Thursday, March 9, 2017

A Modest GOP Proposal: 21st Century Eugenics

Paul Ryan to the Plutocracy: Eat Poor Children Well

Another year, another Republican health plan. The 2017 edition of Eugenics USA Inc. is even more blatantly savage than usual, given that the GOP now controls all three branches of government. The Democrats are again reduced to feebly defending the market-based kludge grotesquely known as the Affordable Care Act. Countering the Republicans with a single payer, Medicare for All plan is apparently asking way too much of them. 

Ironically, it's the hardcore ("Freedom Caucus") conservative wing of the GOP which may end up granting a reprieve both to the middle class refugees clinging to their Obamacare plans, and to the vulnerable people who now depend on Medicaid for their very survival. According to the Hardcores, RyanCare or TrumpCare or We Don't Care, or whatever you want to call the latest hideous plan, simply doesn't go far enough. They not only don't want the government messing with our health care freedoms, they don't want the government subsidizing and enriching the rent-seeking insurance cartel, either.

Since the package keeps the most oligarch-enriching parts of the Affordable Care Act intact, the Freedom Caucus aptly calls it "Obamacare Lite." If only 19 House Republicans and only one Senate Republican nix it, the GOP bill is DOA.

Trump is therefore actively courting the holdouts, most notably his erstwhile nemesis, Lyin' Ted Cruz. They reportedly went bowling for dollars Wednesday night in the White House basement after an intimate dinner upstairs.

The worst part of the GOP's proposal, meanwhile, the one that is getting the least attention from a mainstream media more interested in protecting Barack Obama's legacy and lambasting GOP math than in advocating truly universal health care, is the proposed transformation of Medicaid into block grants. Long an Ayn Randian wet dream of House Speaker Paul Ryan, this block-granting scheme would give states the right to decide how federal Medicaid money is spent, even getting the sadistic option of rejecting this money out of pure spite.  Several red states, including Texas, have already opted out of the ACA's Medicaid expansion for the simple reason that they'd rather punish brown and black people than give their needy population, including whites, any health care at all.

Ryan's current proposal, which has received preliminary plaudits from Donald Trump, would eventually cut off all benefits to recipients after they have consumed whatever allotment of medical care that any given group of plutocracy-serving politicians deems sufficient. 

If Ryan gets his way, estimates the Center for Budget and Policy Priorities, tens of millions of vulnerable people -- children, the elderly, the low-paid working poor and the disabled -- will suffer.

The  slashing of federal benefits effectuated by the block-granting means that "states would likely have no choice but to institute draconian cuts to eligibility, benefits, and provider payments.  To illustrate the likely magnitude of these cuts, an analysis from the Urban Institute of an earlier block grant proposal from Speaker Ryan found that between 14 and 21 million people would eventually lose their Medicaid coverage (on top of those losing coverage if policymakers repeal the ACA and its Medicaid expansion) and that already low provider payment rates would be reduced by more than 30 percent."

 Ryan wants to do with Medicaid reform what Bill Clinton accomplished with welfare reform more than two decades ago. The repeal of FDR's Aid to Families With Dependent Children forced poor mothers receiving cash benefits to go to work for next to no pay, thereby suppressing wages for everybody, and having their cash benefits cut off entirely after a few years. As a result, Clinton and the then-GOP majority in Congress condemned millions of mothers and children  to lives of abject poverty. It's no accident that the death rate for indigent American women has gone up over this same time period. Hillary Clinton's boast that "by the time Bill and I left office, the welfare rolls had been reduced by 60%" has had the desired effect. The number of Americans living on less than $2 cash a day has doubled since welfare reform was signed into law.

(And they wonder why not enough struggling, depressed people turned out to give the Clintons another chance at governing as "progressives who can get things done.")

Many states, moreover, have used the matching federal block grant money granted by Clinton reform (Temporary Aid to Needy Families) for programs deliberately aimed at shaming and controlling the poor. Rather than receive direct cash aid, mothers are forced to attend parenting seminars and other mandated self-help programs on the supposition that poverty and ignorance and immorality go hand in hand.  A 2012 study conducted by the Center reveals that only 30% of the TANF block grants is spent directly on poor families. And since the start of the recession, this money is increasingly used by cash-strapped state governments for other services, such as policing poor people.

The ultimate core philosophy of the block grant scheme is unaccountability. The federal government would have no say on how the Medicaid money is spent. Rent-seekers are cordially invited to the free-for-all.

And if the Reform and Repeal of Obamacare does get through Congress and is signed by Donald Trump, the predatory class will have a trillion more dollars in tax breaks to burn. Less generous tax credits to middle class citizens to use for the purchase of private health insurance policies is a bait and switch tactic, because even the relatively better off will eventually become poor enough, sick enough and old enough to quickly deplete any "savings" gleaned from these tax breaks. This is inevitable, since the GOP plan does nothing to control the skyrocketing costs of medical care. The costs of both health care and insurance will only continue to rise, because the reform package also does away with the individual mandate to purchase the insurance, as well as remove limits on co-pays and deductibles.

"They may be able to afford low actuarial value coverage with the tax credits the bills would provide them" says Timothy Jost of Physicians for a National Health Plan, "but they are unlikely then to be able to afford the cost sharing that coverage will impose."

James Kwak of Baseline Scenario puts it even more succinctly:
  There are more details, but the basic outlines of the plan are simple: Cut taxes on the rich, cut spending on the poor, and expose more families to rising health care costs. The thing is, we’re talking about health care here. People will need the same amount of health care no matter what Congress does. If the government pays less for health care, poor people will have to pay more. If they can afford it, Trumpcare is effectively the same as a tax on the poor. If they can’t afford it, it’s even worse. This is as naked an example of class warfare as you’ll see today.


Kat said...

It is always easy to take away a benefit from the poor, but when the wealthy and powerful benefit, there is no prying it from their death grip. That is why I remain somewhat hopeful about medicaid.
The AMA and hospital groups are powerful political actors. They benefit from Medicaid expansion too (as do the insurance companies that administer medicaid and the pharmaceutical companies). Of course, I think the expansion of Medicaid was a truly dood part of Obamacare.
I think the Republicans are going to play at replacing, but they don't want to face the consequences of doing so.
I read about a plan to provide boxes for babies a la Finland. In Finland this seems like "Welcome, you're valued". Here, to get their boxes new mothers have to take classes on postpartum depression, parenting, and breast feeding (Nicholas Kristof would approve!).
For an excellent discussion on the dubious science behind the push to breast feed from a feminist perspective check out

Karen Garcia said...


Excellent point. The plutocrats will carefully weigh the pros and cons of Ryan's plan, and might very well opt for Medicaid protection... which does, after all, pay for drugs and medical devices. I imagine that Perdue Pharma, manufacturer of OxyContin, has an especially yuge vested interest in keeping depressed poor people hooked on their lovely drug.

Also, Democrat Elijah Cummings is now reportedly helping Trump to triangulate. Maybe a little slap on the wrist re prices for greedy drug makers in exchange for a giant slap on the rear end to poor people re rationed care and a little more "skin in the game" regarding benefits and co-pays out of their own pockets.

Additionally, the cable news shows and networks couldn't survive and their anchors couldn't be paid their millions without the largesse of the drug advertisers. Were it not for all those new diabetes drugs coming out, we might have remained ignorant about the Russian infiltration of our free and fair elections!

Poor people are a perpetual mother lode. The possibilities of extracting every last drop of blood, sweat and tears from them to nourish the plutocrats is seemingly endless. It's the reason that conservatives are so hell-bent on denying poor women birth control.

Neil said...

Re "Countering the Republicans with a single payer, Medicare for All plan is apparently asking way too much of them."

Has anyone actually made a presentation to Pres. Trump about a single payer Medicare for All plan? Specifically the Physicians for a National Health Program (PNHP)? The PNHP claims Medicare for All would save billions, see,

Pres. Trump may not know about the PNHP plan, or its contention that Medicare for All would save billions. If Pres. Trump backs a PNHP Medicare for All plan, fine. If not, then Trump’s refusal could be the basis of legitimate opposition.

Agreed that block grants are a disaster (for healthcare or anything else). Yes, "Rent-seekers are cordially invited to the free-for-all." Okay, what to do about it? Tax credit schemes generally do not benefit low income people who do not earn enough to have tax liability, unless the tax credit scheme accounts for those folks.

Given that the USA is so far behind other developed countries on universal healthcare, and no one is addressing the real reason (white supremacy), why not emigrate to a country that provides universal healthcare, if that is possible? At least one commenter on this blog lives in Canada, which may have a better healthcare system. The healthcare system in England is supposed to be good. People can still leave the USA... finding a smooth landing elsewhere might be a challenge.

Meredith NYC said...

I recently learned that TV Drug ads direct to consumers began in the 1980s. Before that it wasn't allowed, and drug co's marketed to doctors in professional medical lingo. Now their ads use the manipulative pitches on TV to the average person. So we're plagued day and night by drug commercials, a huge expense, profiting the media, and jacking up costs for the public.

By contrast European Union nations don't allow direct to consumer marketing of drugs. Are Americans even aware of this? EU sees it as a matter for doctor and patient--imagine that. So they are free from the obnoxious ads, have lower drug costs, and access for all to health care. We in the US have to pay indirectly with soaring drug prices for being marketed to constantly. One of the great hoaxes in any democracy.

And seems EU Right wing parties don't aim to repeal their universal h/c --it wouldn't be tolerated where they've had it for generations, even if with budget cuts. Canada since the 60s.

But in the US the Gop thinks it can get away with running for office on repeal of ACA, since they've laid the groundwork with decades of anti big govt propaganda. They and the ins co's were the death panels they warned about. Pretty nifty trick to play on citizens of the 'greatest world democracy'. And they caused the destruction of family security with medical bankruptcies that citizens abroad were protected from. But of course they're not as 'free' as Americans.

The media here always avoids international h/c comparisons. Seems verboten even by liberal advocates. Only Sanders mentions it,as he did today on CNN---BUT he doesn't explain how these countries finance and use it. He repeats the same old 1 sentence phrase and that's it.

Abroad, I've seen listed 3 types---single payer, or 2 Tier, or with insurance co mandates--but with govt regulations which here can't even be advocated. Now ACA seems better than it is, since the Gop wants to repeal it.

Bernie Sanders took a busload of cancer patients across the border to Canada to buy affordable medicine. He should have video taped that, or cited it in every campaign appearance. But we heard little about it, nor did we hear about his 2013 Senate hearings with residents of Canada, France, Denmark etc testifying about their h/c for all.
The US right wing has our liberals restricted too.

Meredith NYC said...

I've seen complaints about Canada under their conservative Harper. Forget details. Don't know what's happening with Trudeau on h/c.

I've read the French have great health care, but evidently lack proper dental care insurance. Doctors and dentists sometimes go on strike.

The British house of commons debates Sunday on Cspan show the labour party's Jeremy Corbyn always complains bitterly about h/c budget cuts and waiting times for some procedures, etc etc. Then Teresa May gets up and answers they've increased spending compared to the labour party. Don't know what to believe.

But the thing is that despite all this, they all start at a much better place than the US system. They don't leave out millions. Health care is a right for all. We divide people up by age, job, income, make different rules for them, have a myriad of 'networks', and keep excessive profits as 1st priority.

Imagine being proud of the fact that a 26 year old is allowed to stay on their parents' plan---if they have one. But the 27 year olds aren't! Abroad, age doesn't matter, or family relationships--that's protection instead of discrimination.

Seems their right wing parties don't aim to destroy their h/c access. And govt regulations, far from perfect, are accepted as centrist policy, while here, they can't even be discussed--it's so far out of the mainstream.

Neil said...

Thank you Meredith. Appreciate the points you made, especially your comment about complaints people may have. I believe the American healthcare system is most expensive, due in part to the practice of defensive (legal) medicine. Cuba is a poor country that delivered healthcare to its people. Healthcare in Cuba

This C-Span Q&A interview with T.R. Reid on YouTube is excellent. Also see,

Frontline: Sick Around The World, Five Capitalistic Democracies & How They Do It

In Sick Around the World, FRONTLINE teams up with veteran Washington Post foreign correspondent T.R. Reid to find out how five other capitalist democracies -- the United Kingdom, Japan, Germany, Taiwan and Switzerland -- deliver health care, and what the United States might learn from their successes and their failures...

Healthcare - Justice Network

annenigma said...

Imagine if the Democrats got their act together for just one issue, demanding Single Payer Medicare For All, and held rallies around the nation. In addition to delivering a strong message directly from the public to Trump, the Party might even energize voters to put them back in political office by showing leadership for a change. We all know it would get rousing support - exactly what they're afraid of. They can't betray Saint Barack and his/their corporate donors, so they're sacrificing themselves, and us, for money. Sad.

The latest Suffolk University poll shows the DEMOCRATS ARE EVEN LESS POPULAR THAN TRUMP! And by a large margin too. So probably someone with actual credibility needs to carry that banner.

Let's face it, the Democratic Party is unnsalvageable. They've slipped into hysterical, delusional Russia madness and can't escape their mass psychosis resulting from their precipitous withdrawal from Hopium, the highly addictive drug Obama peddled so sickly, I mean slickly. Hillary tried to pushing it too, but her fake stuff only caused the shakes. Dems now desperately need an intervention, but it's only going to come from losing more elections.

Brace yourselves. The only question now is whether a third party emerges or if we're stuck with Republicans for the next 20 years or so.

Check out the poll. I noticed there were more self-identified Democrats than Republican in this poll. Full poll linked below.

Pence: 47%/35%
Trump: 45%/47%
GOP: 37%/48%
Media: 37%/50%
Dem Party: 36%/52%
Hillary: 35%/55%
Congress: 26%/52%

Neil said...

Re annenigma

Truth: "Let's face it, the Democratic Party is unnsalvageable."

My humble edit: "Imagine if the [American People] got their act together for just one issue, demanding Single Payer Medicare For All, and held rallies around the nation. In addition to delivering a strong message directly from the public to Trump, the [American People] might even energize voters to [create an association of citizens] by showing leadership for a change. We all know it would get rousing support - exactly what [The American People need]."

Meredith NYC said...

Neil…. Right , TR Reid is needed now. Good to know he’s on youtube. He was on TV quite a while ago as the best advocate for h/c reform.

Where is he now in our h/c debate when we need him? I just went to his website and wiki article. He’s got the most convincing arguments in his book and PBS Frontline show, based on his wide research and living in other countries with his family, as a reporter.

He should be on cable TV news and NYT op eds. But he’s staying out of the natl media I guess, doing work in Colorado where he lives.

His wiki bio says he parted ways with PBS---they disagreed on the basic message of his documentary—the profit motive h/c blocking h/c reform. Back then they could never foresee Trump.
I may email him on his site, and ask---where are you now on our natl media as the h/c debate is front and center?? We need a rerun or a new Frontline.

Elizabeth -- Marysville said...

Neil, I think there is also another aspect to the cost of sick care in the U.S. I believe people are more litigious BECAUSE we don't have universal health care. If we didn't have to worry about the future expenses from a condition or disability which may have occurred during medical care, or on the job, or from an uninsured driver, or whatever else life throws at us, medical costs would probably be lower.

paintedjaguar said...

I think "defensive medicine" is largely a red herring anyway. First, if it was such a concern, there's no way such you'd see the sort of sloppy protocols as those which allowed a doctor in Florida to amputate the wrong foot, to cite just one case. To the contrary, medical care in the US has gone more and more towards a fragmented assembly-line structure which almost guarantees mishaps and poor care. Second, I could be wrong but I believe I've read that "tort reform" laws have already been passed in about half the states without making any noticeable dent in malpractice insurance costs.

Neil said...

Sorry for my delay in responding. Old age and disability are not fun.

@ Meredith

Medicare for All needs a new spokesperson, someone who is a dynamic personality to get the attention of Pres. Trump, the American People, and Congress.

Wikipedia reports T.R. Reid is age 72–73. T. R. Reid's next book, on taxes around the world, will be published on April 15, 2017. He may have moved on to taxes.

The Physicians for a National Health Program (PNHP) YouTube Channel

only has one video ready for prime time, a now-dated "Presidential Debate Question"

The rest of the PNHP videos consist of unappealing webinars, and low production value videos that are unappealing. Bernie Sanders age 75 is the only other major proponent of a national health program. Medicare for All needs a new spokesperson.

@ Elizabeth – Marysville

Excellent points. I would add, America needs to address "end of life care". Instead of calling it a "death panel", how about a "smart panel"? End of life care counseling would have benefited my friend recently while caring for her 87 year-old mother who stopped eating, was bedridden, and in a minimally conscious state. There was no chance of recovery, but my friend started a feeding tube for her mom which only prolonged everyone’s agony for almost 2 more years when her mother died at age 89. During those 2 years, her mother developed bedsores and other medical issues.

@ paintedjaguar

When defensive medicine causes a doctor to order an $800 CT scan instead of a $40 X-ray, the cost of defensive medicine to the healthcare system is $760. See Lawsuit-wary docs drive up costs with unnecessary tests,

Tort reform is a mixed bag. See The Fallacies of Medical Malpractice "Tort Reform", "The fact is, healthcare costs are not driven by litigation. The inconvenient truth is that they are a result of epidemic levels of medical error and the economics of the healthcare industry."

Also see, The National Institutes of Health, Defensive Medicine: A Bane to Healthcare

The Southeastern Journal of Legal Studies reports, Medical Malpractice And Tort Reform In The Southeast: It Appears to Have Worked,

I posted a number of additional tort reform articles here,