Slashing Medicare

The first signs of the real agenda for the Trump administration have started to appear this week.  His ousting of Christie (corrupt moderate) as chief of the transition and replacement by Pence (radical right) and the naming of staff from Jeff Sessions’ 41qgxbhh4gl-_sx331_bo1204203200_Congressional office (Sessions is far right and anti-immigrant) is setting the tone for what’s really going to happen.

A white paper on healthcare reform came out yesterday, and its a wonderfully contradictory document.



The key points to which the Trump regime pledges are:

  • Protect individual conscience in healthcare;
  • Protect innocent human life from conception to natural death, including the most defenseless and those Americans with disabilities;
  • Advance research and development in healthcare;
  • Reform the Food and Drug Administration so as to put greater focus on the need of patients for new and innovative medical products;
  • Modernize Medicare so that it will be ready for the challenges posed by the coming retirement of the Baby Boom generation;
  • Maximize flexibility for states in administering Medicaid to enable states to experiment with innovative methods to deliver healthcare to low-income citizens.

The contradictions should be obvious:  for example, “protect individual conscience” should be a pro-choice position, while “protect innocent human life” is pure right-to-life dogma.  The FDA item is a pro-big-pharma position.

The notion of modernizing Medicare should scare people, partly because of the lack of serious thought involved.

  1. On the one hand, like the discussion of the “wall”, concern about the Baby Boom generation is rather late.  Most of that generation is already claiming benefits.  We are on the downside of the Boomers.
  2. Demand on Medicare funds could expand if people were living longer in the US than before, but growth in life expectancy has stopped and is in fact declining for many people.
  3. Foreign workers are paying into Medicare and Social Security funds who won’t be around to collect on them.  This “foreign subsidy” is quite significant in terms of dollars.

Barron’s summarized options that might be considered for Medicare reform, and every one of them will hurt someone.  The two principal options are:

  • Raising fees and taxes to support Medicare
  • Reducing benefits.

The Barron’s article actually recommends that people who want Medicare for all Americas move to Canada.  Of course, you life expectancy increases if you do that, and your costs go down.  Not a bad idea, really.

What Paul Ryan was recommending at the time was a more incremental approach that uses tools already available to consumers — Medicare Advantage and Medicare Supplement plans.  The notion is to reduce what the government covers under basic Medicare and force consumers to buy these plans to have complete coverage.

This is already done by those who can afford it.  Costs such as doctor’s visits and drugs aren’t in basic Medicare.  You need a supplement or advantage policy to cover those expenses.  Given the ease of implementing this, Ryan’s support, and his current relationship with Trump, it seems likely that this is the direction in which the administration will move.

However, adding to what these policies need to cover will add to their expenses.  That’s not great for people living on a fixed budget in retirement.


  1. Brooks, Megan, “Trump Posts Preliminary Plan to Repeal ACA,” Medscape, 13 November 2016.
  2. Donlan, Thomas, “Reforming Medicare and Medicaid,” Barron’s, 8 August 2015.


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