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Are Republicans paying for tax cuts with reductions in Medicare, Medicaid?

"Schumer said, "The Republicans are proposing to pay for their giant tax cut to the rich by gutting Medicare and Medicaid."

"He has a point that the tax proposal includes significant tax cuts and that the Senate Republicans’ budget proposal reduces projected spending levels for Medicare and Medicaid by hundreds of billions of dollars over 10 years.

"However, Schumer has overstated the linkage between the proposed tax and spending cuts. In addition, his decision to highlight Medicare and Medicaid cuts with the vivid word "gutting" leaves the impression that such reductions are a drastic reshaping and are likelier to occur than they actually are."

"We rate his statement Half True."

I was reading about how the federal tax bill would cut Medicare. That is disconcerting, as this is a vital health program for many seniors in our country. I hate being told things by political pundits but having no data or evidence to back up there views.

So I was curious what a cut to Medicare really mean for both today’s seniors and generations to come, including myself in another 30 years? First off, a cut to Medicare does not mean a reduction in benefits or higher co-pays for consumers. It’s a cut payments to physicians and hospitals. Your doctor gets the hair cut, and depending on how you view these cuts, it might reduce access to care. Or it might not. Certainly doctor and hospital lobbyists would protest any cut to their fat. As the AARP explains:

The Senate tax proposal would add $1.5 trillion to the federal deficit over the next 10 years. Under PAYGO, if this bill were to become law, the government would have to lop off $150 billion in spending every year for 10 years.

Medicaid, Social Security, food stamps and other social safety net programs are exempt from the PAYGO law, which went into effect in 2010. But Medicare and other programs — such as federal student loans, agricultural subsidies and the operations of the Customs and Border Patrol — are not exempt.

The law caps how much the government can trim from Medicare at 4 percent. That’s $25 billion the first year, according to a report by the nonpartisan Congressional Budget Office. The annual amount could increase in subsequent years depending on the size of the deficit and Medicare’s budget.

The $25 billion reduction would affect the payments that doctors, hospitals and other health care providers receive for treating Medicare patients. Individual benefits would not change and neither would premiums, deductibles or copays. But with so much less money going to providers, the cuts could have major impacts on patient access to health care — such as fewer physicians accepting Medicare patients.


So cuts to Medicare could affect seniors, by denying them access to new doctors who might decide not to take new Medicare patients. It’s not clear though if doctors are actively dropping Medicare patients.  This 2015 article from Kaiser foundation looks at how many doctors currently accept Medicare patients.

The vast majority of non-pediatric primary care physicians (93 percent) say they accept Medicare—comparable to the share accepting private insurance (94 percent) (Figure 1). A majority of primary care physicians also say they are also taking new Medicare patients (72 percent), but this share is somewhat lower than the share of primary care physicians accepting new privately insured patients (80 percent).


While doctors often have high malpractice insurance costs, not to mention all the costs of education debt, most doctors in America live fairly well off. Other medical professionals not as well, but their employers usually aren’t struggling for cash. Many medical facilities and doctors probably could survive on lower Medicare payments, but they would have to trim fat from their businesses. But would they? Or would they focus more on private insurance business or those who paid with cash? Maybe. But seniors need the most medical care, so it seems unlikely they would leave the government money on the table, even if it was reduced levels from years past.

Unneeded Treatment And Overpriced Services Fuel Health Care Waste

Rooting out waste, fraud, and abuse in all sectors of the economy including government, healthcare and education should be everybody's top priority.

"Wasteful use of medical care has "become so normalized that I don't think people in the system see it," said Dr. Vikas Saini, president of the Lown Institute, a Boston think tank focused on making health care more effective, affordable and just. "We need more serious studies of what these practices are."

"Experts estimate the U.S. health care system wastes $765 billion annually — about a quarter of all the money that is spent. Of that, an estimated $210 billion goes to unnecessary or needlessly expensive care, according to a 2012 report by the National Academy of Medicine."

Why Is Triclosan in Toothpaste?

"Triclosan, an antibacterial ingredient recently banned by the Food and Drug Administration in some products but currently allowed in toothpaste, appears to accumulate on toothbrushes and can be released in the mouth, according to a study published this week in the journal Environmental Science & Technology."

"The FDA began prohibiting the sale of soaps and body washes that contain one or more of 19 antibacterials—including triclosan—last month because manufacturers haven’t proved that they’re safe for long-term daily use and more effective than regular soap and water for controlling certain infections. But because toothpaste is not included in the ban, triclosan can still be found in Colgate Total toothpastes (the only toothpaste line in the U.S. that contains the substance). Triclosan is also permitted in a slew of other items, including cosmetics, athletic clothing, and cleaning products."

One of President Trump’s better ideas is saying that health insurance should cost only $15-20 a month. I wholeheartedly agree with that proposal as many working families struggle to put food on their table, pay the rent, mortage, car and recreational expenses and shouldn’t be overly burdened with healthcare expenses. $15 to 20 a month seems like a reasonable expense for most people — except the most povert stricken people to pay for the healthcare.

While I reject the idea of greater government involvement in people’s personal lives, and think people should be able to choose the health plan they want, it’s obvious that $15-20 a month isn’t going to go very far when somebody breaks an arm when they fall off their four wheeler, or slip on a ladder. To say nothing of the common diseases of old age or poor fortune.

So how do you get to a system where health insurance costs only $15-20 a month but offers people choices on what plan they get and what benefits are included? What system can use market forces to encourage hospitals and doctors to economize but produce the care you need?

I think the solution is government-subsidized healthcare with private insurance. Allow private companies to sell insurance, and allow some flexibility in the plans beyond basic financial protection for people. But have the bulk of the money that funds insurance come from government taxation on the wealth centers of our country, e.g. Wall Street.

Healthcare is enormously expensive. The single individual who lives in a mobile home, works in a factory or more commonly a retailer like Walmart or Lowes, squeaks out a few extra bucks maybe raising some beef cows on their land can’t be expected to care the whole load of their healthcare. The kind of people you see on the back roads of Pennsylvania, Maryland or West Virginia. But there is enormous money out there in our economy — on Wall Street, the big banks, in various financial investments. The rich can and should take a haircut to ensure everybody can afford decent healthcare.

Obamacare tries to do this but it really under invests in our healthcare system, spending too little money and preserving too much of our employer based system. Quality healthcare shouldn’t be tied to one’s job. You shouldn’t have to work for a large company to have access to good care. Obamacare was an incremental improvement but more should be done. The solution is not to repeal Obamacare but to make it better — put more taxpayer money obtained from the wealth centers of our country — and use it to make sure everybody, including those in the backwoods of Appalachia can afford quality healthcare.

As ACA enrollment nears, administration keeps cutting federal support of the law

"For months, officials in Republican-controlled Iowa had sought federal permission to revitalize their ailing health-insurance marketplace. Then President Trump read about the request in a newspaper story and called the federal director weighing the application. Trump’s message was clear, according to individuals who spoke on the condition of anonymity to discuss private conversations: Tell Iowa no."

"Supporters of the Affordable Care Act see the president’s opposition even to changes sought by conservative states as part of a broader campaign by his administration to undermine the 2010 health-care law. In addition to trying to cut funding for the ACA, the Trump administration also is hampering state efforts to control premiums. In the case of Iowa, that involved a highly unusual intervention by the president himself."

"And with the fifth enrollment season set to begin Nov. 1, advocates say the Health and Human Services Department has done more to suppress the number of people signing up than to boost it. HHS has slashed grants to groups that help consumers get insurance coverage, for example. It also has cut the enrollment period in half, reduced the advertising budget by 90 percent and announced an outage schedule that would make the website less available than last year."

The Real Reason the U.S. Has Employer-Sponsored Health Insurance

"The basic structure of the American health care system, in which most people have private insurance through their jobs, might seem historically inevitable, consistent with the capitalistic, individualist ethos of the nation."

"In truth, it was hardly preordained. In fact, the system is largely a result of one event, World War II, and the wage freezes and tax policy that emerged because of it. Unfortunately, what made sense then may not make as much right now."

Suicides per 100k, by Gender and Age

Much of the stereotypes on suicide is that the victims of suicide are bullied teenage girls. Actually, women are much less likely to commit suicide then men, and it's usually older men -- especially those over age 75 who take their own lives. Data is suicides per 100,000 Americans in each demographic group. 2014 data.

Data Source: Suicide rates, by sex and age, United States, 2014. Page 2. CDC Data Briefs.

Who Ate Republicans’ Brains?

"When the tweeter-in-chief castigated Senate Republicans as “total quitters” for failing to repeal the Affordable Care Act, he couldn’t have been more wrong. In fact, they showed zombie-like relentlessness in their determination to take health care away from millions of Americans, shambling forward despite devastating analyses by the Congressional Budget Office, denunciations of their plans by every major medical group, and overwhelming public disapproval."