The Iowa caucuses have solidified Donald Trump and Bernie Sanders as two of the leading candidates in this cycle: Sanders is the democratic socialist channeling liberal disenchantment with the Goldman Sachs wing of the party, while Trump represents the frustration of Republican blue-collar, white, middle-class voters with global competition and immigration.
“You might think the two candidates have wildly different views on the signature domestic issue of the last six years: health care reform. But you'd be wrong.”
Both of them are leading a revolt against their respective party elites.
The similarities don't end there. You might think the two candidates have wildly different views on the signature domestic issue of the last six years: health care reform. But you'd be wrong.
Sanders' plan, to the extent that his campaign has detailed it, is to create a "single-payer" system in the United States. Private health insurance would disappear, replaced by a single, government-run plan that would (according to the campaign) cover "everything."
What does "The Donald" want? Despite his signature vagueness on details, we have a pretty good idea. As he made clear on "60 Minutes," Trump would "take care of everyone," paid for by "making deals" with the hospitals, along with a private plan for everyone. What might this look like in practice?
One way to reconcile the two is to assume that Trump is simply considering price controls. You could have a world where doctors and hospitals can only be paid based on a regulated fee schedule (a la Medicare), and let private plans deal with utilization. This would be, in some ways, Bernie lite: cost controls necessary for single-payer, but without the actual single-payer.
Another interpretation might be to look at how the United Kingdom's system functions. Many (though not all) doctors and hospitals are employed and owned by the government. Payment for services (with some exception) comes from the country's government-run insurance plan. The Donald could be considering doing something similar. First, employ all the doctors and hospitals in the country, and then allow private plans to manage claim payments.
“Trump is simply considering price controls... This would be, in some ways, Bernie lite: cost controls necessary for single-payer, but without the actual single-payer.”
What's particularly concerning about this second approach is that it would be a step beyond even what Bernie Sanders has proposed.
Under Sanders' plan, hospital ownership and physician employment wouldn't really change. The major change would be eliminating private insurance companies. Even this wouldn't be all that new. In fact, over 50 percent of national health care spending already comes from government programs like Medicare and Medicaid. There is much to dislike about Sanders' plan, including the effects it would have on innovation and the economy, but it would simply keep moving us down a well-worn path.
But moving all physicians and hospitals to government employment is a whole different ballgame. This wouldn't be single-payer — it would be a true "government takeover" of the health care system. Never mind that our graduate medical education system (for better or worse) is built on physicians earning a particular salary — for the government to employ all the docs and hospitals in the country would be prohibitively expensive under current costs, meaning that The Donald would need to make yet another "deal."
Conservatives are rightfully concerned about the prospect of a single-payer disaster under Sanders. But those who find themselves supporting Trump should take a step back and realize that, at least on health care, Trump's "art of the deal" could be an even bigger lurch to the left than Sanders.
This piece originally appeared in Washington Examiner
This piece originally appeared in Washington Examiner