OPINION: Blustery Trump puts America closer to single-payer health care

Jan. 18--I was stunned not so much by what Republican President-elect Donald Trump just said about health care as by when he said it.

For virtually his entire presidential campaign, Trump spewed airy, grandiose promises about his plans for replacing Obamacare (the Affordable Care Act) with something cheaper and yet more robust; a new program that preserved the many popular elements of the ACA and eliminated the unpopular elements.

But that was politicking, in which inflated rhetoric and vaguely worded flimflam are part of the seduction.

It worked. He won.

And now, by rights, he should be on to governing. Just days before his inauguration Friday, he should be lowering expectations, scaling back his promises and preparing his supporters for the unhappy compromises, delays and disappointments that lie ahead, not feeding them more fantasies.

"We're going to have insurance for everybody," Trump told Washington Post national political reporter Robert Costa in a Saturday night phone interview.

Lower-income Americans, about 12.5 million of whom obtained coverage under Obamacare's insurance exchanges, "can expect to have great health care," Trump said. "It will be in a much simplified form. Much less expensive and much better. ... They'll be beautifully covered."

Yes, go on.

"It's not going to be their plan," Trump said, referring to the existing, highly controversial, complex and admittedly flawed Democratic program passed in 2010 along party lines. "It'll be another plan. But ... I don't want single-payer."

Really? Because "insurance for everybody" that offers "great health care" "in a much simplified ... much less expensive" form sounds an awful lot like single-payer -- also known as Medicare for all, nationalized health care or universal coverage.

Trump was once all for it. "We must take care of our own," he wrote in his 2000 book "The America We Deserve." "We must have universal health care. Just imagine the improved quality of life for our society as a whole. ... With more than 40 million Americans living day to day in fear that an illness or injury will wipe out their savings or drag them into bankruptcy, how can we truly engage in the 'pursuit of happiness' as our founders intended?

"The Canadian-style, single-payer system in which all payments for medical care are made to a single agency (as opposed to the large number of HMOs and insurance companies with their diverse rules, claim forms and deductibles) ... helps Canadians live longer and healthier than Americans."

And, Trump's rote repudiation of single-payer in The Washington Post interview notwithstanding, it sounds like he's still for it.

So far, the hazy outlines of Trump's ideas on replacing Obamacare -- just like the various ideas floated by Republicans in Congress -- would have some combination of significantly unpopular results: Higher deductibles. Skimpier coverage. Increases in the number of people without health insurance.

Single-payer systems have their drawbacks, too, of course, not the least of which is that they smack so heavily of "socialism" that, despite their popularity and prevalence in most of the rest of the developed world, Democrats have failed for the better part of a century to advance proposals to guarantee basic medical coverage for all.

The very idea has been too identified with the far left to gain mainstream traction, even with polls showing 6 in 10 Americans agreeing with the statement that "it is the responsibility of the federal government to make sure all Americans have health care coverage."

Could Trump, the unorthodox populist blowhard, be the one to make it so? After all, it was a Republican president, Richard Nixon, who opened up U.S. relations with communist China and a Democratic president, Bill Clinton, who ended traditional welfare. Perhaps, similarly, only a Republican president will be able to shatter the GOP's traditionally staunch opposition to single-payer.

Trump's not even in the White House and he's rhetorically led his party into a box canyon on health care. Even while bleating about what a "disaster" Obamacare is, he's pledged not only to preserve the parts of it with huge public support, such as the ban on discrimination against those with existing medical conditions, but also to make it cheaper while not cutting funds for Medicare and Medicaid patients.

True, he has his finger to the winds of change generated by Obamacare and may be guided only by his desire for public approval and his instincts as a con man, but all his big talk has left his party no face-saving way to replace the existing program that isn't something even closer to single-payer guarantees than what we have now.

If Trump is as good as his word -- and yes, "if" insufficiently qualifies his track record of fakeouts, falsehoods and flip-flops -- "Trumpcare" could go from a dark joke to a blessing.

___

(c)2017 the Chicago Tribune

Visit the Chicago Tribune at www.chicagotribune.com

Distributed by Tribune Content Agency, LLC.