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Trump says single-payer ends Medicare “as we know it.” That might not be a bad thing.

There’s this phrase I’ve been seeing pop up from top Republicans a lot over the past week: that Medicare-for-all would end the Medicare program “as we know it.”

”Throughout the year, we have seen Democrats across the country uniting around a new legislative proposal that would end Medicare as we know it,” President Trump wrote in an op-ed for USA Today this week.

House Speaker Paul Ryan was addressing the National Press Club yesterday when he said, “They now call it Medicare-for-all because it sounds good, but it actually ends Medicare in its current form.”

As Democrats increasingly move to support Medicare-for-all policies, this seems like an attack line we’ll see a lot: that Medicare-for-all will eliminate the Medicare that seniors know — and really love! — today.

So let’s unpack that idea.

In a way, it’s kind of obvious that Medicare-for-all would end Medicare as we know it — because Medicare as we know it is a program for Americans over 65, whereas Medicare-for-all is (you guessed it) a program that would be offered to all Americans.

This, of course, is not the implication of the attack that Ryan and Trump are making. The implication is that Medicare will change dramatically for the people who currently rely on it for care.

And that just isn’t true. If you look at the Medicare-for-all proposal from Sen. Bernie Sanders (I-VT), for example, you see that most of the changes seniors would see would make their insurance more generous. The Sanders plan would add dental and vision coverage, neither of which are currently included, into the Medicare program for seniors and add a $1,500 cost-sharing limit on top of the program.

Other Medicare-for-all proposals (which you can compare using this excellent tool from the Kaiser Family Foundation) make similar changes. Some would eliminate the premiums that seniors pay; others would eliminate or reduce certain copayments for medical services.

But taken together, the changes that Democrats want to make are all about making the Medicare program more generous.

There is certainly a discussion to be had about how we pay for a more generous Medicare program. If seniors are no longer paying a monthly premium for Medicare (as they currently do for Medicare Part B, which covers doctor visits), then the money will have to come from somewhere else – presumably increased taxes, lower payments to doctors, or some combination of the two.

The line that Medicare-for-all will end the program “as we know it” seems like one engineered to get past legions of newspaper fact-checkers and avoid their Pinocchios. It’s technically true but also quite misleading.

The real story here is that Democrats want to increase the generosity of Medicare for its current enrollees — and their big challenge is figuring out how to finance that type of change.

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in America’s health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.

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