Executive Order Implementing M4A Under Cover of COVID?

Were he smart, some argue, Trump might issue an executive order that implements Medicare For All (M4A), prior to the US election in November.   Maybe it would be an appealing campaign promise, capturing some populist energy.  COVID-19 has driven increased support for M4A.   As an opponent, Biden dismissed M4A, much to the disappointment of many otherwise enthusiastic supporters.  Putting aside questions of whether this can be accomplished through an executive order, even temporarily, it could shift perceptions to Trump’s favor amongst whatever voters haven’t already formed final decisions of who they’ll vote for.  

There are many reasons why it wouldn’t happen.  

• Trump isn’t smart about health policy.  Many argue he isn’t smart, period.  But he is intelligent at riling up US American passions.  On the topic of health policy, he plainly doesn’t want to be bothered.  Writing recently in the Washington Post,  Paul Waldman sums up how he has failed to grasp anything of substance about voter concerns over healthcare.  Therefore, this isn’t a topic that he understands well enough to excite voters, like immigration or tax cuts. 
• Campaign promises are quite different from actions such as an executive order.  In 2016, Trump told Jeb Bush that the Iraq War was “a big fat mistake”.  But then he found bellicose agents like John Bolton for his administration.  For all the hits on NAFTA, it is still essentially in place, but only with a different acronym.  Therefore, any edict to provide M4A would be more concrete action than has been characteristic of this administration. 
• The donor class (of both parties) would simply not countenance this level of intervention.  The existing system may be unbelievably costly and yet it props up so much profit that they would stop making campaign donations.  
• It would be a stretch to talk his supporters down, after hearing so much about “socialism” and healthcare.  Coming from him they might love the concept, but there would be cognitive dissonance to overcome. 

The more curious feature of M4A may be how it has seized voter imaginations thus far.  The prevailing public sentiment probably isn’t to enroll in what Medicare actually is- a hodgepodge of programs that have been thrown into a pot over decades.  Its various parts have complicated, differing cost and coverage rules. The privatized version, Medicare Advantage, resembles managed care provided by employer-sponsored coverage.  The one unique attribute of Medicare, at least in the USA, is that it is universal- for a limited cohort.  That may be its most appealing attribute; choice research could reveal if this is so. 

Beyond universality, what voters want is probably more like traditional Medicaid.  There would be no fees collected at the point of service, and copayments or coinsurance would vanish.  Unlike Medicare, there would be no means-testing on the basis of income.  Basically, it would be how healthcare looks in Canada.  Profits would be slimmer, and so the odds of many candidates proposing that within an election are zero. 

-published September 18, 2020