The GOP and President Trump, having brazenly broken their campaign promises by refusing to “repeal and replace” ObamaCare, now claim they’ll just repeal it and see what happens. Don’t count on that. At root, they don’t really mind ObamaCare and the “single payer” system (government medicine monopoly) to which it leads. Abominable as it is, they accept it philosophically, so they also accept politically. [1]

There’s a long history here. In a 1999 interview with Larry King, Mr. Trump said: “If you can’t take care of your sick in the country, forget it, it’s all over… I believe in universal healthcare.” In that same year, interviewed on NBC TV’s Dateline, Trump said “I’m liberal on healthcare, we have to take care of people . . . I love universal.”

In February 2000, he told The Advocate “I would put forth a comprehensive health care program and fund it with an increase in corporate taxes.”

In his book, The America We Deserve (2000), Trump wrote that “We must have universal healthcare . . . I’m a conservative on most issues but a liberal on this one. We should not hear so many stories of families ruined by healthcare expenses . . . Doctors might be paid less than they are now, as is the case in Canada, but they would be able to treat more patients because of the reduction in their paperwork. . . The Canadian plan also helps Canadians live longer and healthier than Americans. There are fewer medical lawsuits, less loss of labor to sickness, and lower costs to companies paying for the medical care of their employees. If the program were in place in Massachusetts in 1999 it would have reduced administrative costs by $2.5 million. We need, as a nation, to reexamine the single-payer plan, as many individual states are doing.”

In August 2015, at the first debate of the GOP primaries, Fox TV host Brett Baier asked Trump: “Fifteen years ago in 2000 you called yourself a liberal on health care. You were for a single-payer system, a Canadian-style system. Why were you for that then and why aren’t you for it now?” Trump’s answer: “As far as single payer goes, it works in Canada. It works incredibly well in Scotland.”

In a 60-Minutes interview on CBS TV in September 2015, Trump told interviewer Scott Pelley: “Everybody’s got to be covered [with health care]. This is an un-Republican thing for me to say because a lot of times they say, ‘No, no, the lower 25 percent that can’t afford private. I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now. The uninsured person is going to be taken care of. I would make a deal with existing hospitals to take care of people. And the government’s gonna pay for it.”

In January 2016, the GOP-controlled House of Representatives sent then-President Obama the last of many bills it had previously sent to his desk disingenuously demanding a repeal of ObamaCare. They knew he’d refuse to sign it yet again, but it was for political show, with a tease; according to House Speaker Paul Ryan at the time, “we have now demonstrated that, if we elect a Republican president, we can use this same path to repeal Obamacare without 60 votes in the Senate. This is critical.”

Well, a “Republican president” (Trump) was elected, less than a year later, and yet today, having been in office a half year, the GOP leadership has yet to send Trump the same bill it sent repeatedly to Obama.

Despite saying for six years (since ObamaCare’s unilateral enactment by Democrats in March 2010) that they’d repeal it, and on that basis securing control of the House (January 2011), Senate (January 2015) and Presidency (January 2017), the GOP simply refuses to do it. Even its latest effort, which failed to get the necessary votes, wasn’t a repeal of ObamaCare but a disguised form of it. [2]

Here’s how one analyst described the GOP’s proposed “Better Care Reconciliation Act of 2017:”

This is single-payer for dummies. In a single-payer system, the government picks up the health-care costs for the population, paid for through progressive taxation. The market power of having one insurance payer can work to lower overall health care costs, making the system sustainable. In Trumpcare’s single-payer for dummies, the fragmented private-insurance middleman remains intact. But taxpayer dollars still pick up the health-care costs for those who cannot afford it. Instead of acquiring market power, they just give those taxpayer dollars to the private middlemen, which tells the private middlemen they can charge whatever they want and always get paid. . .

[One] provision would use $8 billion in public funds over five years to compensate people with pre-existing conditions who face higher health-insurance prices (possibly through a privately issued high-risk pool, possibly through just subsidizing those who experience cost increases; it’s a bit unclear at this point). . .

But if that $8 billion doesn’t work to prevent massively increased costs for those with pre-existing conditions, the public will cry out for more protection. And since Obamacare created an expectation that the sick would be protected in America, that would lead to more taxpayer dollars put to this use, leading to higher prices, and more money, and so on, in a death spiral. That’s why it’s single-payer for dummies: It has all of the logic of the government stepping in to make sure everyone has health-care coverage, with none of the efficiencies that should create. Keep in mind that all of this is being done to allow House Republicans to get something, anything, that they can call “Obamacare repeal” out of their chamber, regardless of whether the Senate will pass it. It’s a purely political maneuver. But they’re replacing a twisted Rube Goldberg formation with an even more twisted, even more Rube Goldberg formation that uses public money to plug self-created holes. You’re essentially telling insurers to discriminate and then paying them off for the discrimination. And if you’re using public funds to subsidize insurance and ensure affordability, the next logical step is to have the government pay all health-care costs up to a certain level.” [3]

In just the past week, Mr. Trump revealed his contradictory aims. One day he tweeted this: “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!” But the next day he tweeted this: “As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!” Does he want it repealed or retained? Both? And what does he mean by letting it “fail?” In fact, ObamaCare is succeeding, because its goal is a single-pay state monopoly in medicine; the failure it’s causing in America’s health insurance market is simply a means to that end. [4] 

It’s remarkable that most economists and policymakers have been so fanatical for so long in deriding and trustbusting private-sector “monopolies,” even when justly earned (see Standard Oil, Alcoa, and Microsoft), but are simultaneously so insistent that government should monopolize money, schools, pensions, and medical care.

The truth is, Mr. Trump and most Republicans condone the socialist principles latent in ObamaCare. Perhaps they even realize it’ll continue to erode the better aspects of the system and lead to a “single-payer system” (government monopoly on medicine) – which Obama [and Trump] have always said they wanted. Nor do most American voters today seem to object to this monopoly. They might object to it decades from now, when they realize that access to health insurance doesn’t guarantee access to health care (especially not under socialized medicine, which reduces quality, affordability, and access). But by then it’ll be too late to rehabilitate those freer elements that made America medicine so great in the first place.

Originally appeared in The Daily Capitalist.

[1] “The Pathological Path to Monopoly MedicineThe Capitalist Advisor, July 14, 2017
[2] “‘Repeal and Replace’ Becomes Retain with DisgraceThe Daily Capitalist, March 30, 2017
[3] David Dayen, “The New Republican Health-Care Plan Is Single-Payer for Dummies,” The Nation, May 3, 2017.
[3] “The Health Care Sector Under Obama’s SchemeInvestor Alert, August 26, 2009

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Richard M Salsman

Dr. Salsman is president of InterMarket Forecasting, Inc., an investment forecasting and consulting firm in Durham, N.C. and assistant professor in the program on Philosophy, Politics and Economics (PPE) at Duke University. He is the author of numerous books, chapters and articles, including Breaking the Banks: Central Banking Problems and Free Banking Solutions (1990) and A Gold and Liberty (1995), both of which were published by the American Institute for Economic Research, and The Political Economy of Public Debt: Three Centuries of Theory and Evidence (Edward Elgar Publishing, 2017). He is also a Contributing Editor for The Objective Standard.