Beto O’Rourke’s Ambitious Health Care Plan

America's health care system remains a nightmare for countless Americans who are either under insured or find themselves with medical decisions being driven my insurance companies seeking to minimize payouts rather than doctors and medical professionals.  And even with "good coverage," the deductibles can be staggering and can financially strain average Americans who simply do not have thousands of dollars lying around. Something needs to be done, but the question is what.  Some Democrat presidential candidates are lauding "Medicare for all" - Medicare still is not free and requires regular payments - which those on the right (who put little value of on the lives of most of us) say is too costly. In a response to the problem, Beto O'Rourke seems to be fashioning a proposed solution.  A piece in Slate looks at the matter.  Here are highlights:

Beto O’Rourke may not be feverishly churning out policy white papers like some of his presidential rivals, but over the last few days, the hand-wavy former representative from Texas has at least started clarifying his position on health care. And for a candidate who seems to be carving out space in the Democratic field as a relative moderate, it’s strikingly ambitious.

While campaigning in Iowa on Friday and over the weekend, O’Rourke backed away from his previous support for Bernie Sanders’ single-payer bill. The former Senate candidate told an audience that he was “no longer sure” it was “the fastest way” to achieve “guaranteed, high-quality universal health care for all.” Instead, he talked up another piece of legislation currently kicking around Congress known as “Medicare for America.”

Introduced by a pair of progressive congresswomen, Reps. Rosa DeLauro and Jan Schakowsky, Medicare for America offers a sort of middle ground between a true, Sanders-style single-payer system—which would ban private comprehensive health coverage—and a more modest public insurance option. (It is extremely similar to a proposal crafted by the Center for American Progress, which I’ve described as “single-payer with American characteristics.”)

The bill creates a new, revamped version of Medicare that would be open to all adults and children. It would automatically enroll newborns, the elderly, and the uninsured. It would also bar insurance companies from selling policies to individuals that duplicated the government’s coverage, meaning it would largely wipe out the nongroup market as we now know it. However—and this part is key—the bill would permit businesses to continue offering private insurance as a benefit, as long as it was as comprehensive as today’s gold plans. Companies would also have the option of purchasing Medicare for their employees by paying a tax equal to 8 percent of their annual payroll. Individual workers could opt for the government plan, as well.

One of the major political selling-points of Medicare for America is that it wouldn’t necessarily force workers off of the health plans they currently receive through their jobs, which many people still like, or at least are hesitant to give up. Polling suggests that support for Medicare for All drops drastically when voters are told that it would eliminate private insurance . . . . (The Kaiser Family Foundation has found that 73 percent of Americans back the idea of a national health plan if it would let them keep their current coverage).

That seems to be Beto’s wager.

“It responds to the fact that so many Americans have said, ‘I like my employer-based insurance. I want to keep it. I like the network I’m in. I like the doctor that I see,’ ” O’Rourke said of the bill, according to the Texas Tribune. “It complements what already exists with the need that we have for millions of Americans who do not have insurance and ensures that each of them can enroll in Medicare. It then suggests additional investments in that program so it becomes the program of choice and people who have private insurance migrate over to the Medicare system.”

Another advantage to Medicare for America is that it would be cheaper than single-payer, at least so far as the federal budget is concerned. There are no public cost-estimates for the bill yet. But it would almost certainly save Washington money compared to the Sanders approach, because it would not require immediately transitioning the entire employer-sponsored market onto a government health plan. The new version of Medicare also wouldn’t be free for everyone; families earning more than 200 percent of the poverty line would pay premiums—they would go up with income, but be capped at no more than 9.69 percent of a household’s earnings—as well as copays and deductibles. Of course, the Sanders bill wouldn’t exactly be free either; instead of paying “premiums,” households would simply pay taxes. To a certain extent, the difference there is semantic. While Medicare for America is not a single-payer system, it could create the bones of one, and gradually transition the country in that direction over time as it automatically enrolled more individuals and more businesses chose to buy in. At the same time, by preserving private coverage, it could leave a pressure valve in place, giving voters another option in case the new system doesn’t work out quite as smoothly as its supporters hope (we all remember the rough early days of Healthcare.gov, after all). In the scheme of major Democratic health care plans, it’s arguably the second most far reaching after the Sanders bill; it would do more to fundamentally change the U.S. insurance system than the Medicare or Medicaid buy-ins that other candidates have talked about, which would basically graft a public option onto Obamacare’s framework. Medicare for America would be something genuinely different.

Trump Budget: Slash Social Programs After $1.5 Trillion Gift to Wealthy

Trump message to seniors: just die. 

Once again demonstrating that He and the Republican Party want to bring back the Gilded Age when the wealthy lived in obscene extravagance which many Americans barely survived. After giving the very wealthy and large corporations $1.5 trillion in tax breaks - which has caused the federal deficit to balloon just as every sane commentator predicted - Trump and his enablers in the Republican Party seek to slash Medicare spending in Trump's just announced budget. Rest assured that Medicaid and other programs will be similarly targeted.  For those under 65, Medicare is NOT free.  Recipients pay quarterly premiums and, if they are smart, they purchase a supplement that entails monthly premiums as well.  And for those working past 65, you also continue to pay Medicare withholding tax (I now pay more in Medicare withholding that I did for many years in income tax) - which added to withholding over one's working career can total to a large number. Medicare is anything but an "entitlement."  The same holds true for Social Security.  Thus, Trump's proposal can be described as making working Americans - including the cretins who voted for Trump and the GOP - pay into the Medicare and Social Security systems and then reducing their benefits to give lavish tax cuts to the wealthy.  The Washington Post looks at Trump's budget and the gift it may constitute to Democrats.  Here are article excerpts:

A new proposal by President Trump to slash Medicare spending puts Republicans in a political bind ahead of the 2020 election as Democrats are pitching an expansion of the popular health-care program for all Americans.

Trump’s 10-year budget unveiled Monday calls for more than $845 billion in reductions for Medicare, aiming to cut “waste, fraud and abuse” in the federal program that gives insurance to older Americans. It’s part of a broader proposed belt-tightening effort after deficits soared during the president’s first two years in office in part due to massive tax cuts for the wealthy.

The move immediately tees up a potential messaging battle between Democratic proposals for Medicare-for-all — castigated by Republicans as a socialist boondoggle — and a kind of Medicare-for-less approach. focused on cutting back on spending, from the GOP.

Democrats, including some seeking to challenge Trump in 2020, seized on the proposed Medicare cuts Monday as an example of the GOP seeking to balance the budget on the backs of the elderly and the poor after giving broad tax breaks to the wealthy.

“Make no mistake about it: Trump’s budget is a massive transfer of wealth from the working class to the wealthiest people and most profitable corporations in America,” Sen. Bernie Sanders (I-Vt.), a Democratic presidential candidate, said in a Monday tweet that highlighted Medicare cuts.

In states with large senior populations, such as Florida, political attacks over Medicare cuts have proved so effective that both parties have used them. Sen. Rick Scott (R-Fla.) won his seat after running ads last year accusing Democrat Bill Nelson of voting to cut Medicare.

Trump probably needs to win Florida, Arizona, Pennsylvania and other states with large numbers of seniors to secure reelection in 2020. Older Americans consistently vote at higher rates than younger Americans.

Trump’s proposed Medicare savings are more than three times as large as those in his previous budget, and industry lobbying groups said the reductions would hurt hospitals and seniors. “The impact on care for seniors would be devastating,” Chip Kahn, president and CEO of the Federation of American Hospitals, said in a statement. “Hospitals are less and less able to cover the cost of care for Medicare patients, it is no time to gut Medicare.” Democratic strategists and officials argued Monday that Trump’s budget proposal exposed how little credibility Republicans have in debating health care, and showed signs of confidence that it would sharpen the contrast Democrats are seeking to make in the run-up to the 2020 election.

“It totally eviscerates any integrity to their already pretty flimsy attack,” Sen. Richard Blumenthal (D-Conn.) said. “This assault on Medicare lays bare the real Republican agenda, which is to destroy the health-care safety net. They have no shred of intellectual underpinning or integrity to their attack on Democrats if they make this kind of proposal.”

In last year’s midterm elections, Democrats campaigned aggressively on health care, attacking Republicans over their failed effort to repeal and replace the Affordable Care Act. The dynamic marked a shift from the two previous midterm elections, during which the GOP was the party mainly going on offense on health care, slamming Democrats over the creation of the ACA, also known as Obamacare. “This budget says a lot about the President’s priorities: cut $845 billion from Medicare, while spending billions on his vanity project, the wall,” Sen. Kamala D. Harris (D-Calif.) tweeted, referring to Trump’s request for border wall funding. “This would hurt our seniors and is yet another piece of evidence for why we need a new president.” “It’s a political fumble on the Republican part in the sense that this budget is going nowhere,” he said. “The argument prior to this was the Democrats’ plan versus the status quo. And now it’s the Democrats’ plan versus the Republican plan to cut Medicare.”

Sen. Brian Schatz (D-Hawaii) said on Twitter: “One party wants to expand Medicare and Medicaid and the other wants to cut them. That’s the end of my tweet.”

The question will be whether the racism of Trump's base and that base's hatred of others outweigh their own economic/health care best interest.  If these folks continue to support Trump, they truly deserve to suffer every misfortune imaginable and should get no sympathy from others. 

McConnell Blames "Entitlements", Not Massive Trump/GOP Tax Cuts for Rising Deficits

One need not be a math whiz to do the math involved in comparing the amount of the massive Trump/GOP tax cuts to the very wealthy and huge corporations with the amount by which the federal deficit is soaring.  Yet, Mitch McConnell is ignoring this simple arithmetic exercise and is blaming the federal deficit on "entitlements" such as Social Security and Medicare into which American taxpayers have been paying funds their entire working lives.  In my own case, over the years, I have paid a very large sum into Social Security and Medicare, yet McConnell is depicting me and millions like me as greedy, irresponsible freeloaders looking for a free give away.  Meanwhile, McConnell and his wife have parlayed their political positions to become very wealthy and, in McConnell's case, he enjoys a platinum retirement package that relieves him of the financial concerns the rest of us have to deal with.  The man is despicable.  Give massive tax cuts to the obscenely wealthy and then demand cuts to programs for the poor, the middle class, and the elderly.  This from a man and political party that pretends to honor "Christian values."  A piece in Bloomberg looks at this foul batshitery.  Here are highlights:

Senate Majority Leader Mitch McConnell blamed rising federal deficits and debt on a bipartisan unwillingness to contain spending on Medicare, Medicaid and Social Security, and said he sees little chance of a major deficit reduction deal while Republicans control Congress and the White House.

“It’s disappointing, but it’s not a Republican problem,” McConnell said Tuesday in an interview with Bloomberg News when asked about the rising deficits and debt. “It’s a bipartisan problem: unwillingness to address the real drivers of the debt by doing anything to adjust those programs to the demographics of America in the future.”

McConnell’s remarks came a day after the Treasury Department said the U.S. budget deficit grew to $779 billion in Donald Trump’s first full fiscal year as president, the result of the GOP’s tax cuts, bipartisan spending increases and rising interest payments on the national debt. That’s a 77 percent increase from the $439 billion deficit in fiscal 2015, when McConnell became majority leader.

Shrinking those popular programs -- either by reducing benefits or raising the retirement age -- without a bipartisan deal would risk a political backlash in the next election. Trump promised during his campaign that he wouldn’t cut Social Security, Medicare or Medicaid, even though his budget proposals have included trims to all three programs.

The Office of Management and Budget has projected a deficit in the coming year of $1.085 trillion despite a healthy economy. And the Congressional Budget Office has forecast a return to trillion-dollar deficits by fiscal 2020.

Republicans in December 2017 also passed a tax cut projected to add more than $1 trillion to the debt over a decade after leaders gave up on creating a plan that wouldn’t increase the debt under the Senate’s scoring rules.

At the time, McConnell told reporters, “I not only don’t think it will increase the deficit, I think it will be beyond revenue-neutral.” He added, “In other words, I think it will produce more than enough to fill that gap.”

Senate Minority Leader Chuck Schumer of New York responded Tuesday by saying McConnell and other Republicans “blew a $2 trillion hole in the federal deficit to fund a tax cut for the rich. To now suggest cutting earned middle-class programs like Medicare, Social Security and Medicaid as the only fiscally responsible solution to solve the debt problem is nothing short of gaslighting."

House Minority Leader Nancy Pelosi of California said in a statement, “Under the GOP’s twisted agenda, we can afford tax cuts for billionaires, but not the benefits our seniors have earned.”

Republican Blatant Lies on Health Care

I view quality health care for all citizens as something very important.  First, if one is a moral person - I can't say Christians because evangelicals continue to prove themselves to be both morally bankrupt and hypocrites nearly daily - the welfare of others, especially children and the elderly ought to concern you.  Secondly, Americans pay the highest costs for health care of any developed nation because we fail to cover preventive care and as a result have people flooding ER's with catastrophic illnesses that could have been either avoided or greatly lessened in magnitude.  These un-reimbursed costs get passed on to everyone else and drive up insurance premiums.  The simple math is that to save money, one needs to spend money on basic and preventive care.  A third reason is that from personal experience when one of my children came down with a rare and very deadly disease, I understand how unexpected medical bills can ruin one financially.  Even with "excellent insurance" all of our savings were wiped out and it took me four years to pay off the balance of the bills.  But for a well paying job, I'd have been forced into bankruptcy.  

Polls indicate that a majority of Americans similarly deem health care and access to health care insurance as important, especially when it comes to pre-existing conditions.  Yet what do Republicans want to do?  Gut the Affordable Health Care Act, allow insurance companies to deny coverage to those with pre-existing conditions (or charge them exorbitant rates).  Worse yet, to finance the Trump/GOP tax cuts they want to make cuts in Medicaid and Medicare.  But heven forbid that they be honest with voters about their agenda.  Instead, as a column in the New York Times notes, the blatantly lie.  Here are column excerpts:

Republicans no longer bother with deceptive presentations of facts. Instead, they just flat-out lie.

What do they lie about? Lots of things, from crowd sizes to immigrant crime, from steel plants to the Supreme Court. But right now the most intense, coordinated effort at deception involves health care — an issue where Republicans are lying nonstop about both their own position and that of Democrats.

The true Republican position on health care has been clear and consistent for decades: The party hates, just hates, the idea of government action to make essential health care available to all citizens, regardless of income or medical history.

This hatred very much includes hatred of Medicare. Way back in 1961, Ronald Reagan warned that enacting Medicare would destroy American freedom. Maybe it’s just me, but I don’t think that happened. Newt Gingrich shut down the government in an attempt to force Bill Clinton to slash Medicare funding. Paul Ryan proposed ending Medicare as we know it and replacing it with inadequate vouchers to be applied to the purchase of private insurance.

And the hatred obviously extends to the Affordable Care Act. Republicans don’t just hate the subsidies that help people buy insurance; they also hate the regulations that prevent insurers from discriminating against people with pre-existing conditions. Indeed, 20 Republican state attorneys general filed a lawsuit trying to eliminate protection for pre-existing conditions, and the Trump administration has declined to oppose the suit, in effect endorsing it.

So if you’re a voter who cares about health care, it shouldn’t be hard to figure out where the parties stand. If you believe that Medicare is a bad thing and the government shouldn’t protect people with pre-existing conditions, vote Republican. If you want to defend Medicare and ensure coverage even for those who have health problems, vote Democrat.

But Republicans have a problem here: The policies they hate, and Democrats love, are extremely popular. Medicare has overwhelming support. So does protection for pre-existing conditions, which is even supported by a large majority of Republicans.

Now, you might imagine that Republicans would respond to the manifest unpopularity of their health care position by, you know, actually changing their position. But that would be hopelessly old-fashioned. As I said, what they’ve chosen to do instead is lie, insisting that black is white and up is down. Thus Josh Hawley, as Missouri’s attorney general, is part of that lawsuit against Obamacare’s regulation of insurers; but in his campaign for the Senate, he’s posing as a defender of Americans with pre-existing conditions. Dean Heller, running for re-election to the Senate in Nevada, voted for a bill that would have destroyed Obamacare, including all protection for pre-existing conditions; but he’s misrepresenting himself just like Hawley is. All of which brings me to a remarkable op-ed article on health care in USA Today, which was published under Donald Trump’s name . . . Part of the article claimed that the Trump administration is defending health insurance for Americans with pre-existing conditions, when the reality is that it has tried to destroy that coverage. And what did “Trump” say Democrats would do? Why, that they would “eviscerate” the current Medicare program. Oh, and that they would turn America into Venezuela. Because that’s what has happened to countries that really do have single-payer, like Canada and Denmark.

Why do Republicans think they can get away with such blatant lies? Partly it’s because they expect their Fox-watching followers to believe anything they’re told.

But it’s also because they can still count on enablers in the mainstream news media. After all, why did USA Today approve this piece? Letting Trump express his opinion is one thing; giving him a platform for blatant lies is another. And as fact-checker Glenn Kessler of The Washington Post put it, “Almost every sentence contained a misleading statement or a falsehood.” Even the president of the United States isn’t entitled to his own facts.

So will the G.O.P.’s Big Lie on health care work? We’ll find out in a few weeks.

Politicians Continue to Allow Big Pharma to Screw Americans

Americans pay more for healthcare than residents of any other developed country.  The same goes for drugs.  It is common for American consumers to pay three times (often many times more) the prices paid in Europe, Canada and even Mexico.  The reasons for this rip off of American consumers?  First, the lack of a decent, national health insurance system where managing care, not maximizing prices for private interests, is the goal  Nowhere is the greed and rapaciousness in American healthcare worse than in the area of prescription drugs.  Big Pharma is allowed to hold monopoly power and charge whatever outrageous price it wants and the government refuses to force price negotiations of prices for programs such as Medicare.  The result stems from politicians being bought by pharmaceutical companies.  Indeed, Congress has played a huge role in allowing the opioid epidemic to grow by tying the hands of would be government regulators.  A piece in the New York Times looks at America's broken system.  Here are excerpts: 

So Donald Trump broke another promise: he did not, after all, empower Medicare to negotiate lower drug prices. Instead he (and Michael Cohen, who definitely isn’t his bagman) took money from drug lobbyists, appointed them to key positions, and announced a plan that sent drug stocks soaring. I’m sure you’re shocked.

But promise-breaking aside, would introducing a policy of bargaining drug prices down have been good for America? Actually, yes.

Oddly, I never got around to doing my homework on the economics of drug-price bargaining – partly because I was realistic enough about the political economy to realize that it wasn’t going to happen in America any time soon. Still, the fact that Trump promised to do something makes it somewhat relevant, even if he did predictably break that promise. And it turns out that the economic case for doing what Trump just didn’t do, for putting caps on drug prices, is remarkably strong.

Let’s start with where things are right now. After a drug company gets a patent, it has a temporary monopoly on sales of its drug. So its situation looks like that of a standard monopolist . . . It charges a price that is above the marginal cost of producing the drug – usually well above marginal cost.

[O]verall, society gains from the drug’s existence. However, . . . . society would gain more if someone – regulators, purchasing managers at government agencies, whatever – forced the drug company to charge less than the monopoly price.

[T]he United States would almost certainly be better off with a moderate level of bargaining/price control than it is under the current hands-off regime. Why? I count at least four distinct reasons.

First, a point made by Lackdawalla and Sood is that the profit effects of constraining a monopolist’s price are second-order. . . . . What’s going on here is that the profits lost on existing sales are almost fully offset by the profits on additional sales.

What this means in turn is that the negative effect on innovation is small if prices aren’t pushed down a lot, while the consumer gains are first-order. Some price bargaining is always welfare-improving.

Second . . . . . it’s often argued that pharma companies basically develop too many drugs, wasting resources on what amounts to unnecessary duplication. To the extent that this is true, discouraging some innovation isn’t a bad thing.

Third, the consumer surplus calculation assumes that consumers actually pay for the drug. In fact, many drugs are paid for by insurers – which is necessary, because like much of modern medicine the cost if you need it is far beyond most people’s ability to pay out of pocket. But this means that the price someone is willing to pay may greatly exceed the value to the patient. In general, the interaction of drug insurance with monopoly pricing creates potentially huge distortions in both drug development and drug use, reinforcing the case for bargaining.

Finally, it’s a global market – which means that much of the consumer surplus from drug development accrues to foreigners, not U.S. citizens. Maybe there should be more drug development from the point of view of global welfare. But given the unique unwillingness of the U.S. to bargain over prices, we end up paying a much larger share of the costs of that development than we receive of the benefits. Funny how Trump is America first on everything, except when a nationalist position might be bad for Big Pharma.

Yes, Trump says he wants to force other countries to raise drug prices. Good luck on that.

What this comes down to is that there is a very strong case for doing what Trump promised to do but didn’t. I’m aware that simply saying “let’s bargain over drug prices” isn’t effective unless coupled with a willingness to say no – to tell a drug company that an overpriced drug will be excluded from the formulary. So it wouldn’t be politically easy. But it would be good economics.

After Huge Give Away to Wealthy, Republicans Target Medicare and Social Security

Republicans celebrating the $1.5 trillion tax cut.

While it is very difficult to outdo Donald Trump when it comes to lying incessantly, Paul Ryan and other Republicans are trying hard to meet he Trump standard of dishonesty by blaming Social Security and Medicare for the ballooning national debt conveniently forgetting the $1.5 trillion give away  to the obscenely wealthy and huge corporations that they enacted only a few months ago.  How these despicable individuals have the gall to claim that they stand for "Christian values" when their agenda to slash the social safety net is the antithesis of Christ's gospel message.  A piece in the Los Angeles Times looks at the lies, deceit and desire to harm average Americans being pushed by Paul Ryan - who hypocritically claims to be a "devout Catholic" - and similar despicable liars.  If you believe Ryan and "conservative" economists, I have some swamp land to sell to you.  Here are article excerpts:

One would have thought that after saddling the U.S. economy with a tax cut costing $1.5 trillion over 10 years, conservatives and their patrons in corporate America would soft-pedal the usual attacks on Social Security, Medicare and Medicaid.

One would be wrong.

Recently, the drumbeats for cuts in social insurance benefits have been sounding louder. As is traditional, the call for cutbacks is placed in the context of concern about rising federal deficits. Just two weeks ago, five economists and thinkers at the conservative Hoover Institution evoked the "debt crisis" in the pages of the Washington Post.

"To address the debt problem, Congress must reform and restrain the growth of entitlement programs and adopt further pro-growth tax and regulatory policies," wrote the Hooverites, Michael J. Boskin, John H. Cochrane, John F. Cogan, George P. Shultz and John B. Taylor. As for the tax cut bill enacted in December, the sages said not to worry: They called it "a good first step, as it sharply increases the incentive to invest and grow businesses, which will increase incomes." [T]he Committee for a Responsible Federal Budget . . . reckon that the cuts could cost as much as $1.7 trillion over a decade, net of any economic gains it might engender. The Hoover fellows aren't alone in calling for cutting social programs, effectively to pay for tax cuts that go overwhelmingly to corporations and the wealthy. We've documented how Republicans such as House Speaker Paul Ryan of Wisconsin and Sen. Marco Rubio of Florida started calling for benefit cuts even as the tax bill was making its way through Congress. For the record, the Congressional Budget Office projects that Social Security will rise from an average share of 4.9% of gross domestic product now to an average of 5.5% over the next 10 years. Medicare and Medicaid together will rise from 5.4% now to an average of 6.3% in the same period. To place these figures in context, the CBO also expects GDP to nearly double in that time period, to $29.8 trillion. The tax cuts, by the way, will help push the federal deficit over $1 trillion next year, according to the CBO, which makes clear that they won't pay for themselves. "The tax cuts passed last year actually added an amount to America's long-run fiscal challenge that is roughly the same size as the preexisting shortfalls in Social Security and Medicare," wrote Martin Neil Baily, Jason Furman, Alan B. Krueger, Laura D'Andrea Tyson and Janet L. Yellen. "It is dishonest to single out entitlements for blame….The primary reason the deficit in coming years will now be higher than had been expected is the reduction in tax revenue from last year's tax cuts, not an increase in spending." As is invariably the case, the brief against "entitlements" is peppered with misconceptions and outright untruths. The biggest scam related to the tax cuts is the assertion that they'll provide an "incentive to invest and grow businesses," as the Hoover fellows wrote. The CBO projects that the tax act will increase real GDP by an average of 0.7% and nonfarm employment by an average of 1.1 million jobs a year through 2028, but says those effects are front-loaded and will fade as the decade wears on. The evidence thus far is that the shareholder class will receive gluttonous wedges of the pie, while working stiffs will get crumbs. According to a study by the progressive group Americans for Tax Fairness, Fortune 500 corporations will pocket a total annual tax cut of more than $57 billion a year. Those companies have announced wage increases and employee bonuses totaling about $5.7 billion, and stock buybacks of nearly $201 billion.
Indications that businesses of any size will use their tax cuts to make capital investments are hard to find.

The politicians unsheathing their paring knives for Social Security and Medicare undoubtedly are hoping that Americans' memories are short — that when they claim that it's social programs like these that are driving the deficit, no one will recall that the single biggest driver of red ink is that tax cut delivered to the very members of society who needed help the least.

Is Trump Leading Republicans to Slaughter?

It is Thanksgiving Day - a day for family and friends and hopefully a little bit of love for one's fellow citizens.  Yet even as families gather, Congressional Republicans are taking only a brief respite from the effort to harm countless middle and working class families and the elderly through a tax plan that benefits the very wealthy and large corporations. Most Americans oppose the plan and groups like AARP - which represents the most dependable voters - are condemning the savaging of Medicare and other social programs.   Der Trumpenführer - who estimates show might enjoy a billion dollar benefit - is of course supporting the effort and is supporting alleged child molester Roy Moore because Moore's vote is "needed for the tax bill."  A lengthy piece in Newsweek raises the question of whether Trump is leading the GOP to a slaughter.  I for one, hope that such is the case.  When I left the GOP as the Christofascists (and the white supremacy they brought with them) were ascendant I concluded that only the ruin of the party could excise the cancer.  Here are article highlights:

The prophet led the faithful into the jungle, where he promised they would find salvation. . . . That place was called Jonestown, a village hacked out of the jungle of Guyana. The Reverend Jim Jones did not manage to turn the settlement into the earthly paradise he’d promised his parishioners. In 1978, after a shootout that left visiting U.S. Representative Leo Ryan and four other members of a visiting delegation dead, Jones ordered his followers to perpetuate one of the most grotesque acts of mass murder in American history. “How very much I've tried my best to give you a good life,” he opened his final sermon, laden with dark grievance, as 900 people prepared for their deaths. “But in spite of all of my trying, a handful of our people, with their lies, have made our lives impossible.”

 Time now for the necessary and obvious caveats. Jonestown was a horrific act of homicide. No matter how much you dislike Trump, he is not Jim Jones. His impolitic tweets at North Korean despot Kim Jong Un notwithstanding, he does not harbor a death wish, either for himself or for the country. He probably has more compassion than his critics are willing to concede. And yet his influence on the party he now leads may well prove the political equivalent of Jonestown. Having assumed control of the GOP, Trump may now destroy it: its national infrastructure, its fundraising capacity and, most of all, its support from the American public. A Gallup tracking poll in early October found that only 24 percent of respondents identified as Republicans. That’s the lowest level of affiliation for the party in two years, a lack of popularity that is especially remarkable because Republicans control both the legislative and executive branches of the federal government. But whatever the case, the GOP appears to have made a fatal mistake in allowing itself to be seduced by his populism. All the glories of Trumpism will belong to Trump, while all the failures will be passed off to a hapless band he sometimes calls “the Republicans.” “Republican leaders have made a Faustian bargain with Donald Trump,” says Will Marshall, founder of the centrist organization New Democracy. . . . . Attempts by others to mimic his convictions have been pathetic, transparent and unsuccessful. In Virginia, Republican gubernatorial candidate Ed Gillespie, a creature of K Street boardrooms, ran a campaign of Southern racial grievance and anti-immigrant fearmongering. He lost by 9 points to Democratic Lieutenant Governor Ralph Northam a few weeks ago. Many prominent Republicans believe their party has come to resemble the adherents of Jones, drifting ever further from reality. Trump, meanwhile, has shown no interest in reconciling the disparate factions of the GOP, hectoring leaders of his own party on Twitter as if they were obscure backbenchers . . . .

The GOP “will face obliteration in 2018,” says Republican strategist Steve Schmidt, who served as chief strategist on John McCain’s 2008 presidential campaign. When we spoke recently, Schmidt blamed the party’s fortunes on McConnell and House Speaker Paul Ryan, Republican of Wisconsin, a duo that he says “make Neville Chamberlain look like Churchill,” a reference to the British prime minister famous for capitulating to Adolf Hitler in the Munich Agreement of 1938.  “You were given the choice between war and dishonor,” Churchill said in response to Chamberlain’s cowardice. “You chose dishonor, and you will have war.”

Bruce Bartlett, who served as a senior adviser to Ronald Reagan, told me he wishes there were a Republican who’d utter a basic truth: “Our party is being killed by these idiots” in the Trump administration. And a few have, including Senators Jeff Flake of Arizona and Bob Corker of Tennessee. They have both chosen to retire, however, aware that their anti-Trump positions would likely engender a ferocious primary battle.

Bartlett thinks fears of electoral defeat shouldn’t discourage critics. “It’s better for us to lose power for a generation than to continue this fraud.”

Many Americans dislike Trump’s vision for the nation, but they like the Republicans’ vision even less. Only 17 percent of Americans supported the Republican efforts to repeal and replace the Affordable Care Act. While the Republicans refuse to enact any tougher gun laws, Gallup finds that 60 percent of American support stricter gun laws. The vast majority of Americans rejected the Republican tax cut plan, with support as low as 25 percent in some polls. . . . It fell to Bartlett, the former Reagan adviser, to admit that correlations between tax cuts and economic growth were “a myth.” But once you’re in the jungle, the way out isn’t easy. The vacated Republican seats may entice Bannon-funded candidates who are true believers in Trumpism. That could turn the marriage of convenience between DJT and GOP into a suicide pact. Insurgent candidates such as former Alabama chief justice Roy Moore, who has been accused of child molestation and sexual misconduct, could prove far more devastating than establishment incumbents who may not share Bannon’s nationalist vision but will maintain Republican majorities in Congress.

Speaking last weekend in Arizona, unaware that a microphone had been turned on, Flake admitted to a fear shared by most of his establishment peers: “If we become the party of Roy Moore and Donald Trump, we are toast.”

“It's increasingly hard to see how they recover from this,” says Charles Sykes, the onetime conservative radio host who has left the party and written about it in How the Right Lost Its Mind. “By pandering to the Trumpists, they have isolated themselves from the majority of voters. And this association with Roy Moore will be radioactive.”

Trump may do for conservatives what Stalin did for American radicals, forcing them to re-evaluate their convictions. The onetime eager socialists of City College in the century’s first decades became the neoconservatives who formed the backbone of the Republican Party through the George W. Bush presidency . . . . Trump may try to blame Democrats for this dour national mood, but voters aren’t likely to be fooled. “The Republican brand is shattered for the millennial generation and young people,” Schmidt told me. “It’s shattered for all time for Latinos, with African-Americans. And it’s shattered not because of Trump’s terrible behavior, but because of the absolute cowardice of the leaders of the Congress”. Richard Painter, who served as the ethics lawyer for George W. Bush, wrote on Twitter that he intends to remain part of the loyal opposition to Trump. “I am staying a Republican,” he wrote. “Will not let GOP be taken over by Russian collaborators, racists, pedophiles and outlaws. Will oppose all elected officials who do not stand up for the rule of law.”

In response to that tweet, someone replied with the image of a tombstone for the Republican Party. The cause of death, the doctored tombstone declared, was Donald Trump.

House GOP Budget Bill Will Savage Medicare and Social Security

Republicans have already alienated younger voters with their reactionary social policies, including anti-LGBT policies demanded by the Christofascists who make up Der Trumpenführer remaining loyal base.   Now, with the House budget bill they seem about to alienate older Americans so as to benefit large financial institution and a wasteful Defense Department.  On the chopping block are Medicare and Social Security, often seen as the third rail in national politics, but targets of the GOP unrestrained reverse Robin Hood, despite the seeming collapse of the latest Trumpcare bill that lost two more Republican senators late yesterday due to the horrific impact the bill would have on millions of Americans.  And despite promises by  Der Trumpenführer that he would never countenance cuts to Medicare or Social Security.  Of course, we learned quickly that Trump's promises are worthless.   A piece in the Washington Post looks at the draconian House proposal that would accelerate the GOP's push to bring back the worse aspects of the Gilded Age.  Here are excerpts:

House Republicans unveiled a 2018 budget plan Tuesday that would pave the way for ambitious tax reform legislation — but only alongside a package of politically sensitive spending cuts that threaten to derail the tax rewrite before it begins.

The instructions in the draft budget, however, go well beyond tax policy and set the stage for a potential $203 billion rollback of financial industry regulations, federal employee benefits, welfare spending and more. 

Like the spending blueprint released this year by President Trump, the House plan envisions major cuts to federal spending over the coming decade, bringing the budget into balance by relying on accelerated economic growth to boost revenue. Under the House plan, defense spending would steadily increase over 10 years while nondefense discretionary spending would decline to $424 billion — 23 percent below the $554 billion the federal government is spending in that category this year.

Unlike Trump’s budget, the House proposal cuts into Medicare and Social Security — entitlement programs that the president has pledged to preserve. The House plan also makes a less-rosy economic growth assumption of 2.6 percent versus the 3 percent eyed by the Trump administration. Both, however, exceed the 1.9 percent figure eyed by the nonpartisan Congressional Budget Office in its most recent economic estimates.

 House Speaker Paul D. Ryan (R-Wis.) and the panel’s chairman, Rep. Kevin Brady (R-Texas), have said they intend to pursue a deficit-neutral reform bill, meaning the savings would have to be found in other programs under the committee’s jurisdiction — such as Medicare, disability aid, Temporary Assistance for Needy Families and unemployment compensation.

The Oversight and Government Reform Committee, which has explored cuts to the federal workforce and to federal employee benefits, would be required to find $32 billion in deficit savings.

Members of the hard-right House Freedom Caucus have been pushing for more aggressive long-term spending cuts in reconciliation. The group’s leader, Rep. Mark Meadows (R-N.C.), told reporters last week that the numbers in the draft budget could not pass the House, calling the proposed $203 billion in mandatory spending cuts over the coming decade a relative pittance in a federal budget that already approaches $4 trillion in yearly spending.

Moderates, meanwhile, are staging a revolt of their own. Twenty members of the centrist Tuesday Group signed a letter last month objecting to even $200 billion in mandatory spending cuts, arguing they are “not practical” and would “make enacting tax reform even more difficult than it already will be.”

Average Americans need to (i) hope this bill fails, and (ii) wake up to the reality that to the GOP they are little more than disposable trash.  Senior citizens who have been duped by the GOP's calls to racism and religious based bigotry could pay a high price if this bill and any version of Trumpcare pass.  Meanwhile, those with aging parents best grapple with the reality that they may end up housing the sick and frail parents or have to bear the high cost of their care in nursing homes.  The GOP message to the elderly?  Do us a favor and die.  As for federal employees in Northern Virginia, I hope they punish the GOP by voting a straight Democratic ticket in Virginia's November elections. 

GOP Senators May Yet Kill Obamacare Repeal

Word around Washington is that the fractious House Republicans may be able to cobble together a new bill to "repeal and replace" Obamacare.  Like its predecessor, this concoction would likely throw millions off of health insurance and allow premiums to soar for many even as disingenuous House members bloviate (read lie) about reducing costs, etc., etc.  Frankly, only a total fool would believe the claims since the number one goal in the House is a massive tax cut for the wealthy.  That said, anything that does manage to pass the House - likely on a pure party line vote - still faces sever obstacles in the Senate and not just from Democrats.  As a piece in Politico reports, a number of Republican Senators may be the bill's biggest obstacle.  Here are article highlights:

The House may finally be on its way to scrapping Obamacare, but don’t expect the Senate to go along: Any plan sent over will undergo major surgery — and survival is far from assured.

The hurdles in the upper chamber were on vivid display Wednesday as House Republicans celebrated their breakthrough on the stalled repeal effort. The compromise cut with House Freedom Caucus members won over the right flank, but the changes will almost surely make it harder to pick up votes in the more moderate-minded Senate.

“The Freedom Caucus has done a good job of trying to make the bill less bad,” Sen. Rand Paul (R-Ky.), one of the lead Senate agitators against the House health care push, said Wednesday. “For me, it’s a big stumbling block still that there’s taxpayer money that’s being given to insurance companies, and I am just not in favor of taxpayer money going to insurance companies.”

Phil Novack, a spokesman for Sen. Ted Cruz , also indicated that the conservative Texas firebrand isn't sold, saying “significant work remains” in the Senate, “specifically to address Obamacare’s insurance mandates and enact major patient-centered reforms that will further reduce the cost of health care.”

Sources say it may take more than a month for any House health care bill to run through the traps in the Senate, including internal party discussions and an analysis of how the measure would affect the deficit and insurance rolls. No committee hearings are planned because Republicans don’t want to give Democrats a public forum to bash an effort they are not involved in. And similar to the Senate's dim view of the House's proposal, the lower chamber may not ultimately be able to pass whatever the Senate is able to produce on Obamacare.

Weeks after the spectacular collapse of Obamacare repeal efforts last month, MacArthur and Meadows struck a deal with new language that would allow states to opt out of several key Obamacare provisions, such as its ban on charging sick people higher premiums and the so-called essential health benefits mandate that requires insurers to provide a set of minimum benefits.

The new language was enough to earn the formal endorsement of the Freedom Caucus, but House moderates who were opposed to the previous plan remain wary of backing a proposal that could cause constituents with pre-existing conditions to lose affordable health care coverage. In fact, the new plan may be having the reverse effect on some centrists: Rep. Mike Coffman (R-Colo.) had supported the initial Obamacare replacement but now says he’s a “maybe.”

Influential Senate Republicans also raised doubts about whether the new House proposal is workable. . . . Senators are likely to make Medicaid cuts less severe, deliver more money for opioid funding, make tax credits for the middle class more generous and rework the House’s waivers from Obamacare’s requirements.

In interviews with senators across a broad ideological range, there was growing irritation with attempts to ram complicated legislative language through the House and expect the Senate to clean it up. Some GOP senators suggested that a bipartisan bill may be the only way to overhaul the health care system in a lasting manner.

“I don’t know if this bill is better … the worst thing we can do is replace it with a Republican-only alternative that doesn’t drive down costs, that doesn’t improve access to care,” said Sen. Lindsey Graham (R-S.C.). 

Republicans in the House are desperate to pass a bill.  The fact that it would harm many seems to be irrelevant as long as they can say they passed something - and, of course, delivered a big tax cut to the most wealthy.

The Growing Support for a Single Payer Healthcare System

Last evening the husband and I were reviewing plan options for his salon staff (and us since I am about to roll off of coverage through my former employer that was far cheaper due to the size of the company).  The best description is to say that there are NO attractive options with the costs for us as a couple totaling to well over $1,500 per month ($18,000 per year).  That exceeds the individual annual payments on any of the mortgages on our properties and exceeds what we spend per year even when my hand surgery last year is factored in.  The winners in this game, of course, are the health insurance companies which laugh all the way to the bank.  It's little wonder that (i) health insurance companies are nearly universally hated and (ii) that more and more Americans - other than the wealthy, of course - support a single payer system.  A column in the Washington Post looks at this trend which collides head on with the GOP's effort to throw Americans off of insurance coverage to pad the wallets of the wealthy and insurance companies.  Here are excerpts:

Despite the rise of the tea party and unified Republican control of government, one decidedly anti-free-market idea appears ascendant: single-payer health care.

And it’s no wonder, given that a record-high share of the population receives government-provided health insurance. As a country, we’ve long since acquiesced to the idea that Uncle Sam should give insurance to the elderly, veterans, people with disabilities, poor adults, poor kids, pregnant women and the lower middle class.

Many Americans are asking: Why not the rest of us, too?

A recent survey from the Economist/YouGov found that a majority of Americans support “expanding Medicare to provide health insurance to every American.” Similarly, a poll from Morning Consult/Politico showed that a plurality of voters support “a single payer health care system, where all Americans would get their health insurance from one government plan.”

Divining the longer-term trend in attitudes toward this idea is difficult, as the way survey questions on the topic are asked has changed over time. Views of a health-care system in which all Americans get their insurance from the government single payer vary a lot depending on how you frame the question. Calling it “Medicare for all,” for example, generally elicitsmuch stronger approval, while emphasizing the word “government” tends to depress support.

But at the very least, some survey questions that have remained consistent in recent years show support has been rising back up over the past few years for the broader idea that the federal government bears responsibility for making sure all Americans have health-care coverage.

The increase in the share of Americans on government insurance is partly due to demographics (baby boomers aging into Medicare) and partly due to deliberate policy changes growing the pool of Americans eligible for government insurance (such as the creation of the Children’s Health Insurance Program and Obamacare’s Medicaid expansion).

In both the recent YouGov and Morning Consult polls, for example, the age group most opposed to single payer was the only one that basically already has it: those 65 and up. In other words, single payer for me but not for thee.

That’s not because older Americans hate their experience with Medicare and wouldn’t wish something similar upon their worst enemy. To the contrary, those on Medicare are more satisfied with how the health-care system works for them than people on private insurance are, according to Gallup survey data.

Rather, seniors are probably worried that expanding government coverage to more Americans could put their own generous benefits at risk. 

Trump supporters with deep hostility toward Obamacare, among other government programs. Some of these Trump supporters are, perhaps puzzlingly, themselves Obamacare beneficiaries, receiving government subsidies for private insurance on the individual exchanges. But often what these Trump voters say they want is not a return to pre-Obamacare days; rather, they want in on the great insurance deal that they think their lazy, less-deserving neighbors are getting.

House Speaker Paul D. Ryan (R-Wis.) and his congressional compatriots seem to further believe — despite all evidence to the contrary — that the private sector is on the verge of some innovation that will magically reduce health-care costs and give all Americans the coverage and care they yearn for. 

Americans as a whole pay through the nose for the least efficient and most costly health care system in the world.  Why can't this country learn from the experience of other advanced nations and opt for universal coverage and a single payer system?  Two reasons, I suspect: (i) many of the wealthy don't give a damn about their fellow citizens, and (ii) the evangelical Christians hate most of their fellow citizens and want to keep their monies for themselves.  

The GOP's War on Medicaid

Tom Price, President-elect Trump’s choice for secretary of health and human services, has made proposals to deeply cut Medicaid. Credit Joshua Roberts/Reuters        

The reality is that many of the working poor and elderly facing the need for long term care in their declining years depend greatly on Medicaid.  By extension, so do many health care providers, especially non-profit hospital systems that must treat all whether they have insurance or not.  Despite these realities, the Republican Party led by the always heinous Paul Ryan (born into wealth himself) seeks to dismantle the Medicaid system as well as Medicare.  If successful, America will return to the Gilded Age when the wealthy had quality health care and most of the rest of society did not.  The GOP message to the working poor and non-wealthy elderly is "please die and do us a favor."  This from the political party that feigns to cherish "Christian values."  The big question remains on e of when the idiots who gave into appeals to hate and bigotry and voted for Trump and Congressional Republicans wake up and realize that they have cut their own throats and figuratively signed their own death warrants.  As stated before, I have zero sympathy for adults who did this, but the price paid by millions of children will be deadly.  An article in the New York Times looks at this foul GOP agenda.  Here are highlights:

Progressives have already homed in on Republican efforts to privatize Medicare as one of the major domestic political battles of 2017. If Donald J. Trump decides to gut the basic guarantee of Medicare and revamp its structure so that it hurts older and sicker people, Democrats must and will push back hard. But if Democrats focus too much of their attention on Medicare, they may inadvertently assist the quieter war on Medicaid — one that could deny health benefits to millions of children, seniors, working families and people with disabilities.

Of the two battles, the Republican effort to dismantle Medicaid is more certain. Neither Mr. Trump nor Senate Republicans may have the stomach to fully own the political risks of Medicare privatization. But not only have Speaker Paul D. Ryan and Tom Price, Mr. Trump’s choice for secretary of health and human services, made proposals to deeply cut Medicaid through arbitrary block grants or “per capita caps,” during the campaign, Mr. Trump has also proposed block grants.

If Mr. Trump chooses to oppose his party’s Medicare proposals while pushing unprecedented cuts to older people and working families in other vital safety-net programs, it would play into what seems to be an emerging strategy of his: to publicly fight a few select or symbolic populist battles in order to mask an overall economic and fiscal strategy that showers benefits on the most well-off at the expense of tens of millions of Americans.

Without an intense focus by progressives on the widespread benefits of Medicaid and its efficiency, it will be too easy for Mr. Trump to market the false notion that Medicaid is a bloated, wasteful program and that such financing caps are means simply to give states more flexibility while “slowing growth.” Medicaid’s actual spending per beneficiary has, on average, grown about 3 percentage points less each year than it has for those with private health insurance, according to the Center on Budget and Policy Priorities — a long-term trend that is projected to continue. The arbitrary spending caps proposed by Mr. Price and Mr. Ryan would cut Medicaid to the bone, leaving no alternative for states but to impose harsh cuts in benefits and coverage.

Mr. Price’s own proposal, which he presented as the chairman of the House budget committee, would cut Medicaid by about $1 trillion over the next decade. This is on top of the reduction that would result from the repeal of the Affordable Care Act, which both Mr. Trump and Republican leaders have championed. Together, full repeal and block granting would cut Medicaid and the Children’s Health Insurance Program funding by about $2.1 trillion over the next 10 years — a 40 percent cut.

The Henry J. Kaiser Family Foundation estimated that a similar Medicaid block grant proposed by Mr. Ryan in 2012 would lead to 14 million to 21 million Americans’ losing their Medicaid coverage by the 10th year, and that is on top of the 13 million who would lose Medicaid or children’s insurance program coverage under an A.C.A. repeal.

The emerging Republican plan to “repeal, delay and replace” the A.C.A. seeks to further camouflage these harmful cuts. Current Republican plans to eliminate the marketplace subsidies and A.C.A. Medicaid expansion in 2019 would create a health care cliff where all of the Medicaid funds and subsidies for the A.C.A. expansion would simply disappear and 30 million people would lose their health care.

Sweeping cuts to Medicaid would hurt tens of millions of low-income and middle-income families who had a family member with a disability or were in need of nursing home care. About 60 percent of the costs of traditional Medicaid come from providing nursing home care and other types of care for the elderly and those with disabilities.

While Republicans resist characterizations of their block grant or cap proposals as tearing away health benefits from children, older people in nursing homes or middle-class families heroically coping with children with serious disabilities, the tyranny of the math does not allow for any other conclusion.

Democrats at all levels of government must aggressively communicate the degree to which these anodyne-sounding proposals would lead to an assault on health care for those in nursing homes and for working families straining to deal with a serious disability, as well as for the poorest Americans. With many Republican governors and local hospitals also likely to be victimized by the proposals of Mr. Ryan and Mr. Price, this fight can be both morally right and politically powerful. Republicans hold only a slight majority in the Senate. It would take only three Republican senators thinking twice about the wisdom of block grants and per capita caps to put a halt to the coming war on Medicaid.

America, largely thanks to Republicans and their "Christian" voting base, remains the only advanced industrial nation that views the bulk of its citizens as disposable garbage.    We have the least efficient healthcare delivery system and spend far more per capita on healthcare while receiving less benefit. Congressional Republicans want to make a bad system far worse and in the process likely kill thousands, if not millions of Americans over time if their agenda is realized.  It is because of these "Christian" politicians and their evangelical supporters that I no longer call myself Christian.  To me, being a Christian is something reprehensible and evidence of moral bankruptcy.   Sitting in the pews each week while voting for Republicans who push this agenda is the height of hypocrisy.  The Biblical Pharisees were far better than today's "conservative Christians."