Medicare ‘Reform’ Versus the Populist Tradition


Arrogance, ignorance and callousness are but a few of the negative descriptors being leveled at the nascent administration – most for just cause, given that issue by issue, appointment by appointment, Trump and his inner band of mostly corporate consiglieres are proving themselves every bit as incompetent and blusterous as progressives anticipated.

Particularly justified is the blistering criticism being heaped upon Team Trump for majoring in the minors – giving time and attention to utter minutia (read Saturday Night Live lampoons) to the neglect of dozens of far more pressing and complex matters (say, vanishing polar ice caps).

This relative silence on critical issues is costly on many counts; most glaringly human, as confirmed Trump appointees do little more than quietly and capriciously move to shear their departmental budgets, some in preparation for converting them into entitlement and Medicaid block grants; with the goal of eventually parceling them out to Republican-majority governors (33) and legislatures (68 of 98, the largest discrepancy in US. history).

Were the states awarded control of the Medicaid program per US House Speaker, Paul Ryan’s plan, a 2016 study done by Urban Institute cites between 14 and 21 million would lose coverage should lawmakers almost certainly restrict eligibility.

The lure for conservative budget slashers, as noted by Center on Budget and Policy Priorities (CBPP) official, Edwin Park, is the federal government’s ability to identify a tidy number for all Medicaid funding, effectively absolving itself of the moral responsibility for making sure the most ill and vulnerable men, women and children in America – no doubt, millions of them Trump voters – have access to adequate health care.

Park anticipates that even in states where the number of Medicaid recipients is allowed to remain relatively static, those consumers’ range of services, including physician-ordered pediatric care, would likely be reduced.

Of further concern is Washington’s tendency to decease, not increase block-grant funding, mostly via multi-year freezes despite inflation and expanding populations. (CBPP’s research indicated a 37% net decrease in federal allotments from 2000 to 2016.)

Hopes for a robust Democratic response to the Trump administration’s calm but steady march toward block-granting are uncertain. Facing onslaughts on the Affordable Care Act, humane immigration practices and longstanding foreign policies, Senate and House minority leaders are forced to play defense against an amateurish but increasingly erratic White House.

Additionally vexing is the cold, hard fact that Medicaid recipients are poor folk. And in 2017 America, poor folk do not hold sway over political agendas.

This point was driven home in a Jan. 18, 2017 Washington Post commentary on efforts to block-grant Medicaid, written by visiting Brandeis University lecturer, Ryan LaRochelle: “...many block grant programs are designed to help low-income people — a group that is least likely to mobilize politically. Unlike, say, the elderly — drawn from every economic strata — the people who rely on poverty programs probably won’t organize to protect their programs from cuts or call for improvements. And so those programs atrophy.”

Progressive American populism has, at its best, risen to the moment whenever dignity is systematically reserved for the privileged. In this instance, progressives should expect an all-out Republican effort to bring Medicaid under the auspices of statehouses wherein the decision-makers themselves will never have to think twice about medicine for a colicky baby, a recovery program for an addicted son, or home care for a demented parent.

Addendum: To find outlets for organizing, run a search with the words, Save Medicare.

To contact your elected representatives, start here:

US Capitol switchboard, 202-224-3121.

Don Rollins is a Unitarian Universalist minister and substance abuse counselor living in Blacksburg, Va. Email

From The Progressive Populist, March 15, 2017

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