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


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.


  1. Which half of health care losses does Medicare not cover? Well, one now pays $10 or $20 to visit a doctor. Medicare doesn't cover eyeglasses or dentistry. Medicare tends to cover expensive things and not cover low cost affordable items. That's actually a sensible way to design an insurance program.

    1. The formulas don't break down that way. First there is a deductible, then there is full payment for 60 days, then there is an increasingly large copayment for hospitalization beyond that first 60 days. Medicare isn't breaking things down into small and large costs or considering affordability at all.

      With some dentistry costing thousands of dollars, I wouldn't call it a low cost or affordable item. It wasn't included because it is a chronic lifelong need that will be used by all, and thus unaffordable for a government insurance program.

  2. According to Pew, the median number of books read per person in the US in 2013 was 5 books (12 was the mean). Nationally, 24% read no books at all.

    Back when Hillary tried to reform health care, she didn't promote Medicare for all as "single payer." When Obama tried to reform health care, single payer was considered unrealistic. In his traditional "compromise before asked, in the name of bipartisanship" style, Obama never proposed a single payer system. Later, during the primaries, Sanders suggested expanding Medicare as a step toward single payer health care. Hillary said single payer health care would "never, ever happen" but eventually proposed letting younger people join the Medicare system. So this is largely a Sanders proposal which Somerby is now blaming all liberals for. If liberals don't understand how it works, blame Sanders. If they think it is "single payer" when it isn't, blame Sanders. This wasn't Hillary's doing or Obama's plan. It belongs to the Bernie Bros. That's who Somerby is addressing when he says "We Liberals!"

    Krauthammer thinks Obamacare is unraveling. From what I've read, it isn't. Why is there any need to discuss him further?

    1. Nice rant. Are you here as a demonstration of Somerby's thesis?

      You seem determined to prove him right: liberals are as ignorant as anyone else.

      First, since you can't read properly through your tribal blinders, you mistake his point: Somerby isn't attacking the Medicare-for-all proposal, so the issue of who is to blame for such a proposal doesn't arise -- you're inventing that. (The actual attack is on hypocrisy in liberals and fecklessness in the media.)

      Hilariously -- though as the butt, you're perhaps not to be expected to see the humor -- you go on anyway to show your stripes by saying that it must be Bernie Sanders who has generated any misunderstandings of the US Medicare system.

      Bernie! Why, to hear you tell it, one could think he's almost as big an influence on the American mind as Putin!!

  3. Maybe Somerby does read the comments here. Last week I pointed out that Medicare is not free, and now he is claiming that we liberals don't understand how Medicare works -- that it is not single payer because WE pay for it and for whatever costs are leftover.

    Maybe Bernie and his bros mistake the gloss of Medicare-for-all for "single-payer" but the rest of us, especially those of us actually on Medicare, can tell the difference.

  4. After all these years critiquing the media, politicians, academics, and voters, now would be a good time for Somerby to reveal the perfect, in twenty-five words or less, message to campaign on for how health care should be reformed.

    But Bob "the last honest man" Somerby would never be so vulgar, "It's a complex topic requiring a white paper as a place to begin," he surely thinks, "In the meantime go to some website, to be created later, and start clicking around until you're at least fluent in the specialized terminology required for the discussion, ya New York City simpletons."

  5. Bringing in Bob Dylan just doesn't work here (or anywhere). As deluded as Krauthammer is, he doesn't write a puddle of piddle about his feelings--he is writing about US health care policy.

    Bob Dylan dreams he misses all his old friends (now that he's made it big in the UK and NYC), boohoohoo. Doesn't miss them so much that he would go visit them, but whatevs. And this informs our understanding of Krauthammer in some way?

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