The Trump health care record memory hole
Trump is being disingenuously attacked by Democrats and the media. But the truth of his health care positions is worse than what he's being accused of.
A few years ago, a fellow consultant named Phil who is a relatively high-powered guy in Washington, DC, said that one of the things he found amusing about me was that I had a habit of occasionally defending Donald Trump only for the substance of my defense of him to be infinitely more damning than whatever Trump was being accused of.
Well, Phil. I’m about to do it again. Democrats and the media have memory-holed Donald Trump’s real record on health care with a wave of attention devoted to his supposed interest in repealing Obamacare. And ironically, the substance of that record is worse than what they’re accusing him of.
Here is what is going on. If you consume political media, and I’m assuming you do, you’ve probably heard about this post from Donald Trump the other day. He’s apparently looking at alternatives to Obamacare, because of the cost.
The way this was depicted in the media (and I will refrain from linking to specific pieces because hey, my job is media relations and if I attack one of the reporters who wrote this here, I can’t do my job) was “OMG DONALD TRUMP IS GOING TO DO WHAT TEA PARTY REPUBLICANS IN 2010 AND 2014 PLEDGED TO DO AND TAKE US BACK TO THE BAD OLD DAYS OF NO HEALTH CARE EXCHANGES, SUBSIDIES, ETC., ETC.”
I’m here to defend Trump from that accusation— and take him to the woodshed over his views on health care which remain the reason I will never, ever vote for him unless it is literally a choice between him and straight up socialism and somehow I have relocated to a state where my vote actually might matter in a contest where it might actually be close. (None of this is going to happen. I’d probably rather live in Arizona than Connecticut, but for a variety of familial reasons, I will be stuck in Connecticut in 2024 and probably 2028).
For those who don’t recall, the reason back in 2015 that I concluded that Donald Trump was an absolute no-go for me was his longstanding support for fully socialized medicine. No, I do not mean single payer options. I do not mean taxpayers footing 100% of the bill for insurance plans selected by each citizen. I do not mean Medicare for all.
I mean full-on socialized medicine. What we have in the UK, with our health service, the NHS.
This is a substantially more big government approach than anything you have ever heard even Bernie Sanders advocate for, or probably ever will hear Bernie Sanders advocate for. It is genuinely extremely socialist, even though the right-of-center party in the UK will defend it to the hilt (short version of why: There weren’t great options for dealing with health care coming out of World War II; socialized medicine was adopted; now, many, many decades later, it is the norm and everyone is reliant on it; reforming it in anything but the most modest way possible would be about as popular as instituting mandatory, daily 3-mile runs for everyone deemed mildly overweight across the country— no matter how beneficial privatization could be, it will never happen).
In my experience, it is also a bad model of health care, and no amount of money being dumped into it will improve it. Yes, it’s free for everyone to use. As many free things are, it is also rather low-quality. It’s hard to get appointments for everything from a visit to your GP to a visit with the surgeon who will perform your hip replacement. Wait times, whether for cancer treatment, major surgery, or just at the emergency room, are atrocious. There’s quite a bit of pharmaceutical reliance because it’s easier to put someone on a medication regimen than treat illness in some other, less drug-reliant manner that depends more on facetime with health care professionals. There’s basically no way to access psychological or psychiatric care unless you actually try to kill yourself. It is a major reason why I don’t actually live in the UK, though actually, I have perceived changes that I would consider beneficial given my personal circumstances under PM Sunak.
I digress. The point is, the system sucks. Most people who compare different developed world health care systems and who are critical of the US system— both pre- and post-Obamacare— agree the UK system sucks. Progressives think the UK systems sucks.
But Donald Trump has spent a lifetime praising it, and specifically, the Scottish edition of it which is even more of a hot mess than the English version of it.
He has done this knowing full well what he is doing: Don’t forget, Donald Trump is half-Scottish, and not in the way that people whose families immigrated here in 1790 are half-Scottish; his mother literally came from Scotland and he still has family there and business holdings there and travels there!
Trump was engaging in this praise of Scotland’s system as an active presidential candidate in the GOP primary in the 2016 cycle. Everyone seems to have memory-holed this, but it’s true, even if Trump failed to note that the Scottish system is not really a single-payer system but a socialized system, when the debate moderator asked about his support for single payer systems. (Spoiler alert: Donald Trump is no master of policy detail).
Here is what Trump said in one of the 2016 GOP primary debates:
As far as single payer, it works in Canada. It works incredibly well in Scotland.
Pro-socialized medicine advocates have also favorably noted these comments from Trump around the same time, from a “Morning Joe” appearance:
It’s certainly something that in certain countries works. It actually works incredibly well in Scotland.
This was not a new position for him in mid-2015. He also praised the Scottish system in January 2015 on David Letterman’s show, saying this:
A friend of mine was in Scotland recently. He got very, very sick. They took him by ambulance and he was there for four days. He was really in trouble and they released him and he said, “Where do I pay?” And they said, “There’s no charge.” Not only that, he said it was like great doctors, great care. I mean we could have a great system in this country.
Note: My friend Pete is a doctor in Scotland, and he is awesome. I am definitely not denigrating the quality of doctors in the Scottish NHS. However, I do believe the system impedes doctors and other health care professionals from being as effective as they could be. Trump is praising the system here. That is key to understand.
Fifteen-plus years previously, when Trump was also toying around with the idea of running for President, he also expressed support for universal health care. That time, he praised the Canadian system, specifically, in his book, “The America We Deserve.” Here’s what he said:
We must have universal health care. Just imagine the improved quality of life for our society as a whole… 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.
According to Politifact, he also said these things in 1999 and 2000:
• "If you can’t take care of your sick in the country, forget it, it’s all over. ... I believe in universal healthcare.”
• "I would put forth a comprehensive health care program and fund it with an increase in corporate taxes.”
Nor is all of this pro-universal health care/pro-single payer/pro-socialized medicine stuff a position Trump dispensed with as President. In 2017, he told the Australian Prime Minister that Australia had better health care than the US did. Australia has a publicly-funded system (though it allows private health care, too, as does the UK).
Trump also did more than anyone, possibly bar John McCain but that’s a very big “possibly,” to scupper Obamacare repeal when House Republicans voted for it under his presidency.
President Donald Trump told Republican senators Tuesday that the House-passed health care bill he helped revive is “mean” and urged them to craft a version that is “more generous,” congressional sources said.
Trump’s remarks were a surprising slap at a Republican-written House measure that was shepherded by Speaker Paul Ryan, R-Wis., and whose passage the president lobbied for and praised. At a Rose Garden ceremony minutes after the bill’s narrow House passage on May 4, Trump called it “a great plan.”
The president’s criticism, at a White House lunch with 15 GOP senators, also came as Senate Republican leaders’ attempts to write their own health care package have been slowed by disagreements between their party’s conservatives and moderates.
[…]
One source said Trump called the House bill “mean, mean, mean” and said, “We need to be more generous, more kind.” The other source said Trump used a vulgarity to describe the House bill and told the senators, “We need to be more generous.”
I would argue that those who blamed McCain for scuppering repeal should blame Trump. To me, it always sounded a lot like McCain was lining up with Trump on this issue which, for the record, yes, is a black mark next to McCain’s record. But again, I digress.
The reason you need to pay attention to all this is that in fact, if Trump is interested in gutting Obamacare, my personal suspicion is that he really wants to gut it and replace it with something that looks a lot more like what Bernie Sanders would design— and maybe even further to the left and more “big government” than what Bernie would design— than anything that a Mike Lee or a Ted Cruz would design.
The best case scenario, if you’re a free marketeer on health care— and I am— is that he wants to replace Obamacare with a barely-modified program whose main modification is that it will be called “Trumpcare,” not “Obamacare.” Maybe he’ll change it so grown-up kids can stay on their parents’ insurance until they’re 24 o4 25, not 26.
But I have maintained since 2015 and unless he proves me wrong I will maintain until the day I die that if he had his druthers, Trump would repeal and replace Obamacare with something that looks a hell of a lot like either Canada’s system or the NHS.
The real knock on Trump is actually that he wants to do his part to kill off a decreasingly private system in this country, and further socialize it.
But you’re not going to hear Democrats say that, because “repeal Obamacare” is assumed by everyone to mean “go back to health care the way it was in the early 2000s” (which I think most of us would agree sucked, even if we don’t think Obamacare was an improvement), “repeal Obamacare” is scary and voters respond to fear, and— let’s be honest— a huge chunk of the Democratic base sees Obamacare as the really weak sauce moderate version of what they hope someday can be instituted in America: Something like Medicare for All. Biden needs those votes and he needs them bad. His polling numbers suck, even with diehard Democrats. “Trump wants to take away your Obamacare” is a really potent line of attack, even if what Trump actually wants to do probably makes Elizabeth Warren look mildly free market.
Now, why aren’t we hearing all this from the media, you’re probably wondering. Well, I assume we may hear about it from Avik Roy, or Peter Suderman, or Phil Klein. Those were the original writers with expertise in health care who took Obamacare to the woodshed as a proposal, from a free market perspective.
But you may not hear much about it from mainstream media and here are the reasons why:
Mainstream media is dying (except for a few, big outlets).
That means a lot of reporters who remember 2015, let alone 1999 or 2000, are out of the business— they’ve taken buyouts, switched to doing the kind of work I do (minus the occasional column-writing) or changed careers entirely.
TL;DR: There is almost no institutional memory in the mainstream media at all at this point. The 2024 beat in particular is largely populated by twenty-or-thirty something reporters who were not paying a single bit of attention to who said what in debates in 2015 or 2016. At best, they remember what inspired this SNL skit.
That’s it. That’s the fucking ballgame.
You’re also not going to hear about this from left-of-center media because:
They have zero to gain from depicting Trump as what he is on health care: A true, honest-to-God, big government liberal. Well, at least there’s no incentive unless Biden gets so hated they want to bash him and then Trump is a useful counterpoint— or if it looks like Trump might win, in which case, covering this kind of thing to try to embolden Trump to pursue his true vision on health care might be a strategy worth employing.
Trump has, to be fair, wound up being very popular with the part of the party that used to hate him— the hard libertarian-right, e.g., Ken Cuccinelli, Mike Lee, Ted Cruz— all people who tried to shut him down in 2016. That will make progressives skeptical that Trump is still where he used to be on health care, especially since they broadly believe he has zero philosophical consistency and is only interested in self-aggrandizement (a partly correct analysis).
You’re not going to hear about this from the right, either, and here’s why:
It has become pretty bad business to shit on Trump and the only way that changes is if it looks like he actually might not win the 2024 nomination. I see a pathway to him being defeated, but it’s narrow, and I’m probably more a of creative thinker than most people reading the polls. And hey, they will probably be proved right! Statistically, it is likely!
No one wants to embolden Trump when it comes to policies like single payer or socialized medicine. No one. It seems better to ignore it and hope it goes away.
A lot of people on the right just don’t care about policy anymore, unless it’s about transgender children or immigration (and they don’t much care there, either, beyond “shut the border down” as a proposed solution). I will note here that the Left isn’t that much better; a huge amount of ideological media coverage is now “here’s something bad and very culture warrish about people in the other tribe.”
Add to this list that a lot of people aren’t even reading, listening to radio or podcasts, or watching cable news— even in whatever forms you consider to be the most dumbed-down, philosophically off base or ill-informed. A lot of people are getting a token snippet of political news (which may or may not even be remotely reality-based) interspersed with cute cat videos off of social media, and just applying some moniker to themselves and the appropriate bumper sticker to their car. A ton of people you would expect to have actual political and policy views out there actually just do not.
So, for the time being, you’re going to hear about this topic just from me— and so is anyone else who reads this newsletter. I do hope we hear from Avik, Peter and Phil, though.
I remain convinced that what Democrats and the media want you to take away from Trump’s Truth Social post is not actually what the dude was thinking at all when he posted it. Not even a little bit. For all the reasons set out above.
You should think about that when you start seeing attack ads popping (which they will, including and maybe even especially on social media!) talking about Trump wanting to gut Obamacare.
And you should also think about it when you hear your conservative friends saying everyone on the right should be OK with Trump because at least he wants to gut Obamacare (and yeah, they’ll probably be saying it on social media).
The truth on this topic is rather different to what it will seem, what most people assume, and what most political players will play off of people assuming.