Here are some comments
from Donald J Trump as both candidate and President.
‘I was the first & only potential GOP candidate to
state there will be no cuts to Social Security, Medicare & Medicaid.
Huckabee copied me.’
“I’m not going to cut Social Security like
every other Republican and I’m not going to cut Medicare or Medicaid.”
"Save Medicare, Medicaid and Social
Security without cuts. Have to do it,"
“Republicans will protect Medicare for our great seniors who
have earned it.”
A few days before Election Day, he suggested that
Hillary Clinton wanted to “destroy” Medicare, the public health-care system for
the elderly, which she had vowed to expand, and claimed that he alone would
“protect” it.
Major Savings and Reforms, Fiscal Year 2020,
Even with a booming economy, excluding Social
Security and Medicare spending and revenues, the Federal Government is still
running a net deficit of $608 billion.
National debt as % of GDP
2016 105%
2017 104%
2018 107%
At Whitehouse.gov as part of the Trump
administration budget proposal it shows the % of debt to GDP to be 106.1%. If you actually do the calculation from the
real numbers, it is 107.1%. For 2019 and
2020 it is projected to be 107.0% and 107.4% respectively.
He, DJT/POTUS, has repeatedly said he would
not make cuts to Social Security, Medicare, and Medicaid. He has been believed because people want to
believe things that comfort them, validate their cultural biases. or bring them
hope. Mexico will pay for
the wall., Everybody can now feel much safer
than the day I took office. There is no longer a Nuclear Threat from North
Korea. Save Medicare, Medicaid
and Social Security without cuts. Have to do it.
Here’s the deal; the
President of the United States will tell you whatever he thinks you want to hear
while acting in any manner he perceives to be most advantageous to himself and
the United States’ other oligarchs. He
will lie and mislead while seeking to enrich himself. Your lack of access to health care, a life of
dignity, or a social safety net is of no consequence to him. If you still think POTUS is anything other
than a lying narcissistic coward there is a technical term for you that I can
only provide upon request.
Following is a summary of the proposed budget
from the Trump Administration just for Medicare and Medicaid. The numbers presented are representations of
millions. The minuses are cuts. Do not be misled by their characterization as
“savings” and “efficiencies”. They are
projections for the next 10 years. 339,180,000,000, that’s 339 billion 180
million to be cut just from Medicare. That
figure is not even comprehensive. It is discernible
just from glancing at a few charts available via Whitehouse.gov. Some of them are provided below. I know, it’s hard to believe but I didn’t
just find a meme that supported my views or an MSM source that conformed to
them. You too can actually get your
information from principals rather that talking heads or pundits who make you
feel validated and comfortable. There
are many hundreds of billions more that are being eliminated from America’s
primary social nets. This includes the
big 3, Social Security, Medicare, and Medicaid. When the proposed budget talks about any increases it is based on the rate of inflation. Trump and his cronies are speaking of the national rate of inflation, not the increase in health costs. There is a huge difference. Over the past decade the rate of inflation for the U.S. has ranged from 0.7% to 3.0% Since 2007, health care prices have increased by 21.6%. The faster you run, the farther behind you get
Although the majority of Americans rely on these to some extent, those
who possess most of the wealth, thereby access to and influence of
policy/budget makers, do not. However,
these non-users will spend a lot of money to cut your benefits derived from a
social contract to help offset the deleterious effect of THEIR substantial
benefit from the most recently implemented tax cut.
The Budget proposes to reduce wasteful
spending and incentivize efficiency and quality of healthcare in Medicare,
extending the solvency of the program for America’s seniors consistent with the
President’s promise to protect Medicare.
Tying future growth to inflation growth; the Budget also reduces
Medicare’s spending on beneficiaries’ unpaid cost sharing obligations,
consistent with private sector business practices. The Budget proposes to expand seniors’
personal control and introduce more consumer power into the healthcare market
by allowing Medicare beneficiaries to make tax-deductible contributions to HSAs
associated with high deductible health plans offered by their employers or
Medicare Advantage plan. The numbers
below represent millions.
Medicare: Eliminate cost-sharing on generics–70
–90 –100 –90 –90 –110 –110 –130 –140 –350 –930
Exclude manufacturer discounts from the
calculation of beneficiary out-of-pocket costs in the Medicare Part D coverage
gap–3,120 –5,260 –6,830 –8,230 –9,860 –9,170 –9,910 –11,590 –10,760 –23,440
–74,730
Establish a beneficiary out-of-pocket maximum
in the Medicare Part D catastrophic phase 780 1,860 1,930 1,740 1,620 1,220
1,450 2,210 1,220 6,310 14,030 Give the Secretary authority to contract with
pharmaceutical manufacturers entering into new coverage gap discount program
agreements on a quarterly basis 3 ......... ......... ......... .........
......... ......... ......... ......... ......... ......... ......... .........
......... Permanently authorize a successful pilot on retroactive Medicare Part
D coverage for low-income beneficiaries–20 –20 –20 –30 –30 –30 –30 –40 –40 –40
–120 –300
Eliminate pass-through payments for drugs,
biologicals, and biosimilars–150 –280 –320 –350 –400 –440 –490 –550 –610 –680
–1,500 –4,270
Summary Tables Table S–6. Mandatory and
Receipt Proposals—Continued (Deficit increases (+) or decreases (–) in millions
of dollars) 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 Totals
2020–2024 2020–2029
Medicare–170 –2,710 –3,830 –5,380 –7,010 –8,800
–8,580 –9,160 –10,160 –10,400 –19,100 –66,200 Medicaid: Clarify authorized
generic sales under the Medicaid Drug Rebate program–15 –15 –15 –15 –15 –15 –15
–15 –15 –15 –75 –150
Test allowing State Medicaid programs to
negotiate prices directly with drug manufacturers and set formulary for
coverage–5 –15 –25 –35 –40 –45 –50 –60 –65 –70 –120 –410
Exclude brand name and authorized generic
drug prices from Medicaid Federal upper limit–90 –90 –100 –100 –100 –100 –100
–100 –100 –100 –480 –980 C
Clarify definitions under the Medicaid Drug
Rebate Program to prevent inappropriately low manufacturer rebates–26 –26 –27
–32 –32 –37 –38 –38 –43 –48 –143 –347
Allow
rebates on drugs that exceed 100 percent of the Average Manufacturer Price
Total, Medicaid ...............................
......... –136 –146 –167 –182 –187 –197 –203 –213 –223 –233 –818 –1,887
Total, drug pricing and payment improvements
................................. ......... –381 –2,941 –4,092 –5,662 –7,297
–9,117 –8,913 –9,518 –10,548 –10,778 –20,373 –69,247
Allow States to extend Medicaid coverage for
pregnant women with substance use disorder to one year postpartum 25 20 25 25
25 25 25 25 25 25 120 245
Total,
address opioids 25 20 25 25 25 25 25 25 25 25 120 245
Medicare Appeals: Improve the Medicare
appeals system
Table S–6. Mandatory and Receipt Proposals—
Continued (Deficit increases (+) or decreases
(–) in millions of dollars) 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028
2029
Totals 2020–2024 2020–2029 Address wasteful
spending, fraud, and abuse in Medicare: Improve and tailor the way Medicare
educates beneficiaries about the program 40 60 70 70 70 70 70 70 80 80 310 680
Eliminate arbitrary thresholds and other burdens to encourage participation in
advanced Alternative Payment Models 3–350 –350 –240 100 220 60 20 50 90 120
–620
Consolidate and block grant graduate medical
education payments–790 –1,240 –2,110 –3,090 –4,030 –5,110 –6,120 –7,220 –8,440
–9,710 –11,260 –47,860
Modify payments to hospitals for
uncompensated care–6,030 –7,540 –8,620 –9,670 –10,780 –11,940 –13,180 –14,460
–15,790 –31,860 –98,010
Reduce Medicare coverage of bad debts–410
–1,390 –2,940 –3,920 –4,250 –4,520 –4,810 –5,100 –5,420 –5,750 –12,910 –38,510
120
Summary Tables Table S–6. Mandatory and
Receipt Proposals—
Continued (Deficit increases (+) or decreases
(–) in millions of dollars) 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028
2029 Totals 2020–2024 2020–2029
Address excessive payment for postacute care
providers by establishing a unified payment system based on patients’ clinical
needs rather than the site of care–1,210 –2,880 –5,000 –7,670 –10,470 –12,280
–13,440 –14,700 –16,570 –16,930 –27,230 –101,150
Authorize long-term care hospital site
neutral exceptions criteria–530 –820 –890 –950 –1,000 –1,060 –1,120 –1,150
–1,210 –1,270 –4,190 –10,000
Pay all hospital-owned physician offices
located off-campus at the physician office rate–1,100 –2,010 –2,220 –2,460
–2,720 –2,990 –3,280 –3,600 –3,940 –4,340 –10,510 –28,660
Pay on-campus hospital outpatient departments
at the physician office rate for certain services–4,670 –8,600 –9,670 –10,870
–12,170 –13,580 –15,170 –16,940 –18,840 –20,890 –45,980 –131,400 Redesign
Expand basis for beneficiary assignment for Accountable Care–10 –10 –10 –10 –10
–10 –10 –10 –30 –80 Reform and expand durable medical equipment competitive
bidding–390 –690 –740 –795 –855 –910 –985 –1,045 –1,110 –2,615 –7,520 Support
coverage for innovative alternatives to durable medical
Clarify the Part D special enrollment period
for dually eligible beneficiaries–20 –20 –10 –20 –20 –20 –20 –20 –30 –30 –90
–210
BUDGET OF THE U. S. GOVERNMENT FOR FISCAL
YEAR 2020 121 Table S–6. Mandatory and Receipt Proposals—Continued (Deficit
increases (+) or decreases (–) in millions of dollars) 2019 2020 2021 2022 2023
2024 2025 2026 2027 2028 2029 Totals 2020–2024 2020–2029
Give Medicare beneficiaries with high
deductible health plans the option to make tax deductible contributions to
Health Savings Accounts or Medical Savings Accounts 601 1,066 1,287 1,492 1,597
1,682 1,764 1,825 1,283 4,446 12,597
Expand prior authorization to additional
Medicare fee-for-service items at high risk of fraud, waste, and abuse–430 –510
–540 –570 –610 –640 –680 –720 –760 –800 –2,660 –6,260
Prevent fraud by applying penalties on
providers and suppliers who fail to update enrollment records–2 –2 –3 –3 –3 –3
–4 –4 –4 –4 –13 –32
Pass Treasury collection fees for CMS
overpayment collections onto debtor –20
–20 –20 –20 –20 –20 –20 –20 –20 –20 –100 –200 37,486 –43,986 –50,141 –55,752
–61,765 –68,754 –75,171 –145,312 –456,895
122 Summary Tables Table S–6. Mandatory and
Receipt Proposals—Continued (Deficit increases (+) or decreases (–) in millions
of dollars) 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 Totals
2020–2024 2020–2029
Address wasteful spending, fraud, and abuse
in Medicaid: Strengthen CMS’s ability to recoup Medicaid improper payments–100
–430 –460 –490 –520 –550 –590 –620 –660 –1,480 –4,420
Continue Medicaid Disproportionate Share
Hospital (DSH) allotment reductions–6,510 –6,490 –6,470 –6,450 .........
–25,920
Provide flexibility for enrolling out-ofState
providers in Medicaid 1 1 1 1 1 1 1 1 1 4 9 Streamline the Implement
pre-payment controls to prevent inappropriate personal care services
payments–700 –730 –760 –800 –840 –880 –920 –970 –1,010 –1,060 –3,830 –8,670
Rescind remaining balances from the Medicaid
Improvement Fund ........... ......... ......... –6 ......... .........
......... ......... ......... ......... ......... ......... –6 –6
Total, address wasteful spending, fraud, and
abuse in Medicaid–700 –835 –1,189 –1,259 –1,329 –1,399 –7,979 –8,049 –8,099
–8,169 –5,312 –39,007
Other Medicaid reforms: Implement Medicaid
community engagement requirement–8,300 –10,900 –11,500 –12,100 –12,800 –13,500
–14,200 –14,900 –15,700 –16,500 –55,600 –130,400
Allow States to apply asset tests to Modified
Adjusted Gross Income standard populations–50 –100 –200 –210 –230 –240 –250
–260 –280 –290 –790 –2,110
Reduce maximum allowable home equity for
Medicaid eligibility–570 –610 –650 –690 –730 –780 –820 –870 –930 –2,520 –6,650
Require documentation of satisfactory
immigration status before receipt of Medicaid benefits–190 –190 –200 –210 –220
–230 –250 –260 –270 –290 –1,010 –2,310
Increase limit on Medicaid copayments for
non-emergency use of emergency department–60 –120 –120 –130 –140 –140 –150 –160
–170 –360 –570 –1,550
BUD GET OF THE U. S. GOVERNMENT FOR FISCAL
YEAR 2020 123
Table S–6. Mandatory and Receipt
Proposals—Continued (Deficit increases (+) or decreases (–) in millions of
dollars) 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 Totals
2020–2024 2020–2029
Total, other Medicaid reforms ...........
......... –8,600 –11,880 –12,630 –13,300 –14,080 –14,840 –15,630 –16,400
–17,290 –18,370 –60,490 –143,020.
Whaduyathink?
