By skyforbes 
Earlier today Paul Ryan announced that his plans for Medicare, Medicaid, and the rest of our social programs are game-on. This is exactly the kind of dramatic, scary changes many voters are not expecting and won’t like but are all but inevitable after Tuesday and a now completely unified right wing government. These radical shifts will take time to reach their full extent, but they’ll start quickly after the transition and grow from there.
An underlying story is that Trump and Ryan appear to have patched things up. Trump and Ryan have had a rocky relationship, with Ryan not willing to overtly condone the former’s white nationalism and other affronts. There had been some question about whether or not they would be able to work together, as well as if Ryan would be able to retain the speakership of the House. But earlier today they had a meeting which seems to have gone perhaps awkwardly but well: Trump’s on board with Ryan and his plans. The sweeping Republican electoral victory also all but assured Ryan was no longer threatened for the top spot, and the leadership vote had already been scheduled to happen quickly anyway to minimize any opposition or mishaps. Not that it mattered, because the GOP congress is committed to the proposals Ryan’s been pitching for years now and doesn’t have other plans.
Of course, the reason Ryan has tacitly condoned Trump’s sexual assaults and other affronts is precisely to enable his “Better Way” plan, which is focused on lowering taxes for the rich and helping the banking and other industries at the expense, financially and otherwise, of the middle class and low income. Part of that plan is radically transforming Medicare and Medicaid. I’d guess a lot of people aren’t actually too sure what those are, so in sum:
- Medicaid provides health insurance for low-income and disabled people, as well as more general children’s programs.
- Medicare is health insurance for essentially anyone 65 or older, as well as some younger people with disabilities or chronic problems.
Trump‘s position on that hasn’t been coherent, but it’s been slowly aligning with Ryan’s. He gained a lot of traction by stating flat out that he would prevent cuts in Medicare. But at the same time the campaign expressed its openness to “entitlement reform.” There isn’t even a clear promise to break.
But, even if you did take him seriously about no cuts, as many many voters no doubt did, this is how it’s going to be packaged to work around that:
- Cuts will be deceitfully presented as block grants and per capita caps, which Trump is already explicitly on board with for Medicaid, as well as raising the eligibility age for Medicare.
- False claims about Medicare, etc., being broke will be used to align with and justify “preserving” the programs.
- The initial stages of the transformation will be lumped in with and sold as repealing the dreaded Affordable Care Act, which is ironically a big part of why Medicare is not actually in dire straits and how many many more people are being assisted by Medicaid.
As they’re being cut, the administration and financial work of both programs will also be privatized, essentially moved to commercial insurers. Despite largely unquestioned conventional wisdom, private sector operations are not more efficient or effective. For-profit operations are also of course, by definition, trying to extract profit. Privatization is the antithesis of why these programs were created in the first place. Protecting against that is certainly not going to be the Republican Party, evidence of which you can also see in related forthcoming changes like killing the Consumer Financial Protection Bureau and dropping newly instated rules requiring that financial advisors provide you advice that is actually good for you rather than them.
Meanwhile, the mechanisms and incentives introduced by the Affordable Care Act to lower costs in healthcare itself will have been stopped.
In other words, costs are going to go up even as assistance and protections go down, and a massive amount of people are going to be affected. About 70 million people are supported by Medicaid. Another 54 million people use Medicare. That’s 39% of the country. Essentially, if you’re middle aged and your parents are alive and not wealthy, this squeeze is going to hurt them. Ditto if you yourself are low income, older, disabled, or have children but not employer insurance. It’s a long list.