Donald Trump, pondering the problems with the American health care system, reportedly remarked to his aides at some point over the past two years: “Why can’t Medicare simply cover everybody?”
This would be maybe the biggest policy bombshell in Michael Wolff’s explosive new book, Fire and Fury — if we can believe it.
But the thing is, even though Trump would eventually oversee and endorse health care plans put forward by Republicans that would have led to tens of millions fewer people having health insurance, it is actually pretty easy to believe that he would be open to a universal, even government-funded program like Medicare-for-all.
It reminds us of the sharp contrast between the populist candidate that Trump claimed to be on the campaign trail and the pretty conventional Republican he has governed as. As a candidate, Trump wanted insurance for everybody. As president, he endorsed health care plans that would have led to 20 million fewer Americans having health insurance, compared to the health care law he so desperately wanted to repeal.
Wolff depicts a candidate and a president who is pretty disconnected from and disinterested in the policy particulars of health care reform, even though the pledge to “repeal and replace Obamacare” had been core to the Republican Party’s message for the past seven years.
“No one in the country, or on earth, has given less thought to health insurance than Donald,” former Fox News leader Roger Ailes reportedly said. When you remember that Trump has talked about health insurance as if it works like life insurance, that also isn’t so hard to believe.
But on the merits, Wolff writes, Trump was more inclined to support a universal, government-funded insurance program — more or less the Medicare-for-all plan that has been advanced by Bernie Sanders.
Below is the relevant passage from Wolff’s book:
At first, this might seem shocking: the most powerful Republican in the country endorsing, in essence, single-payer health care. But then you remember what Trump has said about health insurance and health care over the past year.
Back in January before he was sworn in, as the Obamacare repeal debate was getting underway, Trump was promising “insurance for everybody.”
“We’re going to have insurance for everybody,” he told the Washington Post. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
People covered under the law, he said, “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”
Insurance for everybody, a simpler system that’s much less expensive — you could argue that Medicare-for-all achieves those goals better than any of the plans the GOP put forward in the following year, which were projected to lead to as many as 24 million fewer Americans having health coverage, versus Obamacare. And remember, Trump would go on to call the House Republicans’ bill “mean.”
Of course, a Trump plan to expand Medicare never materialized, and it’s easy to divine why, if Wolff’s account is at all accurate: Trump doesn’t really understand health care or have the attention span for its minutiae — it is so complicated, after all.
Instead, according to Wolff, House Speaker Paul Ryan and Trump’s top adviser Steve Bannon steered him toward a more conventional repeal-and-replace plan, the kind that Republicans had been promised since the Affordable Care Act first passed. One meeting with Ryan and his eventual health secretary Tom Price seems to have been crucial:
But Wolff cogently identifies the disconnect between the populist Trump and the Trump who would endorse a plan that slashes Medicaid while repealing taxes on health insurers and pharmaceutical companies.
Bannon, the supposed author and vessel of Trumpian populism, was reportedly uncomfortable with the repeal-and-replace plans, at least in their particulars. He seemed acutely aware that even if Trump was obligated to support repealing the ACA because he was the leader of the Republican Party, its inevitable consequences would clash deeply with his promises to protect the working men and women of America.
He wasn’t wrong.