I could not be more excited about the nomination of Georgia congressman Tom Price to be head of the Department of Health and Human Services. It is what I hoped would happen and expected to happen.
That might sound surprising on a number of counts. During the campaign, President-elect Donald Trump consistently promised voters that he was different than other Republicans, that he fully intended to protect Medicare, Medicaid, Social Security and other essential safety-net programs. Price, on the other hand, has long nursed an ideologue's hatred of such programs. For example, he wants to privatize Medicare and slash Medicaid dramatically, and has consistently voted against efforts to extend coverage even to children through the Children's Health Insurance Program.
So why has Trump decided to take programs that he has pledged to protect and place them under the control of a person pledged to drastically reduce and if possible eliminate them?
Come on. You know the answer already. Because Trump's campaign talk was a scam, as was his posturing as a defender of the working people of this country. Every administration has its priorities, and since we cannot afford both huge tax cuts for the wealthy and decent health care for the masses, decent health care for the masses has been placed on the chopping block.
Because that's what you do, right? When you run on an anti-elitist, populist message that the working people of this country are victims of a rigged system that ignores their needs in favor of the well-connected, the first thing that you do upon assuming office is heap immense rewards on the wealthy, appoint fellow billionaires to your Cabinet¹ and undercut programs that provide citizens at least some insulation against predatory capitalism.
On Medicare, Price and his fellow House Republicans have laid out a plan in which the current system of guaranteed coverage would be replaced with a system in which elderly Americans are given federal subsidies -- the GOP calls them "premium supports" -- which they then use to buy private insurance plans on the open marketplace. If that sounds familiar, it should. It's very much the same structure as Obamacare. Republicans of course reject that comparison, yet when pushed to explain how their "premium support" plan is different, they respond with vague goobledygook.
Because it is, essentially, the same system that they have condemned and reviled for years now.
On Medicaid, Price has given us a pretty detailed road map of where he would like to take us with his "Empowering Patients First Act." Under the current system, everyone who meets eligibility standards for Medicaid is guaranteed coverage, but under Price's approach that promise would be dropped. Federal Medicaid money would be converted into "block grants" to the states, which could then design systems of their own. That approach may sound tempting to some, but champions of the block-grant approach seldom mention that funding for those block grants will be sharply reduced from current spending levels.
According to the Center on Budget and Policy Priorities, Price's health-care plan would reduce traditional federal Medicaid spending by $1 trillion over the next decade. The abandonment of the ObamaCare Medicaid expansion would cut another $1.1 trillion from Medicaid, producing $2.1 trillion that then becomes available for cutting taxes on the wealthiest 1 percent. Some 14 million Americans who now have Medicaid coverage would no longer do so.
Again, Republicans will complain about describing it in those terms; again, their complaints aren't justified because the description is accurate. Money now used to fund health care for millions of Americans will be converted into tax cuts that disproportionately benefit Trump and his wealthy friends. In fact, when Senate Finance Committee Chairman Orrin Hatch was asked whether entitlement cuts are needed to make tax cuts plausible, he didn't mince words: “I think that’s probably the understatement,” he told the Washington Post.
Sadly, the areas hardest hit by such changes will be rural areas and small towns where Trump dominated on Election Day, which also happen to be those areas most reliant on Medicaid. Hospitals in those areas will be closing in droves as their paying customers lose the capacity to pay, and once those areas lose hospitals they lose whatever meager ability they may have had to attract industry and growth.
These are not happy outcomes, but as we're being reminded, elections do have consequences. The consequences of this one are that long pent-up Republican fantasies about how the world ought to work are going to be tested against reality, and a lot of vulnerable people are going to suffer. But if that's what has to happen to open some eyes, then I guess we better get on with it.
¹After ranting against the likes of Goldman Sachs during the campaign, Trump today announced the nomination of former Goldman Sachs partner Steven Mnuchin as Treasury secretary, billionaire financier Wilbur Ross as Commerce secretary and billionaire Todd Ricketts as deputy Commerce secretary.