Responding to my comments about the Rand report on Medicaid Expansion refusal, and about "entitlement reform," a Linked in Forum member thought he had a gotcha:
There seems to be some parallels in:
1) Accepting cuts in future Social Security and Medicare payments now, so we don’t have to accept them later. And
2) Accepting Federal money for Medicare expansion now, with a reduction in Federal support later.
I wonder why [Upper West] supports one and not the other.
My response:
I do not agree with your "parallel" or the premises on which it is based.
On 1: (a) It is highly questionable whether cuts in social security and Medicare will have to be made in the future. In fact, the trend is in the opposite direction, as the latest Trustee's and CBO reports show. If you cut now, you will never know if the cuts were in fact needed. In fact, to the extent that the cuts may slow the economy (less disposable income for seniors), they might lead to more cuts in the future even with the present cuts. I think there should be little debate that any problem with Medicare is mostly due to out of control health care costs here compared to elsewhere in the world. The ACA already is showing signs of reducing those costs.
(b) assuming that without cuts now, future cuts are "inevitable," why are cuts now the only answer? What about a rise in the cap from the current about $110,000 to a higher number or a "donut hole" in which there's a cap between $110,000 to $250,00 and payroll taxes start again at $250,000? What about subjecting capital gains to the payroll tax?
I will never convince you of (b) I think, because (correct me if I'm wrong) you oppose any rise in taxes. But given the trends I mentioned in (a) above there is no current emergency requiring cuts now that will inflict suffering on people now, especially when future cuts are uncertain and there are other ways to deal with the problem.
2. The reduction in Federal Support for Medicaid expansion will be over 10 years, and from 100% to 90%. So the people of states that decline the expansion, e.g., SC, will be paying federal taxes that will pay for expanded Medicaid in other states, while their state will have to pay $1B more in, e.g., ER costs that will either raise their taxes or cut their services (large classes, bad roads etc.). (and that's without considering that people will suffer who can't get health care).
Some issues are complex and nuanced. Refusing free Medicaid expansion money is not one of them.
So to sum up, you've provided an incorrect analogy based on incorrect premises. Other than that, I agree with you.