This is the future, live it up America, we are coming to get you!
Alright, so more and more of the public is worried about how much will soon be left of the social safety net, meaning Food Stamps, Medicare and Medicaid. (I leave out Social Security because, with the exception of the Disability part of the Social Security system, which will be harder to access in the future, Social Security obligations do not account for the fastest growing part of US government unfunded liabilities. Health care accounts for a growing majority of those unfunded liabilities.) So what are those bastard Republicans and the elite-friendly parts of the Democratic Party going to do with the Food Stamp and Medicaid budgets over the next few years as the deficit-cutting mandate both mainstream political parties have adopted becomes more and more of a reality? The House of Representatives, meaning mostly Republican Congressman Paul Ryan at this point, float budgetary proposals where many billions of dollars are slashed from Food Stamps and Medicaid, and the Democrats reject that, still, as old line socially liberal organs like the New York Times inveigh against 'balancing the budget on the backs of the poor.' But as the reality of finally having to do something, starting next year when budget sequestration begins kicking in, overwhelms the public discourse...what do you think will be the final resolution that the politics of the country will produce?
Many here on OS believe in the worst possible outcomes. Concentration, or FEMA, camps for the internally displaced, as massive riots begin sweeping the cities and domestic security forces clash with uprisings of the indigent combined with anarchist protests and demonstrations. Maybe there will be some rioting, but no social unrest like that goes on endlessly. Even the working poor want a return to stability and order, let alone the millions still remaining of the broad middle class, which will be hanging on despite all the pressure they are under. So what does a 'reasonable' picture of these social services look like after a period of civil disorder?
Right now, because of legislation and tradition, public hospitals still provide emergency treatment for the desperately ill and indigent without health insurance at public expense. The hospital budgets still cover that kind of emergency treatment...but that can't go on forever, right? And as the cost of satisfying the demand for Medicaid and Medicare services continues to grow and comes under increasing containment pressure of course Medicare will be receiving a greater percentage of the available health care funding at the expense of Medicaid...the remaining middle class, pitted against the growing ranks of the poor, will jettison the poor, more and more. Ugly class warfare in the future will be fought between those two lower classes, as the wealthy try to insulate and isolate themselves deploying their greater manipulative power.
The progress of this new kind of and ugly class warfare will result in programs of subsidized medical care for the poor, meaning Medicaid, de-listing more and more of their covered, or insured, services. So expensive procedures, like for heart and neurological diseases say, and expensive diagnostic tests, like MRIs, will be made unavailable to the poor, gradually, with rationing first, then outright complete removal. As this begins to happen the trend towards segregating the outright poor from the middle classes will intensify...to the point where we will see a return to the 'Charity Hospital' model that was the norm in 19th century America.
Very soon at that point we will see the phenomenon of the oldest, most run down hospitals in urban centres being re-classified as strictly 'Low Income' health care facilities. Or, if that changeover is legally challenged on constitutional, etc. grounds, then actual Warehouses For The Ill Poor may be constructed by converting, say, presently vacated commercial warehouses. As public funding shrinks, remaining charities and foundations will step in to fill in as much of the void as they can, and medical professionals, like specialty surgeons, will offer a little 'pro bono' work, donating whatever spare time they feel motivated to do so through guilt or humanitarian impulse. Of course this will be far from enough to meet the demand, but nevertheless that's all there will be. So instead of the worst of the doomsday scenarios taking place, where the poor will be left dying in the gutters as in a Third World country, they will instead be shunted off to low-cost Charity Institutions where cheap medical care will still be provided. Simple cases of repairing bone fractures, lancing boils and treating simple infections, etc. will be covered, but expensive, high tech medicine?...forget it. And only inexpensive pharmaceuticals will be available...the more expensive shit, like cutting edge cancer treatment, will be only available to the top 30-40%, say, of the income distribution in the population. THIS is the future...not a total dystopia, but certainly a meaner, much more stratified society.
Very interestingly there might also be a growing movement to separate and segregate the Deserving Poor, with medical problems for which remaining public funds will be dedicated, from the Trash and Troublemakers, such as drug addicts and gunshot and violence victims, meaning gang members in ghettos, etc. and all those with criminal records. The latter groups may get the most rudimentary first aid kind of care, but since complicated gun shot injuries can cost hundreds of thousands of dollars to treat, and inner city hospitals have disproportionate numbers of those cases and the fewest resources to spend on all their patients, even the hard-working poor will probably support cutting off expenditures on the criminals. Just as prisons are no longer funding heart transplants or, ha ha, sex change operations for their inmates.
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kennymotown
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