Battle over Mandatory (aka “Entitlement”) Spending

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I don't think 65 is as old as many want to portray it. There are plenty of people who are fully functional well into their 70's. On the subject of head coaches, Pete Carroll is 73.

Sure, there are people who may not be able to work, but we can address those as exceptions, not the norm, right?
The "norm" is that most people are NOT able to work into their 70s. They just are not. Most people into their early 70s are able to manage their household and daily activities.

Past 75, even daily activities and household management is compromised for many/most.

There might be "many people who are fully functional well into their 70s" but they are NOT the majority of that cohort by a very long shot.
 
The "norm" is that most people are NOT able to work into their 70s. They just are not. Most people into their early 70s are able to manage their household and daily activities.

Past 75, even daily activities and household management is compromised for many/most.

There might be "many people who are fully functional well into their 70s" but they are NOT the majority of that cohort by a very long shot.
This is very true
 
Do not raise the retirement age
Collect SS on all income
Raise the tax rate to 45% above $1M earned, 50% above $10 million earned, 75% above $500M earned and 100% above $999M earned
 
GIFT LINK --> https://www.wsj.com/politics/policy...3?st=pymTuk&reflink=desktopwebshare_permalink

Good background article on how Medicaid works and how cuts would impact Americans

"... Medicaid is the biggest government health insurance program in the U.S., covering around 72 million people as of October 2024, or about 79 million when the affiliated Children’s Health Insurance Program, or CHIP, is included—more than Medicare.

... Begun in 1965 as a program for needy Americans, including low-income children with caretakers, as well as elderly, blind and disabled people, Medicaid has grown over the years. It cost $872 billion in 2023, most of it state and federal government spending, or about 18% of what the nation paid for healthcare.

Enrollment rose during the pandemic, when periodic eligibility reviews were suspended, but since then, millions have been removed from the rolls as reviews resumed. ..."

Medicaid1.jpeg
 

I think the interesting one there is he is saying he won't touch medicaid. I don't think there was much way that he was going to take away social security or Medicare benefits for anybody already on them. I thought Medicaid might be an issue and it still may be.

He told Congress when they're working out their budget don't touch Medicare, don't touch social security and Medicaid you could do something like a work requirement, but it mostly stays in place. We'll see if he sticks to that, sticks to his tax pledges or sticks to his deficit reduction pledges. One of them probably has to break unless he is willing to gut defense.

My guess is it will end up being some Medicaid cuts, some defense cuts and not getting keeping his deficit reduction promise but blame the democrats.
 
I think the interesting one there is he is saying he won't touch medicaid. I don't think there was much way that he was going to take away social security or Medicare benefits for anybody already on them. I thought Medicaid might be an issue and it still may be.

He told Congress when they're working out their budget don't touch Medicare, don't touch social security and Medicaid you could do something like a work requirement, but it mostly stays in place. We'll see if he sticks to that, sticks to his tax pledges or sticks to his deficit reduction pledges. One of them probably has to break unless he is willing to gut defense.

My guess is it will end up being some Medicaid cuts, some defense cuts and not getting keeping his deficit reduction promise but blame the democrats.
Yeah, he will cut Medicaid and say we are just cutting “waste”. Then claim they cut fraud but mostly will have cut programs they consider wasteful.
 
Yeah, he will cut Medicaid and say we are just cutting “waste”. Then claim they cut fraud but mostly will have cut programs they consider wasteful.
That's probably not a bad guess but you can only do so much of that without hitting some of these rural hospitals that his voters use. I guess you could potentially move the money around but at the end of the day everybody wants hospitals.
 
New GOP approach — you aren’t cutting entitlements when you cut employees or services, it’s only a cut of you reduce benefit checks.

 
WSJ with an animated explainer on genuine waste in the Medicaid system (that arises in large part due to each state running their own program):

GIFT LINK 🎁 —> https://www.wsj.com/health/healthca...41?st=14XE9A&reflink=mobilewebshare_permalink

“… Private insurers oversee Medicaid benefits for more than 70% of the about 72 million low-income and disabled people in the program. The companies get paid each month for each person they cover. They aren’t supposed to get paid if a patient leaves for another state.

… From 2019 to 2021, states made duplicative payments for an average of about 660,000 patients a year totalling $4.3 billion dollars in payments.


A spokesman for Centene said the Journal’s analysis overstates the financial impact of the issue and “ignores the financial safeguards in place to address potential overpayments,” including profit caps and a rule that requires insurers to refund premiums to states when medical costs are lower than expected. Centene said it repaid states about $2 billion during the period the Journal studied.

A UnitedHealth spokesman called the Journal’s analysis “incomplete and misleading.” He said it didn’t account for payments the company had returned to states, which he declined to quantify. “Many of the duplicates are children, typically due to parental separation,” he said, and are “reconciled as part of our standard audit process.” …”
 
Yeah, he will cut Medicaid and say we are just cutting “waste”. Then claim they cut fraud but mostly will have cut programs they consider wasteful.
Medicaid has been a target for years. The cuts have mostly been incremental. This administration is going to gut the program. If they do, the ramifications will reach well beyond just impacting people who are on Medicaid.
 
Medicaid has been a target for years. The cuts have mostly been incremental. This administration is going to gut the program. If they do, the ramifications will reach well beyond just impacting people who are on Medicaid.
Rural healthcare, as a whole, is already rough. This country has healthcare deserts, and the seemingly inevitable cuts to medicaid will make it substantially worse, while concurrently threatening the large, specialist-laden, urban systems. You know, the ones maga relies upon when they get lung cancer or lymphoma or a MRSA infection from an unaddressed diabetic foot wound or need a mitral valve replacement or or or ...
 
Rural healthcare, as a whole, is already rough. This country has healthcare deserts, and the seemingly inevitable cuts to medicaid will make it substantially worse, while concurrently threatening the large, specialist-laden, urban systems. You know, the ones maga relies upon when they get lung cancer or lymphoma or a MRSA infection from an unaddressed diabetic foot wound or need a mitral valve replacement or or or ...
Couldn’t agree more. Medicaid doesn’t just cover nursing home payments and trips to the doctor. There are also programs that help people who are challenged function within their communities. If Trump does indeed gut Medicaid, the desert you mentioned will get more barren.
 
Couldn’t agree more. Medicaid doesn’t just cover nursing home payments and trips to the doctor. There are also programs that help people who are challenged function within their communities. If Trump does indeed gut Medicaid, the desert you mentioned will get more barren.
Medicaid also covers a lot of home health, like infusions, wound care, fall and home safety consults (including for acquired and developmental disabilities), and swallowing evals. Good luck in the sticks. Prevalence of Disability and Disability Types by Urban-Rural County Classification – United States, 2016:
  • According to this study, the prevalence of adults with a disability in the United States is significantly higher in rural areas compared to large metropolitan areas. These findings, along with a recent study showing that the percentage of adults having at least four of five health-related behaviors (sufficient sleep, current nonsmoking, nondrinking or moderate drinking, maintaining a healthy body weight, and meeting aerobic physical activity recommendations) was lowest in noncore counties,3 indicates the need for rural public health interventions to be inclusive of people with disabilities.
  • Compared with adults with disabilities living in urban areas, those in rural areas may face additional barriers (e.g., lower socioeconomic position, transportation problems, access to education and vocational rehabilitation services, access to health care and accessible communities)4 to maintaining and improving their health, quality of life, and community participation. Making rural communities disability inclusive and accessible can potentially improve the health and well-being of this population.

And what most folks don't understand is the impact on rural hospitals isn't just a direct pay issue. It's an issue of time occupying a bed. Every day, a hospital bed costs a facility several thousands of dollars, irrespective of whether the patient is receiving care. Insurance only pays for hospital level care while the patient requires hospital level care; when the patient progresses to rehab level care, the hospital gets a rehab level reimbursement. When you reduce home health services, people rely on the hospital more frequently because they aren't, or can't, manage their meds or wound care or O2 renewal or personal hygiene, etc. Sometimes that's considered hospital level care, sometimes not. Additionally, SNFs go out of business, left and right. Therefore, patients linger in the hospital for days, often weeks - I've seen months - waiting for a safe post-acute setting, while generating a fraction of the insurance payment needed to cover their costs (we all eat those costs). These patients devastate hospitals, particularly rural ones, which often operate on razor thin margins - hell, Mass General is losing hundreds of millions, what do you think is happening to the already barebones Rural Co. Hospital owned by HCA?
 
Medicaid also covers a lot of home health, like infusions, wound care, fall and home safety consults (including for acquired and developmental disabilities), and swallowing evals. Good luck in the sticks. Prevalence of Disability and Disability Types by Urban-Rural County Classification – United States, 2016:
  • According to this study, the prevalence of adults with a disability in the United States is significantly higher in rural areas compared to large metropolitan areas. These findings, along with a recent study showing that the percentage of adults having at least four of five health-related behaviors (sufficient sleep, current nonsmoking, nondrinking or moderate drinking, maintaining a healthy body weight, and meeting aerobic physical activity recommendations) was lowest in noncore counties,3 indicates the need for rural public health interventions to be inclusive of people with disabilities.
  • Compared with adults with disabilities living in urban areas, those in rural areas may face additional barriers (e.g., lower socioeconomic position, transportation problems, access to education and vocational rehabilitation services, access to health care and accessible communities)4 to maintaining and improving their health, quality of life, and community participation. Making rural communities disability inclusive and accessible can potentially improve the health and well-being of this population.

And what most folks don't understand is the impact on rural hospitals isn't just a direct pay issue. It's an issue of time occupying a bed. Every day, a hospital bed costs a facility several thousands of dollars, irrespective of whether the patient is receiving care. Insurance only pays for hospital level care while the patient requires hospital level care; when the patient progresses to rehab level care, the hospital gets a rehab level reimbursement. When you reduce home health services, people rely on the hospital more frequently because they aren't, or can't, manage their meds or wound care or O2 renewal or personal hygiene, etc. Sometimes that's considered hospital level care, sometimes not. Additionally, SNFs go out of business, left and right. Therefore, patients linger in the hospital for days, often weeks - I've seen months - waiting for a safe post-acute setting, while generating a fraction of the insurance payment needed to cover their costs (we all eat those costs). These patients devastate hospitals, particularly rural ones, which often operate on razor thin margins - hell, Mass General is losing hundreds of millions, what do you think is happening to the already barebones Rural Co. Hospital owned by HCA?
Once again, I agree. Part of my career was in healthcare on the financial side. A lot of people don’t understand the consequences of what will happen if Medicaid funding is significantly cut.
 
Once again, I agree. Part of my career was in healthcare on the financial side. A lot of people don’t understand the consequences of what will happen if Medicaid funding is significantly cut.
That is why I suspect it won't. Republicans have tried to cut Medicaid before and rural hospitals started shutting down. Republicans pulled back on those efforts real quick.

I think they will try to introduce some sort of work requirement and potentially tighten up the requirements on some services covered by Medicaid but I think it'll mostly stay in place.
 
That is why I suspect it won't. Republicans have tried to cut Medicaid before and rural hospitals started shutting down. Republicans pulled back on those efforts real quick.

I think they will try to introduce some sort of work requirement and potentially tighten up the requirements on some services covered by Medicaid but I think it'll mostly stay in place.
Hope you are right. Because things will get dire for millions of people if you aren’t.
 
That is why I suspect it won't. Republicans have tried to cut Medicaid before and rural hospitals started shutting down. Republicans pulled back on those efforts real quick.

I think they will try to introduce some sort of work requirement and potentially tighten up the requirements on some services covered by Medicaid but I think it'll mostly stay in place.
Republicans aren’t in charge of this. It’s Trump and Musk and they appear to give zero shits about getting it right. That’s not to say they wouldn’t backtrack, but they aren’t terribly quick to recognize (or acknowledge) mistakes and even less so to correct them.
 
Republicans aren’t in charge of this. It’s Trump and Musk and they appear to give zero shits about getting it right. That’s not to say they wouldn’t backtrack, but they aren’t terribly quick to recognize (or acknowledge) mistakes and even less so to correct them.

Ezra Klein pitches the problem as follows: Musk's strategy of radical cuts might work in business, where the feedback is quick and the fixes are more straightforward. But the federal government does not have the same mechanisms for rapid feedback and it oversees processes whose downstream effects won't be apparent until the mid- or long-term.
 
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