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Gridlock, but Medicare Surviving

Terry H. Schwadron

June 18, 2018

It doesn’t take a lot of political insight to see that things have ground to a complete halt in Congress, with the mid-term elections looming. Every politician seems to be completely busy raising money, out of the mistaken belief that it is advertising and not ideas themselves that may draw interest at this point.

It has been fascinating, then to see the gargantuan immigration issue just plow itself into the ground, as Republicans themselves cannot seem to agree, and President Donald Trump cannot seem to keep straight what he does back and doesn’t back. A Capitol Hill Republican gettogether this week promises to straighten out the competing clauses for which bad immigration bill might survive.

The politically interesting part of all this is that the votes of the hated Democrats are needed to pass anything substantial. Still, the President and Republican leaders continue to bash away at Democrats as the root of all evil in society, from backing “open immigration borders” to “raising taxes” to “biasing the special counsel probe” of bad behavior by the president’s campaign.

The one good thing that may come of this paralysiswas reflected in a thoughtful Politico article this week: Republican congressmen are giving up on what might be their last best chance to overhaul Medicare, just as they’re losing their leading champion on the issue, House Speaker Paul Ryan.

Despite bites around the edges — the tax cut bill itself redirected some Medicaid funds — the failure of the Republican majority to be able to act as a legislative force means Medicare will likely last another year — until a new Congress of whatever shape and proportion can decide whether it has the will and votes to tackle “entitlements.”

Politico notes, “The quiet surrender on a subject that’s energized GOP fiscal hawks for the better part of a decade comes as new projections show Medicare’s trust fund in its worst shape since the recession, partly because of Republicans’ other chief obsession: their sweeping tax cuts. That’s left conservatives unsure how to agitate for a politically unpopular Medicare overhaul — one that President Donald Trump detests — and raises new questions about who will take up the entitlement reform mantle as Ryan heads for the exits.”

Campaigner Donald Trump promised not to touch Medicare payments, and so, Republicans are stuck defending the presidential line, even while seething about ways to further cut overall federal spending that has nothing to do with the military. The obvious other choice is social spending, and the biggest chunk of that is in Medicare. This is the same Medicare that many Democrats actually want to expand as a new version of single-payer medical insurance, a Medicare-for-all approach as advocated most loudly by Sen. Bernie Sanders, I-VT.

What makes all of this particularly tricky is the extra $1.5 trillion excess debt that was created for the federal budget by passage of the corporate tax cut bill. You may remember that bill passed without elimination of other government programs. In general, vastly boosting military spending, not substantially cutting social services, and adding a tax cut means that money is slowed for the vast health care system. In addition, this government wants to overhaul veterans health spending to extend VA care into Medicare payments, where veterans can take their health issue to any doctor or hospital. This is a program for which there has been no overall estimate of cost.

Medicare serves nearly 60 million seniors and people with disabilities.

Besides the tax cuts, the decision to repeal portions of Obamacare will put additional strain on Medicare’s finances, Medicare’s trustees are saying. Medicare’s hospital trust fund is now projected to go broke by 2026, three years earlier than projected.

Republicans insist that promoting an overall growth economy will alleviate financial pressure on the program’s trust fund. Remember, the tax cuts, if they work, will reduce payments into Social Security and Medicare. From a health care point of view, eliminating much of Obamacare will reduce by millions the number of people whose health care is covered, pushing more people towards Medicaid and Medicare, and the burgeoning numbers of boomers reaching Medicare eligibility are putting more of a strain on the system.

By the way, I think we can expect the same to be said for Social Security benefits before long.

Though Speaker Ryan said a Medicare overhaul would be a priority for 2018, Republican leaders have abandoned the idea ahead of the elections.


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