The US healthcare system is at a dramatic fork in the road | Adam Gaffney

The Congressional Budget Office has given the revised American Health Care Act a dismal score. Will we let this terrible plan define our healthcare future?

The US healthcare system and with it the health and welfare of millions is poised on the edge of a knife. Though the fetid dysfunction and entanglements of the Trump presidency dominate the airwaves, this is an issue that will have life and death consequences for countless Americans.

The Congressional Budget Offices (CBO) dismal scoring of the revised American Health Care Act (AHCA) on Wednesday made clear just how dire Americas healthcare prospects are under Trumps administration. But while the healthcare debate is often framed as a choice between Obamacare and the new Republican plan, there are actually three healthcare visions in competition today. These can be labelled healthcare past, healthcare present, and healthcare future.

Let us begin with healthcare past, for the dark past is precisely where Republicans are striving to take us with the AHCA. The bill narrowly passed by the House on 4 May is less a piece of healthcare reform than a dump truck sent barreling at high speed into the foundation of the healthcare safety net.

Wednesdays CBO score reflects the modifications made to the AHCA to pacify the hard-right Freedom Caucus, changes that allowed states to obtain waivers that would relieve health insurers of the requirement that they cover the full spectrum of essential healthcare benefits, or permit them to charge higher premiums to those guilty of the misdemeanor of sickness, all purportedly for the goal of lowering premiums.

In fairness, the CBO report did find that these waivers would bring down premiums for non-group plans. This, however, was not the result of some mysterious market magic, but simply because, as the CBO noted, covered benefits would be skimpier, while sicker and older people would be pushed out of the market.

In some states that obtained waivers, over time, less healthy individuals would be unable to purchase comprehensive coverage with premiums close to those under current law and might not be able to purchase coverage at all. Moreover, out-of-pocket costs would rise for many, for instance whenever people needed to use services that were no longer covered say mental health or maternity care.

Much else, however, stayed the same from the previous reports. Like the last AHCA, this one would cut more than $800bn in Medicaid spending over a decade, dollars it would pass into the bank accounts of the rich in the form of tax cuts, booting about 14 million individuals out of the program in the process. And overall, the new AHCA would eventually strip insurance from 23 million people, as compared to the previous estimate of 24 million.

Its worth noting here that Trumps budget released Tuesday proposed additional Medicaid cuts in addition of those of the AHCA, which amounted to a gargantuan $1.3tn over a decade, according to the Center on Budget and Policy Priorities.

The tax plan and budget best characterized as a battle plan for no-holds-barred top-down class warfare drawn up by apparently innumerate xenophobes would in effect transform the healthcare and food aid of the poor into bricks for a US-Mexico border wall, guns for an already swollen military, and more than anything a big fat payout to Trumps bloated billionaire and millionaire cronies.

What becomes of this violent agenda now depends on Congress and on the grassroots pressure that can be brought to bear upon its members.

But assuming the AHCA dies a much-deserved death quite possible given the headwinds it faces in the Senate we will still have to contend with healthcare present.

Last week, the Centers for Disease Control released 2016 results from the National Health Interview Survey, giving us a fresh glimpse of where things stand today. And on the one hand, the news seemed good: the number of uninsured people fell from 48.6 to 28.6 million between 2010 and 2016.

On the other hand, it revealed utter stagnation: an identical number were uninsured in 2016 as compared with 2015, with about a quarter of those with low incomes uninsured last year (among non-elderly adults). It also suggested that the value of insurance is declining, with high-deductible health plans rapidly becoming the rule and not the exception: for the privately insured under age 65, 39.4% had a high-deductible in 2016, up from 25.3% in 2010.

Healthcare present, therefore, is an unstable status quo: an improvement from healthcare past, no doubt, but millions remain uninsured and out-of-pocket health costs continue to squeeze the insured.

Which takes us to the third vision, that of healthcare future. As it happens, another recent development provided a brief glimmer of hope for that vision. As the Hill reported, the Democratic congressman John Conyers held a press conference yesterday (Physicians for a National Health Program, in which I am active, participated) to announce that his universal healthcare bill the Expanded & Improved Medicare For All Act had achieved 111 co-sponsors, amounting to a majority of the House Democratic Caucus and the most in the bills history.

This bill like other single-payer proposals is the precise antithesis of Paul Ryans AHCA. Rather than extract coverage from millions to provide tax breaks for the rich, it would use progressive taxation to provide first-dollar health coverage to all.

Which of these three visions will win out is uncertain, but the outcome of the contest will have a lasting impact on the country. We can only hope that the thuggish, rapacious vision championed by Trump and his administration does not prevail.

Read more: https://www.theguardian.com/commentisfree/2017/may/25/us-healthcare-system-fork-road

Trump’s budget: major slashes to social programs but $1.6bn for the wall

Millions of people stand to lose Medicaid access, alongside cuts to welfare and food stamps, under a proposed budget that still has numerous hurdles to jump

Donald Trump will embrace hardline right-wing economics on Tuesday with a budget that proposes swingeing cuts to social safety net programmes while allocating $1.6bn to a border wall.

Millions of people would lose access to Medicaid, the government insurance programme for the poorest and many disabled Americans. Food stamps for people on low incomes would be cut over the next 10 years under the White House plan and the families of undocumented workers would be frozen out of key tax breaks.

We are no longer going to measure compassion by the number of programmes or the number of people on those programmes, budget director Mick Mulvaney told reporters. Were going to measure compassion and success by the number of people we help get off of those programmes to get back in charge of their own lives. Were not going to measure our success by how much money we spend but by how many people we actually help.

The Trump blueprint is unlikely to become law because it will face opposition from both moderate Republicans and Democrats worried about its social impact and from fiscal conservatives who fear it will increase the deficit.

Chuck Schumer, Democratic minority leader in the Senate, condemned the proposed cuts to Medicaid. This would pull the rug out from so many Americans who need help: those suffering from opioid and heroin addiction, people in nursing homes and their families who care for them, the elderly, the disabled, and children, he said on the Senate floor.
Medicaid helps not only the poor but increasingly the middle class, as well as 1.75m veterans, Schumer added. Heres what candidate Trump said when he campaigned: Im not going to cut social security like every other Republican and Im not going to cut Medicare or Medicaid. He promised he would help take care of those suffering from opioid addiction. If it cuts Medicaid, hes breaking that promise right in half.

Economic experts were also quick to dismiss Mulvaneys claims that Trumps tax plans and budget would boost economic growth to 3%, balancing the federal budget within a decade.

Although Trump is an unconventional president, the budget shares much with the conservative orthodoxy of Ronald Reagan and Margaret Thatcher. It is entitled A New Foundation for American Greatness and Mulvaney said if he had a subtitle it would be, The taxpayer first budget.

Budget
Budget director Mick Mulvaney. We need everybody to pull in the same direction. Photograph: Jim Lo Scalzo/EPA

Cuts to Medicaid over the next decade exceed even the more than the $800bn reductions contained in a health bill passed by the House of Representatives earlier this month.

The president also aims to slash welfare by $274bn over a decade, including $193bn on food stamps, driving millions of people off the programme. This would be several times bigger than cuts attempted by House Republicans in the past. The number of people claiming food stamps spiked to 47m people at the height of the 2007-08 recession and had not come down as expected, still totalling 44m people, Mulvaney said, despite near full employment in the US.

Some $72bn over 10 years would come from social securitys disability insurance programme, including $50bn in savings which would be achieved by helping recipients get off the programme and find a job.

Mulvaney continued: If youre on food stamps and youre able bodied, we need you to go to work. If youre on disability insurance and youre not supposed to be, if youre not truly disabled, we need you to go back to work.

He added: Theres a dignity to work and theres a necessity to work to help the country and succeed and we need everybody to pull in the same direction.

The Child Tax Credit and the Earned Income Credit would be limited to those who are authorised to work in the US. They would be required to show proof of a social security number a move that would have a negative impact on children who are US citizens but whose parents are undocumented.

I could ask you for your money I think, in good faith and good conscience, and say, Look, I need to take some of your money and give it to this family, who deserves the Child Tax Credit, but I cant do it to give the Earned Income Tax Credit, which is designed to help folks who work, to give it somebody whos in the country and working illegally. Its just not fair. Its not right when you look at it through the perspective of the people paying the taxes.

Trump would also reduce federal employee pensions and farm subsidies while keeping campaign pledges to leave core Medicare and social security benefits for the elderly untouched.

He also promised a groundbreaking proposal to provide six weeks of paid family leave to new mothers and fathers, including adoptive parents, championed by Trumps daughter, Ivanka, and costing $25bn over 10 years.

Mulvaney confirmed that the budget plan defunds Planned Parenthood, on the premise that the American Health Care Act will become law, and winds down the support for the Corporation for Public Broadcasting, which feeds the money to outlets such as the Public Broadcasting Service and National Public Radio.

The blueprint also shaves 31.4% off funding for the Environmental Protection Agency and 29.1% off that for the state department and other international programmes.

The cuts to domestic spending would be redirected to the US military, law enforcement and supporting veterans. It allocates $2.6bn to border security, including $1.6bn for the bricks and mortar construction of a wall on the Mexican border, with the remaining $1m allotted to technology and infrastructure.

But the plan a wish list to fund the Trump agenda faces numerous hurdles. The healthcare bill is likely to undergo significant changes in the Senate while a rewrite of the tax code only has a broad outline so far. It also makes assumptions about growth.

People
People protest the Trump administrations bid to overturn the Affordable Care Act. Photograph: David Mcnew/AFP/Getty Images

Mulvaney said Trumps package of spending cuts and tax breaks would boost the USs economys growth rate to 3% over the next decade, a considerable increase from the 1.9% forecast under current policy by the Congressional Budget Office.

The director, due to testify to the House and Senate this week, said: I think what Trumponomics is and what this budget is a part of is an effort to get to sustained 3% economic growth in this country again. I think its sad that the previous administration was willing to admit that we couldnt get better than 1.9% growth over the next 10 years … That assumes a pessimism about America, about the economy, about its people, about its culture that were simply refusing to accept. We believe that we can get to 3% growth.

But economists were skeptical of the claim. Gus Faucher, PNC Financial Services chief economist said US productivity growth had averaged 1.75% over the last 45 years and that the period between the late 1990s and early 2000s when growth topped 3% was the exception. Its asking a lot to expect the exception not the rule, said Faucher.

Marc Goldwein, head of policy at non-partisan thinktank Committee for a Responsible Federal Budget said the budgets numbers did not add up. He said Mulvaneys promise of returning to the 3% growth rates were unrealistic at best.

We are not bringing the 90s back, he said. Three percent was normal then because the baby boomers were in their prime and we had a tech boom. Now baby boomers are aging out of the workforce and the tech booms impact has fizzled, Trumps budget would likely add decimal points not percentage points to US growth, he said.

This is like pretending you have won the lottery when all you have is a handful of scratch cards, he said.

Read more: https://www.theguardian.com/us-news/2017/may/22/donald-trump-budget-proposal-2018-social-care-border-wall

Trump’s alleged boast to Russians could wreck the trust of America’s allies

The vital intelligence-sharing alliances could see permanent damage if it proves true that Trump shared highly classified information at a recent meeting

Donald Trumps Oval Office boasting to the Russians, if confirmed, could wreak its deepest and most enduring damage on vital intelligence-sharing by US allies.

A similar erosion of trust in the presidents loyalties and competence appeared to have accelerated among Trumps political allies in Washington. As the White House fought back hard against the Washington Post report, which was confirmed on Tuesday night by several other US news organisations, it was unclear how far his support from the Republican establishment essential to his survival as president had been weakened.

In the world of intelligence-sharing among nations, however, any semblance of doubt can be corrosive and irrevocable. Even before this latest indiscretion, there had been rumblings of concern from the CIAs partner agencies abroad, uneasy about the Trump campaigns seemingly cosy relation with Moscow, reports of possible collusion in the 2016 election campaign, and Trumps own disdain for the US intelligence community. He frequently appeared to give more credence to conspiracy sites and the Kremlin that the intelligence briefings he received before taking office.

During the transition, many allies voiced concern Trump team might share intel with Moscow. Todays news will compound that concern, Colin Kahl, a senior official in the Obama administrations national security council (NSC), said in a tweet.

Read more: https://www.theguardian.com/us-news/2017/may/15/donald-trump-russia-classified-information-impact-allies