HEALTH MATTERS: Will Donald J. Trump support single-payer?

MONDAY, APRIL 3, 2017

Part 1—Charles Krauthammer's Dream: In the realm of America's health care discussion, how many people could explain what "single-payer" is?

We know we pretty much couldn't! Consider:

Within our own liberal tribe's pseudo-discussions, Medicare tends to be described as "single-payer." And it isn't just us liberals! In the very first sentence of its report on Medicare, the leading authority says this:

"In the United States, Medicare is a single-payer, national social insurance program administered by the US federal government since 1966..."

Thus spake the leading authority! But that's also the way we liberals talk. As a general matter, when we say we support "Medicare for all," we describe that proposal as "single-payer."

(Inevitably, Lawrence will further describe the proposal as "socialism." This helps Lawrence stand out, even as it provokes opposition to his cherished ideal.)

"Medicare for all" is routinely described as "single-payer." For ourselves, we don't really know why.

In the current Medicare system, there are actually two major payers—the federal government and the Medicare "beneficiary" him- or herself. Indeed, here's what the leading authority says, a bit later on, in its lengthy report on this program:

"No part of Medicare pays for all of a beneficiary's covered medical costs and many costs and services are not covered at all...On average, Medicare covers about half of the health care charges for those enrolled. The enrollees must then cover their remaining costs either with supplemental insurance, separate insurance, or out-of-pocket."

We're not saying that's good; we're not saying that's bad. We're saying we've never understood why that's known as "single-payer."

We don't know why Medicare gets described that way—but then again, on the brighter side, neither does anyone else. As with all parts of our national discourse, few of us have any idea what the heck we're talking about.

That's true about our health care system. It's true about everything else.

If we might borrow from our Joyce, the ignorance has long been general over the American discourse! Of course, given the tribalized nature of our society, we liberals tend to notice the public's ignorance only when it's found Over There.

With respect to the nation's discussion of health care, we liberals tend to mock the ignorance of Those People, The Others. We cheer our Harvard men as they mock and name-call working-class women in rural Kentucky. We tend to attribute vast wisdom and knowledge to Us, the good folk Over Here.

We liberals! We may not know what single-payer is, but we're now fairly sure that we want it. And good Lord:

In a recent column in the Washington Post, Charles Krauthammer dreamed a remarkable dream. According to Krauthammer, American president Donald J. Trump could end up supporting single-payer!

Charles makes his prediction here:

KRAUTHAMMER (3/31/17): As Obamacare continues to unravel, it won’t take much for Democrats to abandon that Rube Goldberg wreckage and go for the simplicity and the universality of Medicare-for-all. Republicans will have one last chance to try to persuade the country to remain with a market-based system, preferably one encompassing all the provisions that, for procedural reasons, had been left out of their latest proposal.

Don’t be surprised, however, if, in the end, single-payer wins out. Indeed, I wouldn’t be terribly surprised if Donald Trump, reading the zeitgeist...joins the single-payer side.

According to Krauthammer, Donald J. Trump, who doesn't read much, may end up reading the zeitgeist! Imaginably, Donald J. Trump could end up "joining the single-payer side."

Especially coming from Krauthammer—he's a major conservative star on Fox—that's a remarkable statement.

If we might borrow from our Dylan:

While riding on a train going west, Charles fell asleep for to take his rest. He dreamed a dream that made him sad, describing it in that passage.

Charles Krauthammer, the conservative columnist, unveiled "Charles Krauthammer's Dream!" (For his full description of his dream, see below.)

Could it possibly be that Charles is right? Is it imaginable that Donald J. Trump will pull "the greatest 180 since Disraeli" and get behind "the simplicity and the universality of Medicare for all?"

Everything is possible! That said, we do know this:

It takes the leading authority many thousands of words to describe the "simplicity of Medicare" as it exists today. The simplicity of Medicare is heavily honored in the breach, as almost everyone above a certain age knows.

Charles dreamed a dream that made him sad! That said, two other columnists at the Post dreamed about health care last Friday. Fareed Zakaria and David Ignatius mused about future possibilities in this area too.

Last Friday morning was health care day at the Washington Post! We plan to spend the rest of the week discussing the things the three columnists said, while musing about the hapless way we liberals have pursued our brilliant ideas about health care—brilliant ideas we generally can't define, support or explain, or get anyone in the wider society to consider.

We liberals! We like to mock the nation's "hillbillies" for their ignorance of such matters! As we ponder the thoughts of the Columnists Three, it might be worthwhile to spend some time exploring the extremely tiny, barely noticeable, occasional shortcomings of Us.

Tomorrow: Public schools v. Medicare with respect to single-payer

The full complete statement by Charles: Here's the full passage in which we're told about Charles Krauthammer's Dream:

KRAUTHAMMER: As Obamacare continues to unravel, it won’t take much for Democrats to abandon that Rube Goldberg wreckage and go for the simplicity and the universality of Medicare-for-all. Republicans will have one last chance to try to persuade the country to remain with a market-based system, preferably one encompassing all the provisions that, for procedural reasons, had been left out of their latest proposal.

Don’t be surprised, however, if, in the end, single-payer wins out. Indeed, I wouldn’t be terribly surprised if Donald Trump, reading the zeitgeist, pulls the greatest 180 since Disraeli “dished the Whigs” in 1867 (by radically expanding the franchise) and joins the single-payer side.

Talk about disruption? About kicking over the furniture? That would be an American Krakatoa.

There you have it! With that explosive image, the pundit's column ends.

If we might borrow from our Woolf:

There he was again, Charles thought, sitting bolt upright in bed. Awake.