President-elect Donald Trump sends a strong signal he may look beyond repealing and replacing Obamacare to try to scale back Medicare and Medicaid, popular entitlements that cover roughly 130 million people, many of whom are sick, poor and vulnerable. And that’s a turnabout from Trump’s campaign pledge — still on his campaign website — that he would leave Medicare untouched.
.. His vision for health reform hinges on eliminating much of the federal government’s role in favor of a free-market framework built on privatization, state flexibility and changes to the tax code. The vast majority of the 20 million people now covered under Obamacare would have far less robust coverage — if they got anything at all.
.. “Between this nomination of an avowed Medicare opponent to serve as HHS secretary and Republicans here in Washington threatening to privatize Medicare, it’s clear that Republicans are plotting a war on seniors next year.”
.. “To put in charge of the nation’s health care system and a trillion-dollar budget someone who has never overseen anything larger than a congressional committee ought to raise eyebrows when this position has historically been reserved for an individual with significant administrative experience,” said Rep. Steny Hoyer.
.. “In general they’re trying to shift risk from the government to individuals, and particularly to low-income individuals,” said Topher Spiro, who heads health policy at the left-leaning Center for American Progress. “It’s hard to see how that’s giving them a leg up, and how that’s improving the quality of their lives.”
The Medicare Killers
The transition team’s point man on Social Security is a longtime advocate of privatization, and all indications are that the incoming administration is getting ready to kill Medicare, replacing it with vouchers that can be applied to the purchase of private insurance. Oh, and it’s also likely to raise the age of Medicare eligibility.
So it’s important not to let this bait-and-switch happen before the public realizes what’s going on.
.. First, the attack on Medicare will be one of the most blatant violations of a campaign promise in history.
.. since 2010 Medicare outlays per beneficiary have risen only 1.4 percent a year, less than the inflation rate. This success is one main reason long-term budget projections have dramatically improved.
Who Broke Politics?
As far as anyone can tell, Paul Ryan, the speaker of the House — and the leader of what’s left of the Republican establishment — isn’t racist or authoritarian. He is, however, doing all he can to make a racist authoritarian the most powerful man in the world. Why? Because then he could privatize Medicare and slash taxes on the wealthy.
And that, in brief, tells you what has happened to the Republican Party, and to America.
.. if Hillary Clinton wins nonetheless, they have made it clear that they will try to block any Supreme Court nomination, and there’s already talk of impeachment hearings.
.. When Mrs. Clinton famously spoke of a “vast right-wing conspiracy” out to undermine her husband’s presidency, she wasn’t being hyperbolic; she was simply describing the obvious reality.
.. Well, when Newt Gingrich shut down the government in 1995, he was trying to, guess what, privatize Medicare.
.. Can anything be done to limit the damage? It would help if the media finally learned its lesson, and stopped treating Republican scandal-mongering as genuine news.
Doctors Unionize to Resist the Medical Machine
He was nonetheless unapologetic about the time he had invested.
“Real life is all about the narrative,” he said. “It’s sitting down and talking about bowel movements with a 79-year-old woman for 45 minutes. It’s not that interesting, but that’s where it happens.”
.. Outsourced hospitalists tend to make as much or more money than those that hospitals employ directly, typically in excess of $200,000 a year. But the catch is that their compensation is often tied more directly to the number of patients they see in a day — which the hospitalists at Sacred Heart worried could be as many as 18 or 20, versus the 15 that they and many other hospitalists contend should be the maximum.
.. If you talk to them for long enough, you get the distinct feeling it is not just their jobs that hang in the balance, but the loss of something much less tangible — the ability of doctors everywhere to exercise their professional judgment.
.. “It became difficult to plan your day,” said Dr. Frank Littell, a Sacred Heart hospitalist who has been practicing in the area since the 1980s. “If a patient needed to be admitted to the E.R., you had to cancel all your afternoon appointments.”
Gradually, it became clear that it would make more sense for a subset of internists to be based at each hospital, where they would handle the care of all the patients on site.
.. Asked if health outcomes had improved as a result, Mr. Higman said, “Readmission rates have been reduced — we can show it.” Costs are rising more slowly too, he said, no small thing in a country where many people are bankrupted by medical expenses. But, he added, “as to whether you as an individual are seeing better quality in health care — I think there’s some question there.”
.. The basic accounting problem for hospitalists is that they are not a profit center. That is, when they treat patients, the amount a hospital can bill Medicare and insurance companies is typically less than what the hospital must pay them. The opposite is true for other specialists, like surgeons.