IS A SINGLE PAYER HEALTH CARE SYSTEM IN YOUR FUTURE?

1/23/17

While yours truly doesn’t like to make predictions that don’t have solid numbers behind them, predictions are what makes blogs like these interesting.   So here’s something to anticipate in a Trump presidency:   the introduction of a single payer national health system, or something like it.   There are a number of reasons yours truly thinks such a system will be proposed, but please note that I am not as confident single payer will be implemented as I am that it will be proposed by President Trump.

Mr. Trump has already made noises that have been interpreted in some quarters, and with horror and shock in conservative quarters, as an indication that he is open to single payer.   Those noises so far have been limited to his disapproval of the profits the drug companies are making and his consequent eagerness to negotiate with the drug companies.    While interpreting such comments to mean that Mr. Trump is open to a single payer system remains something of a stretch, there are more reasons to suspect that single payer may be in our future.

First, our health insurance system, perhaps even our entire health care delivery system, was a big issue in the campaign and remains a big issue.   Indeed, yours truly thinks the mess that Obamacare has made of the health system was a much bigger factor in Mr. Trump’s moving into the White House than most people thought.   Why?   We got a letter informing us that our 2017 health care premia would be going up 76%  (That’s not a misprint---76%) from 2016.   We received that letter one week before the election and we weren’t alone.    What is more motivational to undecided voters?    News, days before an election, of a gigantic increase in one of their largest expenses as a result of a program wholeheartedly supported by one of the candidates or a 30 second commercial designed by those who obsess over focus groups?  

Second, Mr. Trump was not elected because of an abundance of affection for the man.    As I’ve said before, the chief reason that he was elected was because he was running against the nearly perfect personification of the political establishment that has managed to gain the ire and contempt of the populace over at least the last 20 years.   But another good reason that Mr. Trump got elected was because people perceived him, and rightly so, as an effective negotiator.   It would seem logical that, since health care costs are a major problem and we have a terrific negotiator in the White House, we apply those bargaining skills to a problem the President was elected, at least in part, to solve.  A single payer system is the system that gives Mr. Trump the most leverage, and the greatest opportunity, to apply those formidable negotiating skills to the problem of health care costs.

Third, it is nearly silly to argue that Mr. Trump, or his supporters, would object to single payer on ideological grounds.   First, Mr. Trump has no ideology; he is interested in getting things done, not in advancing a political philosophy.   Second, his supporters are not the types who pore over yawn inducing tracts from the likes of the Heritage Foundation or the Cato Institute; luminaries of such institutions were among the most vociferous of the anti-Trumpers.   Trump supporters are, by and large, not interested in the finer points of the government’s role in our financial and personal lives, in the government’s long abuse of the Inter-State Commerce Clause to emasculate state and local government, or even in the seemingly ever growing government share of the GDP…at least not in so many words.   Trump supporters are simply angry that their way of life has been vilified, scoffed at, and derided by a condescending, snide, “so smart but not so smart” intelligentsia that has taken control of the nation’s media and government.   People are tired of being treated either like children who must be shown the proper way to live or like lab rats whose bewildering, clearly misguided behavior must be analyzed by political “experts” working to get the next whiz kid with all the answers into the halls of power.   Be assured that if Mr. Trump can use a single payer system to get health care costs down while maintaining a reasonable level of “quality” (whatever that nebulous word means) in the health care system, his supporters, and many of those who didn’t support him, will be ready to coronate the guy.   All the protests of the egg-heads at the conservative and libertarian think tanks will matter not a whit.

Congress may be problem here.   However, note that, while I am confident that something like a single payer system will be proposed, I am not as confident that it will be implemented.   Still, I doubt that Congress will be as big an obstacle in this matter as one might think.   First, if the Democrats can get over their reflexive “nothing Trump proposes…ever” attitude (which, by the way, is a mirror image of the GOP’s “nothing Obama proposes…ever” attitude), Mr. Trump should be able to get plenty of Democratic support for what has been, after all, a Democratic dream since at least the administration of Harry S. Truman.  And the GOPers will go along simply because they are politicians and thus can’t imagine life off the public payroll.   If a Trump designed single payer system is garnering popular support, and hence Mr. Trump’s popularity and influence is increasing, these guys will get on board.   They may pretend to be ideologically motivated, but the GOPers, like their Democratic counterparts, are not profiles in courage; they are politicians, terrified at the notion of having to work at a job that involves more than having one’s hindquarters smooched by obsequious sycophants seeking access to the public purse.   If supporting single payer will help enough GOPers stay in office, even the “conservative” organs in think tankdom will come up with some marginally plausible story that single payer is now “conservative.”   After all, people who work at think tanks don’t want to take regular jobs, either.

Still, the money being spread around by the insurance lobby, the pharmaceutical lobby, the health care delivery lobby, etc., will speak very loudly to those pols who have to weigh a potentially popular program against huge campaign checks, lavish “fact finding” trips, and the possibility of future employment in the “lobbying” field.   Further, it is hard to argue that single payer does not have plenty of inherent flaws.   So passing and implementing single payer should be difficult.   But proposing single payer, especially for a non-ideological president who is supremely confident in the negotiating skills that in large part got him elected, seems a logical component of the Trump approach.   And, again, passage is a real possibility despite its difficulties.