HEALTH CARE/Joan Retsinas

A Christmas Gift: TrumpKids

Dear Santa Trump:

Here is a truly terrific idea for a national Christmas gift – something very very wonderful. Spectacular! A gift that will extend your brand into the arcane realm of philanthropy, put your face up there with the pantheon of great Presidents. Greater even.

The nifty notion: health insurance for all children, otherwise dubbed TrumpKids, modeled after Medicare, but focused on the young, not the old.

The advantages, public-relations-wise, are stupendous. Everybody loves children, at least in this season of ho-ho-hoing everybody professes to love them. Think of Tiny Tim – everybody booed Scrooge, but cheered his redemption. You can be the person who saves all the Tiny Tims. With a flick of your Presidential pen, you can – whoosh – insure all children, rich and poor, white and black, sick and healthy, native and foreign-born (vetted and documented, of course), in blue states and in red states. Medicaid, coupled with the Supplemental Children’s Health Insurance, already insures a huge swathe of children. Add to that the children of federal, state, and local government employees. Then add the Department of Defense dependents. Uncle Sam already covers an amazing number of children. But in taking them under one umbrella – TrumpKids – you will simplify the mishmash.

You will whisk this population away from states, as well as from the private employer-sponsored plans. The Affordable Care Act struggled to lure states to expand Medicaid – but 20 states said “no.” The Affordable Care Act also forced employers to keep dependents up to age 25 on their parents’ policies. With TrumpKids, states won’t need to take on additional burdens, but can turn them over to TrumpKids. Ditto for employers: the barely-employed millenials sleeping in their childhood bedrooms can go on TrumpKids too.

Medicaid raises ideological, as well as fiscal, conundrums. Many legislators, state and federal, want the poor to pull themselves up by their bootstraps. The legislators fear that the “free lunch” of welfare in all its modes (income subsidies, rental subsidies, food subsidies, insurance subsidies) saps the drive of recipients, making them literally free-loaders. The new/old solution: block grants to states for money, letting them rewrite the rules – raise eligibility levels, require co-payments, institute limited networks, set time limits on assistance. No molly-coddling from this group of solons. As for the elderly living in nursing homes – a really huge drag on Medicaid budgets – let states ratchet down payments to facilities, “review” the regulations, maybe return to the market-driven “convalescent homes” of the past.

With TrumpKids on the books, you can wash your hands of those two burdensome populations: poor adults, frail elders.

You will leave states free to institute as draconian — as Scroogian — a set of rules as they, or their supporters, can stomach. Remember: audiences loved Tiny Tim, but weren’t as distressed at the harsh lives of the Cratchitts. So let Congress embrace block grants, let governors and state legislatures sink their adult populations into desperation. Nobody will remember you for that – we can blame the Darwinian state officials. But everybody will remember you for saving the children.

Every President yearns for a signature domestic accomplishment. (On the international front our Presidents have too often sunk into the mire of wars.) Think Franklin Delano Roosevelt’s New Deal. Or Dwight Eisenhower’s Interstate highway system, John Kennedy’s Peace Corps, or Lyndon Johnson’s list of programs, from the National Endowment for the Arts to the Voting Rights Act, to Medicare. You have already promised us TrumpWorks, a program to rebuild the nation’s crumbling bridges and roads. (In fact, the economic boost from TrumpWorks may more than offset the cost of TrumpKids).

TrumpKids will be even more terrific.

Optimistically,

A cynical constituent who wants you to prove the cynics wrong.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, December 15, 2016

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