GRAND DELUSION: Voters Now Face Realities of Far Right Politics
January 7, 2017
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AARP, the American Association of Retired Persons, is out with an explanation of what the Republicans who control Congress and the White House want to do to health reform.
Although their aims may seem counter-intuitive (i.e., crazy) to most people, it's important to understand where they are coming from: they just don't believe the government should have such programs even though the citizenry benefits!
In fact, according to New York Times columnist Paul Krugman, the most extreme Republicans -- like Speaker Paul Ryan -- think citizens should have little or no help from government -- on anything.
Apparently, this idea is what millions of Americans failed to grasp when they voted heavily Republican in November. If they believed Donald Trump's promises to protect Obamacare, Medicare, Medicaid and Social Security, they were badly deluded -- because there is little the Donald -- even if he really wanted to -- can do now that the GOP is in full control of the wheels of government.
Wrote Krugman Dec. 30 in the NYT: "Republican congressional leaders like Paul Ryan nonetheless seem eager to push ahead with repeal. In fact, they seem to be in a great rush, probably because they're afraid that if they don't unravel health reform in the very first weeks of the Trump era, rank-and-file members of Congress will start hearing from constituents who really, really don't want to lose their insurance.
"Why do the Republicans hate health reform? Some of the answers is that Obamacare was paid for in part with taxes on the wealthy, who will reap a huge windfall if it's repealed, even as many middle-income families face tax hikes.
"More broadly, Obamacare must die precisely because it's working, showing that government action really can improve people's lives -- a truth they don't want anyone to know.
"Since its creation in 1965, Medicare has been a 'defined benefit' program, guaranteeing a certain level of health coverage. It now pays about 80 percent of costs associated with doctor and hospital visits. Beneficiaries are responsible for paying monthly premiums, copayments, and annual deductibles.
57 million Americans rely on Medicare to afford health care, but Ryan would convert Medicare from a 'defined benefit' to a 'defined contribution' program. Instead of a guaranteed level of coverage, a dollar amount would be set for Medicare beneficiaries to pay premiums on insurance they would buy from private-sector companies (this is why Ryan calls it 'premium support'). Ryan's plan would also increase the eligibility age from 65 to 67.
A former chairman of the House Budget Committee, Ryan wants to limit how much the government spends on Medicare. In 2015, Medicare accounted for 15 percent of the federal budget, a proportion expected to grow as the number of beneficiaries rises.
"The reforms we're talking about do not affect the benefits for anyone in or near retirement," Ryan said last month. "But for those of us in the younger generations, it won't be there for us if we stay on the current path."
If that sounds like doublespeak, it's because it is just that. Ryan is an advocate, a devotee, of the misguided objectivist philosophy of Ayn Rand, the curmudgeonly "philosopher" who never met a government program she didn't hate.
AARP explains:
"Consumer advocates also want to address growing costs in the health care system, including Medicare. But they contend that Ryan's approach would erode much-needed coverage and shift costs to many who live on fixed incomes and continue to struggle in the shadow of the Great Recession.
"While Ryan says the annual subsidy would be greater for low-income people, critics say it is unlikely to keep pace with the rising costs of insurance. The result, they say, is that beneficiaries would shoulder more of the financial burden -- or go without needed medical care. Although Ryan also says people would be allowed to stay in traditional Medicare, critics argue his approach is designed to gradually increase out-of-pocket costs in the program and nudge beneficiaries into private plans with no guaranteed level of coverage.
"Opponents also say that there are better cost-saving options available. One of the most popular is giving Medicare the authority to negotiate prescription drug prices directly with drug companies. The change would help the federal government control a cost that accounts for $1 out of every $6 Medicare spends. That idea was supported by more than 80 percent of people in a Kaiser Family Foundation poll in 2015. As a candidate, Trump also embraced the idea, another potential point of friction with House Republicans, who generally oppose it, as does the pharmaceutical industry.
What Trump and GOP leaders wholeheartedly agree on is that the first order of business will be repealing the Affordable Care Act, also known as Obamacare. Republican congressional leaders want a repeal vote in January so that a bill can be on the president?s desk right after he is sworn in.
"Although it has received little attention, a full repeal of Obamacare would eliminate Medicare benefits created by the law. Among other things, it improved Medicare's financial outlook by slowing the growth of spending and clamped down on fraud, waste, and excessive payments. It also enabled tens of millions of Medicare beneficiaries to get free preventive services such as flu shots and screenings for cancer and diabetes. And between 2010 and 2015, nearly 11 million Medicare beneficiaries saved $20.8 billion on prescription drugs -- an average of $1,945 per person -- because of the gradual closing of the coverage gap known as the doughnut hole.
While Obamacare remains controversial -- in part because of its mandate to purchase health insurance and because premiums have increased for some plans -- the Medicare provisions have proved popular with beneficiaries.
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