Soak the Poor, Feed the Rich

By James Kwak

After the dangerous clown show that has been the Trump White House, it’s comforting to return to some good, old-fashioned conservative policymaking: bashing the poor to cut taxes on the rich. I’m talking, of course, about the Republican plan to repeal and replace Obamacare.

Health care financing can sometimes seem like a complicated topic. Adverse selection, risk adjustment, blah blah blah. But it’s easy to understand the American Health Care Act or, as it is sure to be known, Trumpcare. In the medium term, financing policies have little effect on the price of health care. At most we can hope to “bend the [long-term] cost curve.” So health care policy essentially comes down to a single question: Who pays?

Let’s start with the most fundamental element of the Republican plan, the one most near and dear to Paul Ryan’s heart, the principle that has kept the conservative coalition unified since 1994: cutting taxes on the rich. Trumpcare will eliminate virtually all of the taxes that Obamacare introduced to expand health care coverage, including the Medicare surcharges that only apply to high earners: 0.9% on earned income and 3.9% on investment income. That in itself is a 16% cut in taxes on investments for a class of people who make lots of money from investments. Health savings accounts will increase the tax breaks available to high-income families. The “Cadillac tax,” which would have affected people with generous health plans, will be pushed back until 2025 (in a transparent bid to improve the bill’s scoring for reconciliation purposes), with the expectation that it will be repealed at some point in the future.

With less revenue coming in to pay for health care, the federal government will pay for less health care. Trumpcare reduces government spending in two main ways. First, people who buy insurance in the exchanges will have to pay more, both in premiums and out of pocket. Obamacare’s income-based subsidies will be replaced by age-based tax credits. The net effect will be to increase the price of coverage for lower-income people and decrease it for higher-income people:

Screen Shot 2017-03-07 at 9.56.44 AM

(The chart is from the Kaiser Family Foundation and is based on slightly different numbers from the proposed bill, but the basic principles remain the same. The final bill does phase out tax credits beginning at $150,000 in family income.)

Because Trumpcare eliminates the individual mandate, more healthy people are likely to opt out of coverage. This will increase the average actuarial cost of people buying individual plans, which will push up premiums—a transfer from sick people to healthy people. Trumpcare also repeals the Obamacare limits on cost sharing (deductibles, copayments, etc.) for low-income families. So in addition to paying more to buy health insurance in the first place, poor people will have to pay more when they actually try to use their health insurance.

The second major way that Trumpcare pays for its tax cuts is by reducing federal spending on Medicaid. The plan reduces the amount the federal government pays for Medicaid expansion (a central component of Obamacare), which at best will simply shift costs to the state level, and at worst (and more likely) will cause more states to opt out of Medicaid expansion altogether. In addition, Trumpcare achieves the long-held conservative dream of converting Medicaid into a block grant program, which means that Republican state governments will be able to use the money in ways that are only tangentially related to providing health care for poor people. (Temporary Assistance for Needy Families block grant money, for example, is routinely used to support abstinence programs or premarital counseling services aimed at getting couples to marry.)

There are more details, but the basic outlines of the plan are simple: Cut taxes on the rich, cut spending on the poor, and expose more families to rising health care costs. The thing is, we’re talking about health care here. People will need the same amount of health care no matter what Congress does. If the government pays less for health care, poor people will have to pay more. If they can afford it, Trumpcare is effectively the same as a tax on the poor. If they can’t afford it, it’s even worse. This is as naked an example of class warfare as you’ll see today.

21 thoughts on “Soak the Poor, Feed the Rich

  1. Insurance co’s have always relied on the healthy or accident free people to pay for the ill and reckless ones, and then deny claims with a battery of lawyers to make the fat margins pay off. They can not educate their way to lower costs, those people are not that good.
    You could have educated your way out of the higher cost of living scenario until the study on human denial overwhelmed education. Leading to the only solution following majority rules and the law of numbers, war.
    If we wait long enough, the guy who caused the problems says he will clean up his problems, just to build them all over again. It sounds like the definition of insanity, and it is. He says his insanity is of a lesser degree than the problems he created so that justifies the risk of clean ups.
    Tip of the day: There are no solutions to perpetual higher costs of living, live today, for tomorrow we die.

  2. I don’t want to quibble too much about your use of the term Trumpcare. But I do think it lets the Republicans off easy. And I think they’re more responsible than Trump. I prefer GOPCare, so that there is no mistaking who people need to hold accountable in the midterms.


    Big insurance, Big government, Big pharma….

    politicians are trained poodles barking the right sounds taught by their master…this is clearly a “GOVERNMENT” that exists


    to put the hurt on YOU….

    $$$$ is “speech” – and has freedom of speech protection….

    Every algorithm is based on the master formula:

    More misery for others = More $$$$ fro ME ME ME

    Obamacare created the latest heroin/suicide epidemic – economic genocide via data control – “you MUST apply for the job on the “Internet”….:

  4. We always say it could be worse Annie, but i’m beginning to see a pinnacle here, a guy even went so far as to poison the toothpaste. If your gums bleed after brushing, its not because of hard bristles, he put a gum dissolver in there to swell the gums and trap the bacteria, just his contribution to not getting his way, what ever way that would been,(education?), his private misery is now your private and personal misery so to speak. Like all gasoline comes from the same place and just has different distributors, so does the toothpaste. And he’s done give up on talking about it at this point so you’ll just have to take your lumps that way trying to find the last good one around.

    Now we made big batch of the good stuff some 13 years ago so I have a life time supply, the rest of you guys, i’m not so sure about. Good luck with the new normal, or in some cases, not so new.

  5. As long as the “profit chain” is asymmetrically constructed by insurance pools and corporate medical systems, the patient is not only at a disadvantage but a complete surrender to those profit incentives. Medical cost is elusive and every stage of the translation. Cost/Medical Ratio is about profit prioritizing and big business is about life style, social power and class luxuries not medical delivery expedience or “fair” market exchanges. Risk is no longer the true distribution for patients but for investors and the distribution of continuous revenue streams (now the aggressive target of private equity vultures that care nothing about the patient, only payment due). The hypocracy is loaded down with examples of idealism that surely does exist in the medical community and even the lower levels of insurance servers. Idealism disappears at the for profit magnitudes that soon become mergers and acquisition along with impossible path dependence, lack of true transparency, the “shareholders” as target goals rather than the customer/patient being served, and all the top level middle class is kept well tended so the true power that could change things knows no pain to the process (and is the first to complain when their policy is impacted as if they are victims of the poorly served latching on and “costing” them pocket money. There is no morality outside of the well insured. I know first hand that Doctors themselves divide good patients from bad patients on the basis of insurance and ability to pay.

    Consider this ex\excerpt:
    “Researchers surveyed the 50 U.S. hospitals with the highest price markups – the ratio of charges to allowable Medicare costs – and found that some hospitals were increasing their prices by as much as 1,000 percent over the actual costs of common procedures. Such rising list prices are increasingly gouging U.S. patients, particularly out-of-network patients and the uninsured. Even for those with health insurance, choosing the wrong hospital – or being driven by an ambulance to a hospital out of one’s network – can suddenly mean massive bills totaling tens of thousands of dollars.

    The study underscored that the private healthcare market, unlike other free markets, has few of the checks and balances in place that would allow patients to make informed decisions about treatment. “We as consumers are paying for this when hospitals charge 10 times what they should,” Gerard Anderson, professor of health policy and management at Johns Hopkins Bloomberg School of Public Health and co-author of the study, said in a statement. “What other industry can you think of that marks up the price of their product by 1,000 percent and remains in business?”
    (read the full article here:…Health Care Costs In The US On The Rise, Hospitals Now Charging 10 Times Medicare Rates For Common Procedures: Report By Philip Ross.

    Of course higher prices at the pump means the Insurance rates must change to cover it all and that vicious cycle perpetuates itself.
    Health is not the incentive. Prices and fair unconditional humane care
    is not the absolute goal. Of course the “market” rations the best to the better off, and that concentration seems to be the real attraction to Republicans that always seem to want it all for themselves…and resent when their privileges are made common…or god forbid…shared value!

  6. The boss demands charity work too Bruce, even when a couple of his own beautiful daughters heads are about to be served up to the guillotine, he insists on nothing but charity to resolve his issues. I Guess that’s why it takes so long to actually get to peace on Earth with a side of heaven naturally. After all the dues to be paid, he had no money left to raise the kids. Kids that turn into adults on their own, become problem adults, requiring expensive care and treatment that becomes financially unsustainable, or in this insurance case, became.

  7. They get in your face ONLY to hurt you.

    Every algorithm runs off the master formula:

    More misery for others = More $$$$ for ME ME ME

    Look at the Big Picture – the new priest class are the Shamans of Gizmology. Their dogma is that the selfie stick is a greater human achievement of “manual labor” than the Queen Mary ocean liner was…

    Leave the USA for sane human health care….

  8. Your algo still confuses me Annie, I can see less money leading to more misery, or even the desire of someone to create more misery for others, but just how does the creation of more misery, lead to the collection of more money for them? If I could create misery to make money I’d leave my manual labor job to become a full time couch potato. Now if I could create misery to wake a sleeping crowd, well that’s another story.
    Plus its hard enough to trust USA health care as it currently is, try leaving the USA for health care and you land in Bruce’s lap of ‘There is no morality outside of the well insured. I know first hand that Doctors themselves divide good patients from bad patients on the basis of insurance and ability to pay.’, not to mention being groped at the border or airport on your way out. Better to have a retired Dr. in the family who now only treats family members, but that takes a large family.

  9. ” Trumpcare is effectively the same as a tax on the poor. ” Having to pay for something that you receive is a tax somehow?

    Really? That is the best you can do to summarize?

  10. Other major Western democracies went with single payer, and as a journalist I saw it work in two countries. It worked well — faster and smoother, less paperwork.

    Less doctor stress — this was obvious, and to me, extremely significant. A preoccupied or distracted doctor hampered by bureaucracy is not at his/her best. Doctoring and clerking are very different.

  11. No, there is nothing simple about this, and trying to simplify what is complicated, does not always work. The following for example, just adds to the confusion:

    “If the government pays less for health care, poor people will have to pay more. If they can afford it, Trumpcare is effectively the same as a tax on the poor. If they can’t afford it, it’s even worse. This is as naked an example of class warfare as you’ll see today”

    That is misleading, with less from subsidies it will not lead to the poor paying for more, or not exclusively anyway, what will happen instead is that the poor will be less likely to have insurance, and then they will more often just use emergency room care when necessary. Then, everyone else will pay more via higher insurance premiums and co-pays as providers offset their losses.

    And for this to be “class warfare” it would be necessary to establish that subsidized health-care is supplementary income. And low wages and incomes ‘is’ part of the problem here, but by not making that aspect of the problem part of the equation…health-care subsidies just seems to be a charity issue from the rich to the poor. But of course the rich have been taking an increasing share of productivity gains, so, government transfers to provide health-care have become de facto compensation.

  12. Usury is “More misery for others = More $$$$ for ME ME ME

    Take Uber – $25 out of every $100 booked in the driver’s hometown NEVER returns back to the driver’s hometown – whereas before the full $100 stayed in your town – distributed among the owners and the drivers who, mostly, live in the same town or close by….it’s a SUCK OUT from local currencies. What part do you NOT want to understand about suck outs of what labor does via “selfie-stick” “disruptive” technology??!!

    FOR PROFIT “health insurance” is a sadistic abomination – a SUCK OUT doing great psychological damage to anyone living with such anxiety about their basic needs. The best people cannot bring themselves to go into the clinician professions anymore in USA because of the way they will be curtailed in doing REAL health care! Truth. Doctors were thrown out of the “public hearings” when the ACA was being crafted….is your memory that short?

    The way societies dealt with the vampires and predators wandering in to their civilizations as “shamans” in the distant past was SIMPLE – the people agreed among themselves to clean out their gene pools of genetic disease/defects – voluntary birth control. Might have been enacted cruely among some tribes, but definitely not in the more ethical and intelligent societies.

    For real scientists you cannot hide the true cause of today’s miseries. The start of black lung and cancer epidemics have clear temporal baselines. Best human gene pools (centuries of careful cultivation) are being devastated by the manufactured by-product poisons of the craven avarice driven economy of “energy” and “weapons”.

    Of course the SLAVES do not deserve health care from the owners – that is the #1 “cost-saving” benefit of slavery to begin with!

    Fact remains that coal company owners NEVER allowed the miners to improve their lot in life through education and innovation. If the daughter became the local doctor, the “black lung” could not be hidden for so long and scrubbers would have been developed within a decade of the operation.

    There is no hiding the iniquity.

    Get outta my face is still the battle cry. I can heal myself and family if you do and that is NOT desired because someone sadistic makes their $$$$ off me dying slower and according to their economic plan.

    And what hypocrisy! The globalization of everything BUT health care?

    How about may the BEST COUNTRY win the competition for cures and genetic security for their “normals”?

  13. More from the forbidden epochal revelation:

    This is what I refer to when I say – “Get outta my face” :-)

    54:2.3 (614.8) Lucifer’s folly was the attempt to do the nondoable, to short-circuit time in an experiential universe. Lucifer’s crime was the attempted creative disenfranchisement of every personality in Satania, the unrecognized abridgment of the creature’s personal participation — freewill participation — in the long evolutionary struggle to attain the status of light and life both individually and collectively. In so doing this onetime Sovereign of your system set the temporal purpose of his own will directly athwart the eternal purpose of God’s will as it is revealed in the bestowal of free will upon all personal creatures. The Lucifer rebellion thus threatened the maximum possible infringement of the freewill choice of the ascenders and servers of the system of Satania — a threat forevermore to deprive every one of these beings of the thrilling experience of contributing something personal and unique to the slowly erecting monument to experiential wisdom which will sometime exist as the perfected system of Satania. Thus does the Lucifer manifesto, masquerading in the habiliments of liberty, stand forth in the clear light of reason as a monumental threat to consummate the theft of personal liberty and to do it on a scale that has been approached only twice in all the history of Nebadon. *

    54:2.4 (615.1) In short, what God had given men and angels Lucifer would have taken away from them, that is, the divine privilege of participating in the creation of their own destinies and of the destiny of this local system of inhabited worlds.

    54:2.5 (615.2) No being in all the universe has the rightful liberty to deprive any other being of true liberty, the right to love and be loved, the privilege of worshiping God and of serving his fellows.

  14. You know Annie, it’s highly possible that the writers of the book were expressing their displeasures with the creation and direction of the federal reserve and their band of A students. The privatization of eugenics after dismissing it publically a decade after their own creation. Throw in a few nick names and tricky words to ward off the negative spirits and a movement is born.
    Like MIT.
    Question, why are there 3 rings around Saturn?

    Answer: Because there are two around Uranus.

  15. Uranus is the father of Saturn – like father, like son…an ahole

    68:2.11 (766.1) Vanity contributed mightily to the birth of society; but at the time of these revelations the devious strivings of a vainglorious generation threaten to swamp and submerge the whole complicated structure of a highly specialized civilization. Pleasure-want has long since superseded hunger-want; the legitimate social aims of self-maintenance are rapidly translating themselves into base and threatening forms of self-gratification. Self-maintenance builds society; unbridled self-gratification unfailingly destroys civilization.

  16. I believe we are intellictually today at a similar point that the country was at just after the start of the civil war. And should prepare to enter a defensive stage rather than place hope or faith on a momentum winning strategy.

    We are winning some battles yes, but winning the war is going from a distant last chance, to a more probabal no chance, if momentum has any sway in the matter, and like the difference between the rich and poor, I have yet to see where it does not prevail once past a certain point of consecutive lost, or won, opportunities.

    Lincoln wrote this after relizing the war was not going to be a quick and easy one, it was going to be dragged on, risky, long, and costly. And that the country should prepare to suffer the costs of this war in the form of a day a year of fasting and prayer of a country, and for a country. It was well written then, and just as significant today.

  17. Really? More WAR?

    MORE Nihilism, hedonism and anarchy form the “elite”?!

    Your nimrod wall street engineered economic genocide flash crash against the USA middle class – the FIRST slave-free industrial revolution HONEST LABOR society in the history of humanity – is a wet dream to take the whole planet back to THIS. Fck you and the horse you rode in on…everyone who lost their home to fraudclosure is a refugee, everyone who goes hungry in USA because of food stamp “cuts” and PERMANENT job loss are refugees, everyone who WAS genetically healthy and has to rot away in INSURED poverty is a refugee…

    The JUST WAR is against you “ugly” “squeel like a pig” ‘mericans…liars, thieves and murderers with your DELUSIONAL made-up crap “holy books” in hand…which now includes your endless psychobabble prevaricating interpretation of “The Constitution” to make LEGAL your lying, thieving and murdering!

    Ironic that al jazeera is running this UN story since it is their continent that is at risk thanks to oil sheikhs and THEIR “holy books”….

    Cheapest way to let you mad dog warriors get your “war” in USA? Let us ladies have our go at cleaning out the male gene pool, for a change…one guy who heard me make this suggestion at work snarked – “…that would leave like one guy out of 10,000 alive, right?….”.

    The Shamans of Gizmology – the NEW priest class – certainly did deliver the scale Lucifer lusted after – the “creative disenfranchisement” of BILLIONS of normal-minded and healthy humans…”…you MUST use this most unsafe internet to apply for a job…”

    Truth, beauty, and goodness repeat in history, also.

    Man the best “man” win….

  18. I agree Annie, the male pool needs cleaned,(yet Eve was warned that if she created adam, he would ruin her whole universe, ……..and he did), as well as guys with vaginas you can add, problem is you would lose your work force by the law of numbers. And their is nothing “normal-minded” or “healthy” about western values or its way of life after complete consideration of the laws of nature, this has been proved simply with the current health care catastrophe at the location of its worst offender, America.

    And absolute truth, beauty and goodness has yet to be achieved in the universe, that’s what all the war is about. Eye of the beholder and all, plus he/she says that since they named the body parts, they have a right to your self determination, including years and life style, they say they gave you an extra 27 years this go around and you should be happy about that, even if you suffered and were dying during the whole extension, and they claim the title of being gods, go figure.

    I have to give them credit for knowing what were doing with the naming of body parts, now financing their own twin daughters success, they have quite a ways to go over there and I’ve shown them all the places they came up short. But heck, what’s another million years to people who claim title to being gods? Even if they do get stranded at third base as many times as Charlie brown tried to kick the football to home plate.

  19. I would simply put everybody on Medicaid and then educate them on how to not need it, or rarely use it type thing, plenty of examples of success over there. Oh yeah, that’s just another thing reserved for a day that never arrives , I believe we have built a society that we can no longer afford to maintain.

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