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.