In most respects, Donald Trump and Sen. Bernie Sanders represent polar opposites in the race for the White House. But on one issue — Obamacare — they have surprisingly similar takes on how to fix the 2010 healthcare reform law.
Both say Obamacare is a failure — albeit for different reasons — and have suggested a better option would be to involve the federal government more directly in negotiating costs and services with doctors, hospitals, and providers — a hallmark of nationalized healthcare systems.
By contrast, Ted Cruz, who edged out Trump in this week’s Iowa causes, has said he will repeal “every word of Obamacare” if elected president, but hasn’t provided details on what he would propose to replace it. Meanwhile, Hillary Clinton, who narrowly bested Sanders in Iowa, largely backs the Affordable Care Act, with a few minor tweaks.
But both Trump and Sanders have staked out clear positions on reforming Obamacare that call for greater federal government involvement in Americans’ healthcare.
Sanders has championed the idea of a single-payer system that essentially expands Medicare — which now covers seniors and disabled Americans — to everyone. Such a plan is not quite socialized medicine as practiced in Canada and Europe, where citizens’ taxes pay for healthcare provided by doctors, hospitals, and clinics through government contracts. But Sanders’ $1.8 trillion Medicare-for-all plan would give the government a stronger hand in setting standards, regulating, and running the healthcare system.
Sanders acknowledges his plan requires new taxes, but would save Americans thousands of dollars a year in healthcare premiums and costs.
Trump has opposed Sanders’ proposal, but has said he favors a plan that is more similar to a single-payer program than the proposals espoused by Clinton, Cruz, or any of the other GOP presidential contenders.
On ABC’s
This Week last Sunday, Trump said he would repeal Obamacare and replace it with a system that covers the 33 million uninsured Americans through a new public-private healthcare system.
“We’re going to work with our hospitals,” he said. “We’re going to work with our doctors. We’ve got to do something.”
Trump stressed that the system he envisions “doesn’t mean single payer.” But he acknowledged the notion might cost him votes among Republican voters who oppose any form of federal mandate on healthcare.
“And if this means I lose an election, that’s fine, because, frankly, we have to take care of the people in our country. We can’t let them die on the sidewalks of New York or the sidewalks of Iowa or anywhere else,” Trump said. “If somebody has no money and they’re lying in the middle of the street and they’re dying, I’m going to take care of that person.”
On CBS’s
60 Minutes last September, Trump called Obamacare “a disaster” — citing rising insurance premiums and deductibles — and said he’d replace it with a government-funded plan that covers all Americans.
“Everybody’s got to be covered,” he said. “This is an un-Republican thing for me to say…. I am going to take care of everybody. I don’t care if it costs me votes or not….
“The government’s going to pay for it. But we’re going to save so much money on the other side. But for the most it’s going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.”
If Trump’s plan will fly with conservative or moderate voters remains to be seen. But the latest polls suggest many Americans — while bitterly divided as a whole over Obamacare’s costs and benefits — support the idea of covering all Americans, regardless of age or health status.
A new Kaiser Family Foundation poll found that 58 percent back a health plan in which all Americans are able to obtain their insurance through some means — including an expanded form of Medicare.
The downside, of course, is universal insurance coverage would require trillions of dollars in new spending and taxes.
This is the chief reason that Cruz and other GOP contenders have stressed their intention to repeal Obamacare:
- Florida Sen. Marco Rubio has said he supports expanding tax credits for insurance coverage, creating high-risk pools to cover people with pre-existing conditions, and reforming Medicare and Medicaid.
- Dr. Ben Carson has called for increasing tax-free Health Savings Accounts to pay for coverage.
- Both Ohio Gov. John Kasich and New Jersey Gov. Chris Christie have staked out a middle ground on Obamacare, saying they oppose the law, but agreeing to its Medicaid expansion in their home states.
- Jeb Bush has outlined a detailed plan that jettisons the individual mandate requiring all Americans to have insurance, new rules requiring large employers to provide health benefits, and new insurance benefit standards — replacing them with tax credits for people to buy insurance and block grant-like Medicaid grants.
For Cruz, who scored a big victory in Iowa, the focus has remained largely on simply repealing Obamacare; he has not provided many details on what — if anything — he would propose to replace the law.
In recent weeks, he has upped his attacks on Obamacare and attempted to lump his three of his biggest challengers together, by suggesting they share a similar position on healthcare reform.
“Donald Trump and Hillary Clinton and Bernie Sanders have the identical position on healthcare,” Cruz said during an appearance last weekend on NBC’s Meet the Press, “which is they want to put the government in charge of you and your doctors.”
While that may be a bit of an exaggeration, at least as far as Trump is concerned, some political observers see at least some irony in the way the healthcare debate has developed — especially the positions taken by Trump and Clinton.
Should the two become their parties’ nominees, it would mean Democrats will have rejected for the candidate pushing for a single-payer healthcare system (long supported by liberal activists) while Republicans will have embraced the candidate who has suggested he likes the idea.