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Trumpcare Is Very Destructive to Both Medicare and Medicaid

Republicans ran against the Affordable Care Act, but no one ran against Medicare and Medicaid, because the programs work very well and they’re very popular.

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Janine Jackson: “Far from seamless” was how the Washington Post described the debut of House Republicans’ much vaunted — by them — replacement for the Affordable Care Act. Like others, this story was about how right-wing Republicans might present hurdles to the plan’s passage, because it’s too much like the dreaded Obamacare, and how they might be appeased.

So much coverage of healthcare is set in terms of the political process — who presents obstacles, what groups are being whistled to — that the specifics, the reality of how changes in policy could affect actual people, can sometimes get lost. And healthcare could hardly be a worse place for that to happen.

Here to help us see some of what’s going on with this GOP bill is Nancy Altman. She’s co-director of Social Security Works and co-chair of the Strengthen Social Security coalition and campaign. She joins us now by phone from Maryland. Welcome back to CounterSpin, Nancy Altman.

Nancy Altman: Thank you so much for having me.

It seems that in the media Medicare and Medicaid are mostly mentioned as a kind of in-one-breath tag-on to Social Security, when a story is giving a thumbnail of so-called “entitlements”; these programs are rarely center stage. I wonder if you could tell us about how this Republican plan, from what we know of it, would affect Medicare and Medicaid, and, along the way, remind us of what those programs do?

The so-called Trumpcare, this new healthcare plan that the Republicans have just rolled out, is very destructive to both Medicare and Medicaid. The Republicans ran against the Affordable Care Act, the so-called Obamacare, but no one ran against Medicare and Medicaid, because the programs work very well and they’re very popular.

Both programs were enacted in 1965. The idea behind Medicare — it’s a part of Social Security — is that you cannot really be economically secure if you’re one illness away from bankruptcy. So Medicare provides basic health insurance for those 65 and over who are receiving Social Security.

Medicaid is intended as a low-income program, but it is the only part of our healthcare system that provides basic insurance for long-term care. So actually many seniors, many middle-class seniors, who find themselves in need of long-term nursing home care wind up relying on Medicaid.

So they are both programs that cover much of the Social Security beneficiary population. All three programs work very well; they’re very popular. And I should say one more thing, that Paul Ryan, the speaker of the House, and other Republicans have been gunning for all these programs for decades.


And now I think they see they have their chance. So what this does is it basically destroys Medicaid. That was expanded under the Affordable Care Act. That expansion is going to be gone, but in addition they’re going to, instead of now having, if you’ve got that insurance and you need a medical procedure, it gets paid for, instead they’re going to do a kind of cousin of block-granting, where they’re going to give the states money and just say, OK, you take care of your own population. States often are strapped. It will be very hard to keep that coverage.

And for Medicare, they literally raid Medicare. They take about several hundred billion dollars out of Medicare and what they do is give very large tax breaks for the very wealthy.

Let me just add that Medicaid, listeners should know, besides seniors, of course, it’s also a main source of funding for a wide variety of disability services as well. People with disabilities, including older people who need attendants or even, you know, Ari Ne’eman wrote a piece on Talk Poverty, talking about the 24-year-old with Down syndrome who gets a job coach, the six-year-old with a disability whose parents need support. Medicaid is also critical to people with disabilities and providing them more independence and freedom, that’s true.

That’s exactly right. And to millions of children in this nation, too, who are low-income.

Right. Right.

And Medicare also provides basic insurance for people with disabilities. So it’s seniors, which is why the AARP has come out against this bill, but, as you point out, it’s millions and millions of other Americans.

Right. Well, the Washington Post, that piece had a source from Heritage who was talking about how this GOP plan isn’t good enough, because it doesn’t create a “free-market healthcare system.” So that’s one of the points on the continuum of conversation, is a system where poor people just die — because I don’t know what else that means. Now, some people may be ideologically OK with that, but for a lot of people, I think it fits with their understanding that we’re just in a situation of scarcity; we can’t afford a system that the government administers. That’s, if you would say, the big lie.

That is the big lie. We are the wealthiest nation in the world, and we are at the wealthiest moment in our history. We’re wealthier than we were in 1935 when Social Security was enacted. We are wealthier now than we were in 1965 when Medicare and Medicaid were enacted. And you’re exactly right, the long-range plan for Medicare is to what they call “voucherize” it, which is basically to turn the clock back before 1965.

Before 1965, millions of seniors could not get health insurance at any price, because they had pre-existing conditions; they were just seen as too expensive. And those that could, had to pay huge mark-ups for health insurance, and that’s why we wound up getting Medicare. They want to turn this back to the private sector and let people just go out, give them some premium support to go out and to buy insurance and help pay for premiums, when that is just the wrong way to go.

I guess we have to push back, then, with a big truth, or a bigger vision. And I have seen some people saying, well, the fact that this plan is creating these kind of fissures, even among Republicans, for whatever reasons, but they think maybe that’s opening space to talk about single-payer….

Medicare for All. Medicare was intended as a first step. In fact, there was a debate whether you first covered all children, because it’s much less expensive and they have a lifetime of health, or seniors, where, as I said, the need was dire…but they saw it as simply the first step. Even though Medicare covers the most expensive part of our population — seniors and people with disabilities — it is much more efficient than private-sector insurance, because it is universal for all people over age 65.

Other countries can provide all of their citizens with complete, affordable access to healthcare, and they have better health outcomes and they spend less than we do. If we expanded Medicare to for-All, and start it by simply lowering the age to 62, putting in a MediKids program, we would have a much more efficient program. And maybe that’s where we’re going, because that is a system that works.

Right. And just in terms of how we talk about it, it seems, maybe not “easy,” but straightforward. And then also: It’s estimated one in five Americans have some form of disability. Everybody’s going to get old if they’re lucky. And yet these show up as “interests” in the media conversation. There’s a New York Times piece: “Repeal of Health Law Faces a New Hurdle: Older Americans.” There’s this frame of some against others, like it’s Lord of the Flies, as though we can’t think about healthcare from a whole-society viewpoint, which of course seems like the way to go.

It is. I mean, this is really Washington at its worst, where families are interest groups, you have children against grandparents…. That is not how America works. Our grandparents are not better off if their grandchildren are not educated, and grandchildren are not better off if their grandparents can’t afford the basic necessities of life. So we are all in this together. It’s one of the strengths of all of these programs, Social Security and Medicare. The concept is: We all contribute and, as you say, we all hope to get old; if we have the misfortune of becoming disabled, we have these basic programs that are there for all of us; it unites us. And we are certainly wealthy enough, not only to afford these current programs, but to expand them.

We’ve been speaking with Nancy Altman. She’s co-director of the group Social Security Works and co-author of the book Social Security Works: Why Social Security Isn’t Going Broke and How Expanding It Will Help Us. Nancy Altman, thank you very much for joining us this week on CounterSpin.

Thank you.

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