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.

The most interesting developments will be in the judicial system. If the social welfare programs will have to be rationalized and curtailed what will happen to the present expensive corporate-run penal system and the courts?  The for-profit prison administration corporations have maintained their economic profitability so far but, if push comes to shove, that entire sector will have to be downsized as well.  Will that mean much smaller prison populations in the future or their cheap restructuring as inexpensive, inmate-run internal penal colonies, outside of the orbit of the Constitution?  If that's going too far then certainly de-incarcerating huge numbers of non-violent drug offenders will necessitate the expansion of the charity hospital and publicly-funded food distribution model to which I turn below. (Also, the present-day system of expensive court procedures will also have to change, with a cheaper, more rudimentary justice system for the bottom half of the population, while trying to maintain a more expensive and elaborate judicial process for the top half. If you think this is Constitutionally impossible wait till severe economic hardship begins lashing millions of people, and there is a loud, society-wide outcry to find savings wherever possible in government and re-direct those savings to honest, decent working people who don't approve of lavish spending on Public Defender lawyers for criminals, harrumph!) 

And what about Food Stamps.  That program will be re-engineered also. Right now it provides too much flexibility and choice in food purchasing decisions, and therefore costs too much.  In the future, instead, there will be 'Government Food Distribution Facilities' where only staple products like macaroni and cheese, bread, potatoes, baloney, peanut butter, etc. will be made available to the poor with biometric, electronic ration cards.  The state will subcontract the material and administrative aspects of these food distribution facilities to private businesses which will be making bulk purchases, in the market, of these staples.  Say goodbye to the present system of inefficient Food Stamps with their high overhead costs and perverse outcomes, such as offering students using them the freedom to purchase fancy foods like goose liver paté and organic cilantro, or whatever the fuck they buy.  Soon it will only be Government Welfare Victuals, in addition to whatever artisanal healthy produce they can grow on small plots on 'urban farms' as in Detroit, for those tens of millions of Americans in the Soylent Green future who will be on the permanent dole.

Speaking of Soylent Green, hmmm, I wonder, is there an opportunity for a clever corporation of the future to combine its Cemetery Services Division, burying the poor and deceased students (the ones who have given up on this system in despair and overdosed on Government Twinkies...wink) temporarily in futuristic Corporate Potter's Fields and recycling their carcasses through re-processors into Corporate Junk Food for the biometric ration card recipients?  Hmm, have you ever heard of PINK SLIME in the present-day beef industry?  Oh, the wonders of free-market technology!...wink