Donald Trump didn’t campaign on cutting medicaid or throwing people off of subsidies they depend on for healthcare. Trump campaigned on leaving medicare and medicaid alone, increased coverage, and lower premiums for everyone. It was a campaign promise that, rhetorically at least, fit nicely with his Republican colleagues calls for “repeal and replace”. When it comes to actually enacting policy Trump’s goals are pretty unrealistic to begin with, but the Republican Plan is a pretty obvious attempt to do exactly the opposite.
It cuts medicaid, reforms medicare in a way that is at it’s core a roundabout cut by moving funding to the state level, and on it’s face the bill will cut coverage for over 15 million people while doing very little to reform rising premiums and healthcare costs. By almost all accounts the bill is the dud. And anyone from Breitbart, to Tucker Carlson, to far right members of congress will say as much. Yet Donald Trump is holding to the bill steadfastly, going as far as saying it’s the only shot at real healthcare reform. A line straight from the mouth of Paul Ryan and one that fundamentally reverses a slew of campaign promises.
Trump continuously campaigned on reforming health care to benefit the little guy. From day one that was his focus and it set him apart from many of his more orthodox Republican counterparts. Instead of broad cuts for all manner of entitlement programs, Donald Trump campaigned on leaving them alone. Sometimes he even went as far as saying he would increase benefits and he even campaigned on single payer for a short while. Which is funny because that is really the only policy proposal that can offer all that Donald Trump has promised and he stumbled upon it by accident.
If a healthcare system is to be judged on how effectively it delivers healthcare to both the able bodied and the most vulnerable citizens, Paul Ryan’s healthcare plan falls incredibly short compared to a single player plan. If a healthcare plan is to be judged by how small of an impact it can have on the pocketbooks of the wealthy, then Paul Ryan’s plan is a work of art. However tax cuts for the rich will not provide healthcare for millions of Americans or put a lid on rising premiums or health care costs. All problems that would be effectively solved by a single payer healthcare system like the ones found all across the industrialized world.
Single payer provides healthcare for everybody in government run tax funded hospitals and clinics, providing basic preventative care and most procedures for free or a small standardized fee. On top of that many people are able to purchase private plans to cover more specialized issues. Which means “access”, the chosen buzzword for Republicans talking healthcare, isn’t an issue because everybody has it. Every sick person receives care and it’s accessible to everyone. Which might seem like an expensive system, but it generally ends up costing far less per capita because of the collective bargaining power a federal health care system is inherently imbued with.
The government gets to hold the entire market over the healthcare markets head and ensure that prices are fair to the people. For example prescription drugs are cheaper for those with medicare due in large part because of the sheer number of people who the government can sell a particular drug to. It behooves everyone to be the chosen provider for medicare recipients. Which is why medicare is one of the most popular and effective government programs, it works really really well. Advocates for a medicare for all single payer system hope that on a larger scale the program would have similar success.
If other countries experience with single payer systems is any indication such a program very well could reduce prices and increase access to care. Countries like France, the Netherlands, or even the UK and their much begrudged National Health Service manage to provide more people, more care, all while costing less per capita.
Donald Trump and republicans claim they want to keep people covered while trying to control costs, which probably isn’t true, because if it was Ryancare would look a whole let less like a tax cut for billionaires and a whole lot more like single payer.