Medicaid

The Awful Health Policy and Cynical Politics of Trump's Budget Plan

The president wants to cut Medicaid but leave Medicare untouched, rewarding supporters at the expense of America's long-term finances.

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Gage-Skidmore / Foter

Trump's budget plan has already generated headlines for its cuts to social safety net programs, but the most notable thing about it may be what it doesn't cut: namely, defense spending, Social Security's old-age benefit, or Medicare. The president's plan plows savings from reductions in discretionary spending into increases in the military budget while leaving America's largest entitlement programs essentially untouched.

The differing treatments of Medicare and Medicaid, in particular, is a sign of both the new budget's mistaken fiscal orientation and its cynical political priorities, as well as how the two intertwine: Trump and other Republicans aren't willing to cut the programs that are the biggest drivers of the long-term debt because they are the programs that benefit Republican voters the most. It's bad health care policy and ugly politcs.

Trump's budget starts by assuming that the Medicaid reforms included in the American Health Care Act (AHCA), the House bill to rewrite Obamacare, would go into effect. If the AHCA became law, the bill, which passed the House early this month, would convert Medicaid from a program of essentially unlimited federal matching funds into a system of per-capita block grants, meaning that federal payments to states would continue but be capped based on the number of individuals enrolled in the program, with increases determined by formula.

The case for these reforms is that Medicaid, in its current form, is a dysfunctional mess. The best evidence is that, on average, the program, a jointly financed federal-state program for the poor and disabled, does little if anything to improve physical health outcomes for beneficiaries.

As conservative health policy wonk Avik Roy has argued, the AHCA reforms would finally put Medicaid on a budget while giving states more flexibility to experiment with the program, and would represent perhaps the most significant entitlement reform in modern history.

The case against, as Cato Institute health policy scholar Michael Cannon argues, is that the per-capita structure might inadvertently create incentives for states to continue expanding the program in order to increase federal funding. And that's if they ever went into effect at all, a real question, given that the bill delays the reforms until 2020.

In reality, this may all be moot: Republican Senators and governors have signalled discomfort with the way the House bill treats Medicaid, so it's an open question whether they will ever become law.

But Trump's budget goes significantly beyond the AHCA in ways that don't entirely add up. It also assumes another $610 billion in additional savings from reforming the program beyond the GOP bill, and it assumes $250 billion in savings from rewriting Obamacare—a dubious figure given that the most recent version of the AHCA was scored by the Congressional Budget Office as reducing the deficit by $150 billion.

Meanwhile, the budget basically leaves Medicare untouched, and might even give it a boost. It repeals the Independent Payment Advisory Board (IPAB), which would presumably eliminate the cap on Medicare spending growth that IPAB was designed to enforce.

Repealing IPAB is a longtime conservative goal, and there are lingering questions about the legality of its structure. But the immediate practical effect of this would be to eliminate one of the few mechanisms designed to limit the growth of Medicare spending without proposing any mechanism to replace it. As conservative health policy wonk Chris Jacobs dryly notes in his analysis of the budget's health care provisions, despite concerns about IPAB, "some conservatives may also oppose efforts to repeal a spending constraint on our nation's largest health care entitlement without any similar efforts to control the program's large (and growing) outlays." Trump's budget, in other words, would create conditions that might allow Medicare to grow even faster.

The president's fiscal plan, then, digs deep into Medicaid while making no serious cuts to Medicare—despite, as Jacobs writes, the fact that Medicare will spend $9 trillion over the next years, and is staring down insolvency in just over a decade. Medicaid spends less each year than Medicare and is projected to grow less rapidly than Medicare over the next decade. Indeed, Trump's proposed cuts to Medicaid can be understood as attempts to preserve and prop up Medicare in its current form.

In fairness to Trump, he promised on the campaign trail not to cut Medicare, and this budget delivers on that promise. But he also promised not to cut Medicaid. It's not too hard to understand why Trump chose to propose the cuts that he did.

Medicare is a federally run health care program for seniors, and seniors tend to be Republicans and Trump supporters. Many Republicans have warm feelings toward the program, with 46 percent saying they support expanding the program to cover all Americans, which would create a national single-payer system. Medicaid beneficiaries, on the other hand, are poor and heavily concentrated amongst minorities. Trump's budget, then, is an effort to preserve federal benefits for a group that heavily supports him politically by cutting benefits to a group that does not.

That's a problem for the nation's finances, because it leaves the largest driver of the debt untouched. It's ugly politics, because it treats government as a dealer of zero-sum handouts, pitting the interests of one group of Americans against another. And it's poor health policy, because it helps perpetuate an environment where deep systemic reforms remain essentially impossible. It's not exactly new for Republicans. (Amongst the GOP's chief criticisms of Obamacare was that it cuts Medicare.) But it is telling.

In his analysis, Jacobs describes Trump's proposals as "functionally incoherent." As a matter of policy, he is no doubt correct. As a matter of shallow short-term politics, Trump's budget makes all too much sense. The underlying mentality is not one that is oriented towards reforming, limiting, or improving government. Instead, it's one that treats the federal budget as a vehicle for handouts to supporters while effectively disregarding the nation's long-term fiscal challenges. Trump isn't draining the swamp. He's just shoveling the muck around.

NEXT: Another Advantage of Divided Government: Easier to Impeach the President

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  1. Republican Senators and governors have signalled discomfort with the way the House bill treats Medicaid

    Thus conservatism: once a massive entitlement has come into existence, it must be conserved at all costs.

    1. “The whole modern world has divided itself into Conservatives and Progressives. The business of Progressives is to go on making mistakes. The business of Conservatives is to prevent mistakes from being corrected. Even when the revolutionist might himself repent of his revolution, the traditionalist is already defending it as part of his tradition.” — G. K. Chesterton

  2. Good breakdown. Thanks, Pete.

  3. I read a headline that said Trump’s budget cut “Trillions”.

    Yes, Trillions, with a Tee.

    Given the state of state-mouthpiece journalism, I’m guessing he cut around $11.50 from the budget.

    1. In this case, it is (T)rillions over 10 years. The media is hyping how bad that sounds because they hope it will scare those who want entitlements to continue. To Conservatives it sounds good because its cutting, well, trillions.

      1. And not a cut. Everything increases. Its a ‘cut’ in the rate of increase.

        1. Absolutely the political game of projecting 10% increases then “cutting” the budget by only increasing it 8%.

          1. That’s a 20% cut!

            I’ve been googling all afternoon and have yet to find actual numbers of how much was previously projected to be spent each year over the next ten compared to how much Trump plans to increase it by.

            I did find historical numbers showing that between 2013 and 2015 total Medicaid spending increased by 22% and the federal portion by 34% Spending doubled from 2006 to 2015.

            That deserves a healthy cut in the rate of growth.

      2. “To Conservatives it sounds good because its cutting, well, trillions.”

        Sorry but that dog don’t hunt anymore. Since when have conservatives consistently supported cutting spending? At most they pay lip service to cutting spending.

        1. Those hunters just don’t use dogs anymore.

          1. What? I asked a question. When do conservatives consistently support cutting spending, not just in their rhetoric, but in actual deeds? You have a small minority of Republicans in Congress who do support it. The rest, it seems, do not.

            1. That small minority is larger than the zero count of libertarians.

        2. Conservatives do support cutting spending. Republicans don’t.

          1. So who are these conservatives who are not Republicans who support cutting spending?

    2. Yes, and that cut is terribly draconian.

  4. The libertarian case for not cutting spending, folks. So let’s follow the logic. Cutting medicaid is irrelevant because it doesn’t do anything about the runaway spending on SS and medicare. But cutting defense spending is imperative because it… doesn’t do anything about the runaway spending on SS and medicare…?

    In the not too distant future federal medicaid spending will approximate defense spending. If we include state dollars along with federal spending it already is.

    So again, if petey wants to make the argument that medicaid spending is irrelevant due to SS and medicare spending, then I expect him to stop whining about defense spending–certainly in the same posting at a minimum.

      1. “Trump and other Republicans aren’t willing to cut the programs that are the biggest drivers of the long-term debt because they are the programs that benefit Republican voters”

        Just what was your TOEFL score?

        1. “Therefore, this Medicaid reform should be resisted.” – this line must have been stealth edited in while you were reading and then edited out

    1. You sense make lots!

    2. “The libertarian case for not cutting spending, folks”

      Who is making this argument? Would this be the Strawman Suderman in your mind?

      Personally I prefer to live in a world where we don’t have Medicare, or Medicaid or Social Security at all. But it’s not wrong to point out that Trump is engaging in some fairly ugly health care politics here.

      1. So suderman did not make the claim that medicaid cuts are irrelevant and cynical? Huh.

        “Trump’s budget, then, is an effort to preserve federal benefits for a group that heavily supports him politically by cutting benefits to a group that does not.

        That’s a problem for the nation’s finances, because it leaves the largest driver of the debt untouched. It’s ugly politics, because it treats government as a dealer of zero-sum handouts, pitting the interests of one group of Americans against another.”

        1. And I would add that it’s pretty fucking obvious that any government handout must, by definition, be zero sum.

          1. Really? That’s your argument?

            “That’s a problem for the nation’s finances, because it leaves the largest driver of the debt untouched.”

            1. Is there something wrong with that statement?

              1. Sure is! Suderman isn’t lavishing Trump with praise for his budgetary approaches! That only proves Suderman is on TEAM BLUE

        2. No he did not. The way I read it is, he is describing his interpretation of the way things currently exist, not the way things ought to be. It IS a problem for the nation’s finances that Trump doesn’t want to touch the single largest component of spending. But I don’t see anywhere Suderman saying “… and therefore don’t cut Medicaid at all”.

          1. And is proposing to remove one limiting influence on Medicare spending. And this whole discussion of “cuts” to Medicaid relies on the AHCA passing as it is currently written, which is far-fetched.

            That’s the context behind that line, context which is lost when you selectively quote one line and complain that it’s insufficiently… I’m not even sure what the complaint is here. Are we supposed to continue celebrating the AHCA?

        3. So pointing out that Trump’s proposals are primarily based on prioritizing the free shit his supporters want more than any coherent strategy or sincere desire to limit spending, debt, etc. means he’s saying don’t cut Medicaid at all? His overall budget is still a disaster even if you assume the “cuts” to Medicaid and non-defense discretionary spending actually happen, which they in all likelihood will not, certainly if the first budget “battle” is any indication. Not to mention the stance on Medicaid of the senators who will be necessary to pass any health care bill.

          1. No I think I get it. We are supposed to praise Trump for crossing the very lowest of bars set before him. Since Trump didn’t raise spending on EVERYTHING by eleventy billion percent (you know, just like HILLARY would have!!!), Trump deserve a pat on the back.

            1. I realize you’re saying this in jest, but it’s important to point out that even looking at the areas where Trump is proposing cuts or smaller increases, he hasn’t done any of it. And looking at the first budget deal, it seems likely that he’ll cave on those areas to get what he wants elsewhere.

  5. His budgets proposes to double taxes and spending over the next 10 years. What else do we need to know?

    1. I am sure His Usual Defenders will come along any minute now to inform us that his budget is Totes Better than Hillary’s would have been.

      1. It is, but it isn’t good enough.

      2. Pathetic rhetorical trick.

        Pointing out the blatantly obvious = His Usual Defenders only in Chemjefflandia.

    2. Hillary would’ve tripled it.

      1. Nuh-uh! She would have quadrupled it!

        1. That dog just doesn’t hunt anymore.

          Hillary would have never been President.

          1. Hillary would have feasted upon the entrails of mere mortals as she roared in laughter.

            As much of a sure train wreck that trump will be, I still would rather watch him bring it all down rather than that evil cunt. 8 years of trump acting like an idiot is far more palatable.

            1. ^^^ suffering from Hillary Derangement Syndrome

            2. It is only more palatable to the extent that Trump does comparatively less damage to what remains of our republic.

            3. It is only more palatable to the extent that Trump does comparatively less damage to what remains of our republic.

  6. Medicaid beneficiaries, on the other hand, are poor and heavily concentrated amongst minorities.

    Not really. That is merely how it is perceived.

    The largest group in most states are the permanently disabled. Yeah they are poor but no more ‘minority’ than average – and they weren’t part of any Obamacare ‘expansion’.

    The (generally distant) second largest groups are either a)the really really old and white who are in nursing homes or b)children of poor parents who are ‘browner’ than average. Neither of these were part of any ‘expansion’ either – though the brown children are not in GOP-voting households.

    The smallest group (and lowest or 2ndlowest-spending per beneficiary) in most states are the expansion group – adults who now get coverage for themselves based on low income. These are obviously the vile and a bit brown motherfuckers who are destroying America because they now see a doctor where before they mostly just sucked it up and didn’t. The camel’s nose (Islamic terrorists?) in the tent of an America that is now careening towards the entitlement of Marxist tyranny.

  7. The assumption in this article and every other one claiming medicaid is cut is false. Trump proposes increasing Medicaid year after year.

    2017 378b
    2018 408b
    2028 688b

    1. You’re looking at the baseline spending. The proposed spending tops out at 524 in 2027, and projects Medicaid spending as % of GDP to fall from 2 to 1.7.

      Still very much the DC sense of “cut,” but not as bad as you posted.

      1. Can you give a link to the source of these numbers? I have some graphs I want to make.

  8. I support the House healthcare bill for three major reasons. In no particular order:

    1) Kills the ObamaCare Medicaid expansion.

    2) It gets rid of the individual mandate

    3) It stops requiring businesses to offer health insurance to their employees and stops considering them full time employees if they work for more than 29 hours a week.

    If Trump’s budget reflects these assumptions, we should all be celebrating.

    Cutting Medicaid alone is worth celebrating. Whining about cutting Medicaid because Medicaid isn’t also being cut is like whining about winning the lottery because you didn’t win it in all the other states, too.

    Cutting Medicaid is still an act of bravery, but cutting Medicare and Social Security are the third rail of politics. Unless a president runs a campaign and wins on reforming Medicare and Social Security, I wouldn’t expect the House to pass a budget that cuts either one of those things. If cutting Medicaid is the best we can get through congress at the moment, then take a knee, run out the clock, take the win, and we can keep on fighting for more in the next game.

    When’s the last time a president proposed a cut to Medicaid?

    Did Gingrich ever dare to go that far?

    Has any president been so bold as to cut Medicaid before? Who was the last president to be so bold?

    1. That’s true. Criticism & commentary should reflect what’s politically possible, & I think you’ve a good handle on that.

      1. Didn’t Republicans prove that doing more than simply repealing the Medicaid expansion is politically possible when they voted to repeal Obamacare about a dozen times? They ostensibly have a president who would sign such a bill, so anything less is a disappointment.

        1. It was different when there was no way President Obama would sign it.

          Right?

          If and when Congress gets a bill on Trump’s desk that eliminates the ObamaCare Medicaid expansion, does away with the individual mandate, and kills the requirement that made employers slash workers hours to 29 a week, Donald Trump will sign it.

          Because Republicans were willing to pass something that Obama wouldn’t possibly sign does not indicate that doing more is possible.

          20 Republicans voted against the House bill–almost all from swing states like Ohio and Pennsylvania–and the bill only passed the House by four votes. If the bill had been any better, it wouldn’t have passed the House.

          1. Why does it change now that Obama is gone? Trump has no worries about repealing Obamacare. Most of Congress is the same, Republicans have a majority in both chambers; it should be easy!

            What they have now is inadequate. Especially considering that the individual mandate isn’t really gone, it has only changed its appearance. If the bill was simply to take away the Medicaid expansion, and that was all it claimed to do, then maybe it would be acceptable because it leaves the Obamacare issue unaddressed.

            1. “Why does it change now that Obama is gone?”

              Because when they passed it before, there was no possibility of their bill being signed–so long as Obama was in the White House.

              Now that the responsibility for repealing ObamaCare is clearly on them, they’re more sensitive to consequences of total repeal.

              Also, like I said, as the House becomes more Republican, that means that more and more Republicans in the House are from swing districts. They may have gotten into office on the backs of registered Democrats who voted for them–lots of Republicans are like that in Ohio, Michigan, Pennsylvania, and Wisconsin.

              It’s the difference between hitting a home run in the batting cage and hitting a home run in a game against an MLB pitcher. And I should say, this is the way things are supposed to be in a democracy. The biggest problem we have in this country isn’t that the Republicans won’t do what libertarians want. The biggest problem is that the American people want the government to do things like prohibit insurance companies from discriminating on the basis of preexisting conditions. House members don’t just answer to libertarians at the ballot box.

            2. Ultimately, the only way to win is to take our message to the people–which Reason used to be great at doing. Until then, we have to take what victories we can get. There are a lot of things to like about the House bill–take a look at the three I listed above. They were only able to pass that by four votes. Looking at the votes, that’s the best we can get right now. Doesn’t mean this is over once they pass this one bill. We can keep fighting for more free markets.

              If we don’t take the deal we have, the support for killing ObamaCare is going to die completely. They’ll just fund it for another . . . however many years. The alternative to the House plan isn’t repeal of ObamaCare. The alternative to the House plan is ObamaCare.

              1. The AHCA bill is absolutely not the best that the Republicans can do. We know this based on the example set forth by Pelosi, Reid and Obama in 2009-2010. They were in a very similar situation – their base was demanding huge health care changes, but their moderate members from swing districts were nervous about voting for something that would endanger their re-election. So what did leadership do? They forced their wavering members to walk the plank and vote for ObamaCare even though they knew it would cost them their re-election. And when the House predictably flipped in 2010, because of Obama, the status quo was maintained due to veto threats. Ryan and McConnell *could* do the same thing here. They could force their members to swallow full ObamaCare repeal and replacing it with something truly market-oriented, like a Singapore-style HSA-based system. But they won’t, *because they don’t actually favor repealing ObamaCare*. They LIKE certain parts of it, they just can’t admit so to their base which does demand full repeal. So if you are on Team Ryan here saying that we should support their cowardly effort to half-heartedly repeal kinda-sorta parts of ObamaCare, you are rewarding their duplicitous behavior. And frankly I don’t care if that is what you want to do, being a Republican and all. But I don’t know why anyone with libertarian sensibilities who genuinely wants to see the full thing repealed should settle for it.

                1. “They forced their wavering members to walk the plank and vote for ObamaCare even though they knew it would cost them their re-election.”

                  That’s the weakest link in your argument right there.

                  Generally speaking, representatives to the House don’t do things that they know will cost them their seats.

                2. So, two points:

                  1) We know that this is the best that the Republicans can do under the circumstances because the Republicans in the House passed it by just four votes–with 20 Republicans voting against it.

                  That’s a market data point. In commercial real estate, we typically have two kinds of data–asking prices and comparable sales (or leases).

                  The asking prices are basically theoretical–you use those when there aren’t many actual sales like your property. Office parks aren’t as liquid stocks, bonds, or currencies, and they aren’t necessarily commodities either. They have characteristics that can differentiate them. If you’re looking for something comparable to what you’re building, you might need to look at asking prices and discount them to fill in the blanks–but whether anyone will actually pay the asking price is an open question.

                  Actual sales are much better for comparison purposes. Someone actually bought an 80,000 SF warehouse for x dollars PSF–and some bank actually financed it. That’s a legitimate market signal for an 80,000 SF warehouse building.

                  What the Republicans were willing to ask for when Obama was in office was theoretical.

                  When it came time to decide whether to write a check, all the Republicans could get for it was four votes more than they needed.

                  A better bill would have failed. The House plan is so good, it may not make it through the Senate.

                3. 2) The stuff that’s in that bill is pretty awesome.

                  What is it that you want that isn’t in the bill?

                  All the polls show that the American people don’t want to get rid of the prohibition against discriminating on the basis of having a preexisting condition. Put that in, and it won’t pass the House, much less the Senate.

    2. In the 10 years from 2006 to 2017 federal Medicaid spending grew by 86%. Trump proposes over the next 10 years to increase spending by only 82%.

      Oh, the horrors!

      (Good first step, but the reaction is so totally overwrought)

      1. “Trump proposes over the next 10 years to increase spending by only 82%.”

        Trump proposes spending 82% more on Medicaid over the next ten years–you have a link for that?

        1. It was from a comment above where I asked for a link (I’ve been looking)

          I downloaded a spreadsheet from HHS which details all health spending up until 2015. The commenter above said under Trump federal spending for Medicaid is proposed to go from $378b in 2017 to $688b in 2026

  9. The president wants to transfer $700 billion from Medicare to Medicaid , rewarding supporters at the expense of America’s long-term tax payers.

    Suderman wrote this in 2010?

  10. If they’re actual honest to god cuts, what the @#$! is Reason whining about?

  11. Those of us that have paid taxes, SS, and Medicare their whole lives certainly think we should come before the takers of social welfare that they have paid nothing for their whole lives. Do you want us to be destitute when we retire and have little health care. All of us don’t make 6 figure incomes with golden benefits or union benefits that pay thousands a month in retirement. Those up North can always move here to the south and they can live great on their inflated pensions. We cannot do that. SS does need to make some tweaks to keep the program strong. Medicare I don’t know as much about it’s fiscal health but I do know in a couple of years I will need it and a supplemental plan but certainly don’t want to spend the bulk of my retirement funds paying for insurance. I would hope for a decent retirement after working till 66.

    1. I hate to be the one to break it to you, but the sad truth is, your government has lied to you. There is no SS account with your name on it that has money that you are “entitled” to. Every penny you paid in while working was immediately paid out to then-current recipients. Or it was simply transferred to the general fund to be spent on God-knows-what. But it wasn’t saved on your behalf. SS taxes are just another tax, like income tax, and SS benefits are just another transfer payment, like welfare. From the government’s point of view, SS beneficiaries are just another category of welfare recipients. No one wants you to be destitute when you retire. But around here anyway, no one (or almost no one) thinks that government should be the institution that should be providing for your or anyone else’s retirement. All that money you paid into SS should have been put into a *real* investment account with your name on it that you had full ownership of, that you could use as your nest egg when you retire, instead of squandered by politicians and bureaucrats to fund their idiotic schemes, making you dependent on their support in order to even have a reasonable retirement.

      1. True-the federal government has no dollars-they exist always and ONLY as numbers on federal govt ledgers…the actual dollars never exist until the federal govt INSTRUCTS banks to mark up the numbers in a recipient’s bank account-the federal govt can do this continually-meaning it never can run out of dollars. Yes, the economy could run out of real resources from insufficient public & private investment, but that’s something else entirely different.The federal government creates all its spending money out of thin air-no taxes/no borrowing involved at all. MONETARY SOVEREIGNTY Your lie about all the “money being spent” is tantamount to you believing the federal government is just a powerless little weakling and that YOU have some sort of power over it-you don’t. If that money creation thing “bothers” you, check out the US Constitution, Article One, Section 8. And no, the Fed is not a private corporation also out to personally FUCK YOU OVER. Sorry.

  12. “Medicare is a federally run health care program for seniors.”
    Just to flush out the details. Medicare is the health insurance seniors are forced into because all the taxes levied on their earned income over their entire lives leaves them unable to afford anything else. I have yet to have a good experience since I had to start on medicare.
    On the other hand, Medicare and Medicaid should serve as absolute proof that single payer, if the federal government is that payer, will be a complete and total disaster.

    And there must be some kind of mistake, Elizabeth Warren, and actual named source, is screaming that Trump is gutting Social Security!!

    1. Anecdotal straw man bullshit. From the start my Medicare experiences have been 100% non-problematic and remain so…go cry somewhere else, little miss snowflake. Those payroll taxes you paid & the premiums you now pay are direct & immediate transfer payments to past/current recipients of the program. No dollars are or were ever set aside in a special little account with YOUR name on it. Today’s victims of your perceived payroll tax scam PAY FOR YOU today…oh, the horror! Calling this site “Reason” allows you to NEVER look past the irony.

  13. ‘…biggest drivers of the long-term debt…’ Federal debt is bank savings deposits at the Fed. Bank deposits anywhere, burden no one. Securities account dollar balances @ the Fed have doubled in the past decade and the federal government continues to pay on the debt (over $94 trillion redeemed in fiscal ’16) without a problem. The US federal government pays all its debts (incl. interest on the debt) simply by crediting accounts-taxes & borrowing pay for NOTHING. ALL US dollars = debt. If you are so concerned about debt being an “unsustainable problem” as YOU yourself continue to accumulate more & more dollars into your bank accounts, then by all means, please send ME all your problematic US dollars (debt)!…Dollars whether in your pocket as currency, residing in reserve accounts in the banking system or in securities accounts @ the Fed- are all a LIABILITY of the US federal government-to cry over the securities account portion of debt (dollars) means you are 100% clueless about federal finances. MONETARY SOVEREIGNTY (Sole limit to federal deficit spending: too much inflation, yet the federal govt has 100% ability to control the VALUE of the dollar-one reason you do pay federal taxes. Federal ‘borrowing’ also allows the federal govt to control the VALUE of the US dollar).

  14. Thank you Peter for hitting the nail on the head. A great lie being promulgated by the Republican Party is that is for lower spending – but of course, it’s only for lower spending on the supporters of the other party. I figured out this fa?ade when the Republicans implemented Medicare Part D. (I also figured out their cronyism by St. Ronald’s embrace of ILLEGAL ALIEN AMNESTY, which allows employers to bust Americans’ wages.)

    Of course, there are a lot of Trumpists on Medicaid, both as part of the ObamaRomneyHeritageCare expansion and the part for old folks in nursing homes; there should be fertile ground for a proper Democrat with more heartland social ideals to exploit this (I would love to see the extraordinarily Honorable and Red-State-popular Louisiana Governor John Bel Edwards make run at it.)

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