputable and crucial need. Trump’s base disproportionately comprises rural white people without college degrees. Life expectancy has consistently fallen among this demographic over the past several years. In their revealing book Deaths of Despair and the Future of Capitalism, Anne Case and Angus Deaton illuminate the confluence of drug overdose, alcoholism, suicide, and deaths from chronic illness that have conspired to end these Americans’ lives prematurely. They place the blame for these ills at the feet of America’s corporate health-care industry, calling it a “cancer at the heart of the economy.”
And it’s true: our health-care system has failed Trump’s America. Consider the epidemic of rural hospital closures. Between 2010 and 2020 nationwide, 120 hospitals closed. The three states with the highest number of closings are Texas, Tennessee, and Oklahoma—all red states. As of November, the pandemic forced another 12 to close—all but three in deep Trump country. Many of these closures were accelerated by the spiteful politics of rejecting Medicaid expansion, which would have simultaneously expanded health insurance to residents of rural communities, and thus helped keep their hospitals open.
Because we rely on employers to provide health insurance, our overpriced health-care system has also accelerated job losses in rural communities. As Case and Deaton note, “The exorbitant price of health insurance has caused firms to shed workers; this is not a natural disaster but rather one based on rent-seeking, politically protected profiteering, and weak enforcement of antitrust in the healthcare sector.” Health insurance is an albatross on American industry that has helped drive the offshoring, outsourcing, and automation that has decimated working class jobs and destabilized entire communities.
It’s hard to envision a policy intervention with more salience to Trump’s base than fixing America’s health-care system. And it’s hard to imagine doing it in a way that more directly addresses the unique challenges people in rural communities face than passing Medicare for All. First, it would guarantee every single person access to high-quality, affordable health care. Because it is progressively financed, it would save low-income families money by eliminating premiums and out-of-pocket costs from the kitchen-table budget. It could also cut the rash of hospital closures decimating health care in rural America by freeing them of the impossible task of scraping out a profit margin while treating patients who are uninsured or underinsured. Indeed, under Medicare for All, rural hospitals could be reimbursed through innovative financing mechanisms like “global budgeting” that reimburse hospitals according to their catchment’s needs, rather than fee-for-service, which relies on the throughput of individual paying customers. And finally, because it’s a national program, it would protect rural communities from being robbed of their health care by GOP-controlled state legislatures just to “own the libs.”
Now to the S-word. If Medicare for All is socialism, so are public schools and public libraries—and more to the point, so is Medicare, which Republican voters adore. Either way, the socialism retort tends to assume way more ideological coherence than really exists among the voting public. For instance, in a 2019 Kaiser Family Foundation and Cook Political Report poll of key battleground states, only two percent of Trump voters said they would switch their vote if Donald Trump himself were to support Medicare for All. The upshot is that Republican politicians and donors might abhor Medicare for All, but large swaths of Republican voters are open to it. A recent Politico-Harvard poll found that a full 50 percent of Republicans believe Medicare for All should be an “extremely important priority” for President Biden and the new Congress.
Biden is on record opposing Medicare for All, an issue that was thoroughly litigated in the Democratic primary. However, he has vowed both to unite the country and to advance policies that are as big as the problems Americans face. In the throes of the worst pandemic in modern history, which has seen millions thrown off their health insurance as millions more were thrown out of jobs, Medicare for All is the kind of policy that could do just that.
Dr. Abdul El-Sayed is a physician, epidemiologist, and host of America Dissected.
Dr. Micah Johnson is a resident physician at Brigham & Women’s Hospital in Boston. They are the authors of the new book Medicare for All: A Citizen’s Guide