Healthcare Labyrinth blog logo

The Trump-Biden Great Entitlement Debate

After promising not to touch Social Security and Medicare throughout his campaign, GOP 2024 candidate and former President Donald Trump seemingly reopened his views on the issue – only to have Biden attack him and then Trump having to clean up after.

Here is the back and forth (this could be the only real debate we see from the candidates) :

In comments to a journalist on whether he had changed his views on entitlements, Trump declared:

“So first of all, there is a lot you can do in terms of entitlements in terms of cutting and in terms of also the theft and the bad management of entitlements, tremendous bad management of entitlements. … There’s tremendous amounts of things and numbers of things you can do. So I don’t necessarily agree with the statement.”

It seems reasonably clear that Trump likely was talking about cleaning up administration and fighting waste, fraud, and abuse. But imprecise and long-winded statements – a Trump staple – tend to give his opponents openings and ammunition for attack. 

Sure enough, Democrats, including President Biden, came out on the attack. Biden declared following Trump’s comments:

“Many of my Republican friends want to put Social Security and Medicare back on the chopping block again. If anyone tries to cut Social Security or Medicare or raise the retirement age again, I will stop them. Working people built this country. … Even this morning, Donald Trump said cuts to Social Security and Medicare are on the table again. The bottom line is, he’s still at it. I’m never gonna allow that to happen. I won’t cut Social Security. I won’t cut Medicare.”

A bit stung by the episode, Trump clarified his remarks today:

“I will never do anything that will jeopardize or hurt Social Security or Medicare.  We’ll have to do it elsewhere. But we’re not going to do anything to hurt them. … There’s so many things we can do. There’s so much cutting and so much waste in so many other areas, but I’ll never do anything to hurt Social Security.”

Campaign fodder for Biden

Despite the clean up, there is no doubt this is good fodder for the next eight or so months. Perfect campaign ads for Biden that will resonate. As I pointed out recently, while the economy and the border tend to outrank healthcare as an issue, healthcare affordability and coverage continue to be great concerns for Americans.  Healthcare can be a deciding issue in some of the swing states — more precisely counties — that will decide this presidential election once again.

We need a real conversation on entitlements

I bring up what happened to Trump and Biden’s response because I actually think we need a sincere debate on entitlements in this country.  We almost never have it.  The minute anyone even opens up a responsible conversation on what should be done, discussions are shut down. Politics rules.

Social security policy is non-existent

On Social Security, the Congressional Budget Office projects that Social Security benefits might have to be reduced by at least 20% if no changes are made.  Social Security trust funds will be depleted at some point in the 2030s. I will set aside a policy discussion on Social Security because we are on a healthcare website, but I do give Sen. Bob Cassidy, R-LA, credit for calling out both Trump and Biden for having no Social Security reform plan. Cassidy is looking at creative ways to bolster the fund.

No real discussion on Medicare, either

I don’t think either Joe Biden or Donald Trump are serious about protecting Medicare or Social Security. Neither has proposed a robust plan to truly stabilize Medicare for the long term.  Sure, Biden has now proposed a wealth tax to help fund the Part A Trust Fund (bankrupt in the early 2030s at last look), but it simply extends the fund’s life. He usually solves problems with more taxes. You might argue that Medicare drug price negotiations represent true reform. Yes, I give Biden credit for that, but that covers just one sliver of the overall program. Overall, what he has proposed is not substantive reform.  The Trump of this election refuses any real discussion on entitlement reform. Somehow he feels his status as a former president means he has no duty to tell voters what policies he would have if he were re-elected.

This year we did have some hope that entitlements, and more specifically Medicare, might be substantively discussed.  Former House Speaker Kevin McCarthy had signed onto the idea that there should be a fiscal commission created to look at entitlements and propose reforms outside of the political spotlight.  Congress might then have to vote up or down on proposals that came back. In the Senate, a group of bipartisan senators had proposed something similar.  But so far, no bill has passed. 

The public’s view

The public is fickle.  At election time, the message is: “don’t touch my Medicare.”  At other times, polls show a more sophisticated electorate, one that recognizes the solvency problems, the need for structural reform, and the need to have some changes to ensure the program is there over the long term.

My Medicare plan

What worries me is that Biden is using Trump’s comments to solidify the political nature of entitlement reform. He attacks on the notion that Trump somehow would take away your Medicare.  Not fair and also not very constructive. 

I say it is time for all of us to demand candidates tell us what they truly would do on reform – and taxing the rich alone cannot be the answer. 

For what it is worth, here is my plan taken from my book, The Healthcare Labyrinth (a bit abbreviated).  In the world we live in now, I admit that if Marc Ryan were running for president, he would have blistering attack ads being run against him. Or would he?  Would the electorate recognize the intent is to have a healthy dialogue on the issue?

Here is the rough plan for both Medicare and Medicaid as both programs are clearly unsustainable and should be reformed together. They serve many of the most complicated cases and Medicaid is our public program for long-term care. My book, The Healthcare Labyrinth (available at this site) also has a comprehensive plan for healthcare reform overall, some of which I have touched upon in other blogs:


  • Means testing the program or having wealthier folks pay more for premiums and cost-sharing
  • Looking at the eligibility age
  • Refining the Medicare payment system for medical services and drugs
  • Re-examining the benefit structure, such as augmenting in some areas and deprioritizing others
  • Reining in fraud, waste, and abuse
  • Reining in myriad reform pilots in traditional Medicare in hopes of gaining traction on lowering costs and improving quality
  • Fostering additional growth in Medicare Advantage (MA) as well as a delinking of the rate structure from inefficient traditional fee-for-service (FFS)
  • Enhancing how dual eligible populations are overseen, especially integrating medical and long-term care between Medicare and Medicaid
  • Allowing people to opt out of Medicare with a premium subsidy from the federal government that they could take somewhere else to obtain coverage
  • Some changes in taxation to balance benefit and other cost savings


  • Look at the rich benefit and onerous mandates
  • Consider scaled premiums and cost-sharing based on income
  • Reform the entitlement nature of the program, with a middle-ground generous and flexible per-capita cap program (sensitive to regional cost, economic, inflationary, and other winds)
  • Refine federal matching rates, including reimbursing only to a certain level of benefits and income
  • Address low provider reimbursement so as to improve network access, establish medical homes, boost quality, and alleviate pressure on the commercial and Medicare worlds
  • Institute reasonable personal responsibility measures to change behaviors
  • Create a national aging plan, including a buy-in strategy to long-term care services


The truth is, both candidates are absolutely irresponsible for not having real policies to transform entitlements for the long term. Both would kick the political can down the road. W need real policy proposals. We cannot wait any longer.  The longer we wait to make some tough decisions, the greater the pain later and the less likely we can sustain the programs. 

But we do need sensible people who will bury politics and extreme positions for a time to strike the bargain.  That appears to be severely lacking in Washington.

#medicare #medicaid #managedcare #entitlementreform #coverage #healthcarereform #healthcare

— Marc S. Ryan

Leave a Reply

Your email address will not be published. Required fields are marked *

Available Now