Here’s some free advice for conservatives: if you think something Barack Obama proposed is a bad idea, it’s still a bad idea if Donald Trump proposes it.
The latest example of this is Trump’s plan on health care reform. In an interview with the Washington Post, the president-elect promised that everyone would have health insurance.
“We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”
Trump also promised that health insurance would be cheaper and better than under Obamacare. He pledged to force drug companies to directly negotiate prices for pharmaceutical drugs under Medicare and Medicaid. “They’re politically protected, but not anymore,” he said of pharmaceutical companies. According to one estimate, the federal government could save $103 billion this way over 10 years.
Trump has not opposed universal health care in the past, having advocated for it at least five times since 1999.
On Monday, Trump’s spokesman Sean Spicer clarified some of Trump’s remarks. Spicer told NBC that Trump would provide insurance for everyone “through marketplace solutions, through bringing costs down, through negotiating with pharmaceutical companies, and allowing competition over state lines.”
Providing universal health care has not been a priority for Republicans in the past, but there are indications that many would like that to change. According to a recent poll conducted by the Pew Research Center, 60 percent of Americans believe that government has a responsibility to make sure all Americans have health coverage. That’s up from 51 percent in March 2016. The biggest jump in that view is from lower- and middle-income Republicans.
Conservative intellectuals have been thinking about ways to use market-based solutions to deliver universal health care. In September 2016, conservative health care expert Avik Roy published a plan “Transcending Obamacare,” which provides near-universal health care using markets. In fact, most of the industrialized world provides universal health care coverage with systems that are arguably more free-market than the one in the United States.
Health care isn’t the only welfare benefit that Trump that would like to extend. He also promised to extend both universal child care benefits and paid leave, both topics that Republicans traditionally have not touched on. However, free market think tanks such as the Niskanen Center have been working on their own Universal Child Benefit plan.
The biggest obstacle to Trump’s revamped welfare state is the nation’s fiscal picture. Currently, America’s public debt is equal to slightly less than 105 percent of the nation’s gross domestic product, but only 75 percent of that is actually held by the public.
While the country does not have an immediate problem with its debt, the long-term financial outlook is not good. In the future, Medicare and Social Security will consume a growing portion of the federal budget and balloon the debt to 141 percent of GDP.
Expanding health care coverage, providing paid leave, and introducing child care benefits are worthy goals. But they have to take the fiscal situation into account and they cannot crowd out free market-based solutions.