Barry L. Liebowitz, M.D.

WASHINGTON--Republican and Tea Party politicians are bent on an ominous campaign to destroy and replace so-called Entitlements-the government programs that minorities and the poor have relied upon as safety nets for decades.

These social and health care programs originated as a result of hard-fought struggles by civil rights activists, clergy, unions and other social progressives.

They include Social Security, Medicare and Medicaid, the latter of which is not officially called an Entitlement, but is nonetheless the most important government healthcare plan for the poor, according to pundits.

In January, Republicans in the House of Representatives voted to repeal and replace ObamaCare, which many progressives believe is the most significant social legislation in decades because it insures an estimated 32 million Americans, nearly half of which are working class minorities.

While Democrats called the vote “symbolic” and meaningless, Republicans were quietly arguing that the grandstanding vote was the beginning of an offensive to destroy ObamaCare, or more correctly, the Patient Protection and Affordable Care Act.

If successful, gains made by activists for decades could be reversed, say observers. Many Republicans are targeting Medicaid, which is the most vulnerable of the programs because it serves mostly the poor and is controlled by the states, many of which are opposed to both Entitlements and ObamaCare.

“The Medicaid crystal ball that serves the poor is very, very cloudy,” warned Barry L. Liebowitz, M.D., president of the Doctor’s Council that represents 4,000 physicians around the country. “We’re going to see major cuts in Medicaid. Every state is looking at cutting them as a source of further revenue for their other projects.

“We’re going to see, once again, that budgets will be balanced on the backs of those who are the most vulnerable,” he said.

A random sampling of other union leaders, progressives and the clergy, especially African Americans, revealed that the gains made by America’s poor are now more threatened than ever. They predicted that the victory last November by Republicans in the House of Representatives would begin to transform America’s way of providing health and social services.

Republicans, who argue against entitlements as Socialism, want to privatize America-meaning they want private industry to operate and control government social programs.

However, in recent years, attempts to privatize hospitals and other government institutions were unsuccessful.

According to sources, the insurance industry and others are quietly making strides to privatize health care. Future Medicaid and other government cuts are expected to make local and state governments more vulnerable to privatization efforts.

Critics say that President Obama’s recent conciliatory gestures to business could be either a positive or negative step towards privatization.

Liberals and progressives, on the other hand, assert that privatizing social programs would continue to be detrimental to the poor as well as the middle class.

“We cannot let Entitlements and ObamaCare fail,” declared the Rev. Dr. Luonne Rouse, a professional therapist and pastor of the United Methodist Church in Huntington, New York. “The level of depression and anxiety is growing among our people. That is a fact and we must take the necessary steps to help them.”

Rouse, who is a vice president of Clergy and Providers for Racial Healthcare Equality, called on the clergy of all faiths to “get more involved in this new struggle to preserve Entitlements and other civil rights gains.

Presiding Bishop William P. DeVeaux, who represents the 6th Episcopal District of the AME Church in Atlanta, agreed, noting: “Our people must be educated as to what is going on in Washington. We cannot afford to allow certain forces to setback the clock for our people. We have fought too long and too hard for what we have accomplished.”

Born out of the War on Poverty and finally won with ObamaCare after more than a half-century of struggle, these programs face planned destruction by the GOP to deliver them into the hands of the insurance and medical business complex.

Threatened by the expansion of coverage for 32 million more Americans, the loss of profits and control, primarily by the insurance industry, state governors and private healthcare companies and others are pressuring Congress to kill or cripple health care Entitlements.

Medicare and Medicaid, at first opposed by the medical industry, became a multi-billion dollar bonanza that was riddled with widespread fraud and profit, later curbed by government regulations and curtailed by the new Affordable Care Act.

The new Republican offensive is to scrap the Affordable Care Act and privatize Medicare and Medicaid to run them without government regulations or control, leaving American health care at their mercy. They want to offer, “cash vouchers” for people to buy private insurance on the open market instead of through government Exchanges.

“The Republican game plan is to destroy ObamaCare and privatize America,” economist Herman Smith told The Spiritual Herald.

Despite a solid Republican House of Representatives vote to repeal the Affordable Care Act, Senate approval by a slim Democrat majority is not expected, and President Obama has vowed to veto it.

But aroused conservative forces are determined to stop Medicaid, the health care system for the poor, from becoming an Entitlement one way or another, and possibly increasing the age requirement for Social Security-protected Medicare for the elderly.

Many states have already obtained “waivers” to dodge new regulations and allow companies like Wal-Mart to offer “mini-Med” health insurance to employees that provide limited benefits.

A full-bore offensive by the Republicans and the others in general plans to cripple or destroy Medicaid if they cannot prevent it from becoming an Entitlement under the new law.

The solution to saving Medicaid, the federal-state funded system for the poor, under the current law is an Obama veto—if the Supreme Court does not declare it unconstitutional.

“But,” said economist Smith, “it is also that poor people need to be educated to fight to keep it. It’s poor whites that are taking the repeal position, because they don’t know any better.

“It’s poor whites who are in the Tea Party, it’s poor whites who are taking the position against it because they don’t know its benefit, and in poor states they don’t miss it because they don’t have it.”

Smith believes that the Tea Party represents virtually the same forces that opposed civil rights legislation in the 1960s for African Americans and others. “They represent a continuing threat to us because they will never be happy with the gains we have made over the decades,” he added.

“The biggest fights are going to be against an expansion of Medicaid, which would be an Entitlement in the new bill that takes effect in 2014, but has not yet taken effect,” commented Harvard Public Health professor Robert Blendon to The Spiritual Herald.

“There will be a battle to reduce something that has not yet happened,” he said. “I don’t envision there’s going to be a huge change in either Medicare or Social Security prior to the 2012 election.

But the Medicaid expansion, which is huge in the new bill, could be cut back before it is implemented.”

It is Medicaid that would offer health care for the first time to 32 new low-income or impoverished Americans that the aligned forces of insurance, business and state governors are targeting, claiming as House Speaker John Boehner of Ohio declared during the repeal vote that it would “break the bank.”

The Republican stance amounts to providing health care for those who can afford it under Medicare but resisting or restricting eligibility under Medicaid except for those on welfare.

“Medicaid was legislation that came out of the War on Poverty to cover people who normally would not have access to health care,” said Smith.

The late Democrat, Senator Daniel Patrick Moynihan of New York, said that many conservative forces, including the media, “fomented the discord that led to the destruction of the anti-poverty program.”

In addition, many doctors, hospitals and private forces stole billions of dollars from anti-poverty programs, helping to fuel the argument that its should be destroyed. Today, the consequences for minorities have been devastating. Cuts in Medicaid, for example, have helped increase the incidence of racial healthcare disparities.

The most glaring instance of these disparities can be found in the growing incidence of obesity—now hovering in the 70 to 80 percent range in America’s inner cities. Obesity, which is the parent of such diseases as hypertension, diabetes and cancer, has a bleak future because of its direct funding link to Medicaid.

“We’re seeing a threat to Medicaid as an Entitlement,” Smith noted, because it is seen as “welfare” funded by states and the government, while Medicare is a fully funded benefit under Social Security supported by payroll deductions.

Many states are desperate to prevent the new millions from being entitled to coverage under Medicaid because states fund Medicaid 50-50 with Washington and several warn the new flood would drive them into bankruptcy. Republicans call Medicaid entitlement a deficit buster, and that forcing small business to provide care is a job destroyer.

Medicaid poured money into the states and benefited the insurance, pharmaceutical, medical, medical supply industries and physicians, said Smith, but expansion will force states to operate massive systems.

“They oppose it now because the states do not have the infrastructure to administer it. In the past you didn’t have the level of federal regulation, and the reason for the federal regulation was because of Medicaid fraud.

“They keep saying, keep government out of the citizens’ business, but the government has to be there because when they just gave block grants, there was Medicaid fraud,” he said, noting that money was used for other purposes.

With Social Security, too, funds were used for other purposes, he said. “That’s what is rendering the system bankrupt. They’re talking about increasing the age of getting Social Security at 62 or 65 to age 67 or 69, which will prolong the system. There’s a fight between the parties. The Republican Party wants to privatize the system.

“They’ll only be successful if we don’t educate the Tea Party, the independents, all of those who don’t understand. The deeply rooted problem here is the average citizen is not educated.”

The crippling or loss of Medicaid for the poor would be a catastrophe,

Liebowitz of the Doctor’s Council told The Herald: “There are very few alternatives for many, many people of our great country if Medicaid goes. Even in our own great state of New York, Medicaid is a primary target.

“It does serve a community that has very few resources, but it’s somewhat incompatible with the private medical system. We’re very fortunate that in the City of New York, we have the Health and Hospitals Corporation, which takes care of everyone, independent of their means, and independent of their country of origins.

“We’ve been doing that for 250 years. When you walk into a Health and Hospitals Corporation hospital, such as Bellevue or Kings County, whether you have a splinter in your finger or you need a heart transplant, you would get it.”

Threats to funding and reimbursement to doctors threaten such care, he said, as physicians turn away Medicaid patients. “You have to understand that the cost of private doctors, or even in the public system, to see patients at a loss means they can’t stay in business; they’re under the gun anyway.

“Because of the socio-economic state of the country, visits to physicians have diminished. If you touch the reimbursements, the Health and Hospitals Corporation is going to be severely hit. This year, I believe it’s a 2.4 billion deficit, and we are addressing that by reorganizing the system.

“All I can tell you is that most doctors when they leave medical school, are already nearly a quarter of a million dollars into debt. So subsequently, by cutting all these things, you are really going to diminish the return and equality of people that will be going into medicine.”

Blendon doesn’t “envision anything is going to be destroyed. There are going to be battles of trying to more limit benefits under Social Security and Medicare, and some limits on the benefits under Medicaid. I don’t see any benefit being destroyed.

“The battle is going to be limiting COLA (cost of living adjustments) clauses, having people pay more co-pays and deductibles, not having generous services, moving retirement ages back, not have people eligible. So the focus is going to be on restricting what is available to people under these programs, but they’re going to be there.

“With Medicaid, the issue is whether or not the benefits that are available to people are more limited and the income eligibility is broader or more restricted. The new bill has raised the eligibility for Medicaid very substantially. The battles will be, can we afford to cover as many people under Medicaid as is posed by the new legislation.”

“So you’re eligible for Medicaid based on your income situation, something about your family history, and there’s been a huge expansion envisioned in this bill about who would be eligible. Millions of people not eligible today would be eligible in the future.

“Those who argue we can’t afford that and say we have to restrict it by income. Others are also arguing the program’s benefits are too generous, that we can’t afford to cover as many services as are covered, and Medicaid’s future should be more limited in what it offers.

“Medicare under Social Security is controversial,” he said. “You only have three choices. You raise the tax that people pay, you move the retirement age, or you reduce the benefits that future generations will get. At the moment, there is not an agreement about what combination of those three should be done.

“You can raise the taxes for under-65 people, you can move the retirement age, you can cut back the benefits. You can pay doctors in hospitals less, or you can reorganize health care so it’s tighter, better organized, cost issues taken into account when treatments are going.

“So it’s taxes, eligibility, benefits, paying providers, and then trying to make the system function much tighter in how it cares for people so it saves money. There’s no agreement at the moment in real life about what combination of those things would be done.”

The battle over repeal turns on Entitlement—who is legally “entitled” to government-subsidized health care, and who is not. Medicare is an Entitlement under Social Security, funded by payroll deductions.

Medicaid has not been, but would be under the new Affordable Care Act, and Republican efforts are to prevent it from becoming so.

“‘Entitlement’ means that if you’re a child below a certain income you’re entitled to A, B, or C. Everything else (Medicaid) is an appropriation that’s voted every year, so it can be changed, up and down.

“Entitlements are for people with Medicare and Social Security. What it really means is that the law say if you paid in, you’re entitled to a set of benefits for the rest of your life when you retire. That is not subject to years of decisions by the Congress.

“Medicaid is a mix, because some people are entitled by law to get coverage, people on public assistance. But others are optional,” depending on income levels and eligibility.

States play a major role as they fund Medicaid 50-50 with the federal government, and resist federal mandates to pay for the poor by restricting eligibility.

“The big debate between the parties is that Republicans believe that these programs would be better if they had more private-sector options,” said Blendon.

“Republicans envision it would be better to give people some sort of a cash voucher, and they buy private insurance when they retire. Some and some will get better, and some will get worse, and some will pay more out of pocket for that.

“And they still believe in private accounts under Social Security. In many states, they want to offer private policies that may have fewer benefits than Medicaid that have more choices and flexibility for it.

“There’s going to be a substantial debate, depending on what happens in the parties, about whether or not there are private options that are made available, and many of the private options may give people more choices, but they may have much less extensive benefits.

“The big debate is, do we move the retirement age, and do we pay more taxes?”