Most of Donald Trump’s public statements include the rote declaration that Obamacare is a disaster. This is true, of course, but it doesn’t tell us anything new. It’s only when he starts elaborating on his objections that one gets a sense of what he believes, and he doesn’t talk like a friend of the free market. During last week’s Republican debate, for example, he was asked about his past praise of single-payer health care and replied, “As far as single-payer, it works in Canada, works incredibly well in Scotland.” This answer was both antithetical to free-market thinking and profoundly ignorant.
His praise of Scotland’s system, for example, demonstrated that he is unaware of its role in creating one of the UK’s worst public health disasters. It works so “incredibly well” that tens of thousands received contaminated blood transfusions over two decades, resulting in at least 2,000 deaths and countless Hepatitis and HIV infections. Last spring, the Scottish Health Secretary found herself desperately trying to mollify an outraged public after a dilatory and unnecessarily protracted government inquiry produced widespread charges of “whitewash” by offering one generic recommendation.
As to Canada, it’s abundantly clear that Trump has never heard of the Naylor report, released last month by a blue ribbon panel led by a former president of Toronto University. To give you the general flavor of the report, it uses the term “arrested development” to describe the Canadian single-payer system: “Patients told us about limited access to a variety of services.… They also observed that the narrow scope of Medicare [the name of their national system] led to large out-of-pocket expenses for many Canadians, particularly those without work-related private health insurance plans.”
That’s right. One of the single-payer systems praised by “the Donald” works so poorly that its patients must buy private health insurance to get decent medical treatment. And yet Trump reserves some of his worst verbal abuse for the free market providers of such coverage. As he put it during the debate, “I have a big company with thousands and thousands of employees and if I’m negotiating in New York or New Jersey or California, I have, like, one bidder. Nobody can bid. You know why? The insurance companies are making a fortune because they have control of the politicians.”
If Trump’s rant seems confusing, it’s because he’s confused about his topic. The point he’s groping for involves the inability of some companies to buy insurance across state lines. But he has failed to do his homework. As John Merline writes at Investor’s Business Daily, “What Trump apparently doesn’t know is that companies like his typically provide insurance benefits under ERISA, which allows multistate firms to offer uniform health benefits to workers, wherever they live.” In other words, Trump doesn’t know how the insurance market works, even for his own business.
That isn’t the only worrisome feature of his insurance comments. When Trump goes on a rant about insurer profits in response to a question about Obamacare, he is channeling single payer advocacy groups like Physicians for a National Health Program (PNHP). This post at the PNHP blog, for example, registers much the same complaint: “One can argue that the private insurance industry should be regarded as obsolete.… However, the ACA has extended its life.” And what is the author’s primary indictment against insurance companies? “Private health insurers are all about making money.”
The problem here, if it’s not obvious, is that “the Donald’s” instinctive reaction to Obamacare is not that of a conservative. When genuine conservatives think about Obamacare, they think about its dubious constitutionality, its dramatic expansion of government, its abuse of individual liberty, its attack on religious freedom, its interference with the doctor-patient relationship, its government-imposed rationing, its illegal use of federal funds for abortion, ad infinitum. People whose first reaction to a question about Obamacare is to denounce the insurance industry are called Democrats.
Which brings us to Trump’s political “evolution.” He likes to compare himself to Ronald Reagan, who was once a Democrat, in this regard. However, as the New York Times points out, “In his 1987 book ‘The Art of the Deal,’ Mr. Trump grouped Mr. Reagan with former President Jimmy Carter among leaders… who ‘don’t deliver the goods.’” And “the Donald’s” political trajectory has been remarkably erratic “He … registered in New York first as a Republican, then a member of the Independence Party, then a Democrat, then a Republican again, and then became unaffiliated.”
Will Trump be this erratic on Obamacare? Well, oddly enough, health care is one of the few things about which he has been consistent. He wrote fifteen years ago that he was for single-payer health care and he sang its praises again during the recent GOP debate. We should take Trump at his word. He may sincerely want to get rid of Obamacare, but he’s no friend of free market health care.