“We’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit,” Ryan said during an appearance on Ross Kaminsky’s talk radio show. “… Frankly, it’s the health care entitlements that are the big drivers of our debt, so we spend more time on the health care entitlements — because that’s really where the problem lies, fiscally speaking.”
Wash Post December 6, 2017
https://www.washingtonpost.com/news/wonk/wp/2017/12/01/gop-eyes-post-tax-cut-changes-to-welfare-medicare-and-social-security/?utm_term=.49e1141cc032

Perhaps it is okay that the Senate and House are working to reconcile a tax bill that will benefit the rich at the expense of the rest of the nation. We exist in the “double-down on failure, double-down on immorality” era of American politics. Citing the Congressional Budget Office, since 1979 and the beginning of trickle-down economics, the top 1% of earners have seen their incomes increase by 192% and the middle 61% of earners (literally the middle class) saw their incomes increase by 40%. Another tidbit is that the top 0.5% of earners during this same period have gone from controlling 6% of the wealth of this country to 18%. (https://www.cbpp.org/research/poverty-and-inequality/a-guide-to-statistics-on-historical-trends-in-income-inequality). In the words of the famous management consultant Edward Deming, “every system is perfectly designed to achieve the results it gets”, and over the past four decades trickle-down economics has, as designed, made the rich richer. Supporters need to merely acknowledge that we have a tax bill that will double-down on this approach, concentrate wealth, increase income disparity, and further increase the deficit at the expense of the overwhelming majority of Americans.

Under the banner of alternative facts the tax bill is being trumpeted as the way to prosperity for the US. A path where everyone will benefit, but what is particularly galling is that without even waiting for the tax bill to be signed by the President Paul Ryan is suggesting an attack on Medicare and Medicaid funding as a way to offset the tax breaks to the rich. A tax bill that will create tax breaks causing a trillion dollars in new deficits. Unfortunately, reducing benefits will not decrease expenditures on health care, it will only serve to make the country sicker. Primary care will become unaffordable, health maintenance and chronic disease management will be beyond the grasp of those who need it, and we will see an increase in emergency room utilization and hospital admissions that could have been avoided. We will have reversed the progress seen under the Affordable Care Act. Healthcare expenditures decrease when we invest in keeping people healthy. Decrease the burden of disease and cost of decreases. Increase barriers to access and the cost of health care increases. Remember always that the costs of healthcare are dollars in the pockets of those who benefit from the system as it is. Even this might be ok, but……

What I find singularly nauseating is the puritanical, moralizing attack on millions of Americans that is being cloaked in the rhetoric of fiscal responsibility. Paul Ryan and his ilk are cheerfully supporting a tax bill despite the greater than a trillion dollars in increased debt for the nation. Supporting this tax bill and thus revealing that their true motivation is rooted in a basic hostility to anyone not in the top 1% of the country. Listen closely to the rhetoric of trickle down economics and you will hear the subtext that those who require assistance are responsible for their plight. It is a person’s moral failings that have resulted in the their being ill, or hungry, or homeless. These are the basic tenets of the prosperity gospel writ large, large enough to affect a country.

Sadly, it is a fiscally irresponsible approach that reinforces their moralistic world view. Attacks on healthcare, attacks on housing, attacks on behavioral health are not about fiscal responsibility as it has been shown that investment in these programs is less expensive than withholding support. This strain of conservatism loves the term entitlement, not for its technical meaning, but because its colloquial meaning reinforces their moral argument. This is not an economic argument this is a moral argument, and in Paul Ryan’s lickspittle world only the top 0.5% of Americans are worthy of our support.

The hypocrisy of presenting yourself as a fiscal conservative to drive a moralizing agenda that damages the economic health and the nation’s health is obscene. Simply stated, it is a better investment to provide care. If you care about the prosperity of the nation then you will provide care. If you care about the prosperity of the upper 0.5% of the country – including those that benefit from the healthcare system as it is – you will eliminate social support because ultimately more money will be spent on health care. Costs that we would have avoided had we invested in health, and not in sickness.