Now that Donald Trump looks increasingly certain to become the Republican presidential nominee after his big primary victories Tuesday in five Northeastern states, we in the healthcare business press will be spending a lot of time poring over his healthcare policy pronouncements and proposals.
Over the last few months, some analysts have identified what seemed like intriguing differences between Trump and mainstream Republican Party leaders on issues such as the Affordable Care Act, single-payer health insurance and Medicare—even though House Speaker Paul Ryan (R-Wis.) on Wednesday downplayed any significant conflicts.
But maybe we could save a lot of time by just re-reading mainstream GOP health policy platforms from the past few years. Paul Waldman of the Washington Post offered a smart warning about assessing the real estate tycoon's policy statements:
“Perhaps the most important thing to understand about Trump's relationship to the conservative policy agenda, and to any agenda at all, is that he just doesn't care about policy in the least,” Waldman wrote Wednesday. “He has some sincere opinions on some issues, but for the most part, not only has he never thought much about any policy issue one might present him with, there's almost nothing he thinks about an issue that isn't subject to revision.
“That's why we've seen a particular pattern repeat itself so often. Trump will get asked a question about an issue he obviously hasn't considered before. He'll give an answer that doesn't line up with conservative orthodoxy, because he isn't aware of precisely what conservative orthodoxy is. Then Republicans will get enraged, the controversy will blow up, and a day or two later — after he's had a chance to learn what he's supposed to say — he'll come back and offer a revised version of his position.”
Waldman noted Trump's previous attention-getting statements on healthcare, such as his praise for government single-payer systems in other countries, his repeated rejection of cuts in Medicare and Social Security, and his support for a government role in providing healthcare for needy people. All those sounded like heresies to orthodox conservative ideology: “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,” Trump said in January, sounding like a democratic socialist. “And if this means I lose an election, that's fine, because, frankly, we have to take care of the people in our country.”
But when Trump issued his brief seven-point health plan early last month, it consisted entirely of standard GOP talking points, including repealing Obamacare, offering a household tax deduction for buying insurance, letting insurers sell plans across state lines, expanding health savings accounts, and converting Medicaid into a state block-grant program. There were no bold new government initiatives to take care of people without money.
That's probably why Paul Ryan seemed so confident about the continuation of the conservative Republican policy agenda whether Trump, Sen. Ted Cruz, or Gov. John Kasich wins the nomination.
"We have lots of different views but come from the same principles,” Ryan said on MSNBC Wednesday. “The principle for … healthcare (is) put the patient in charge. Let she and her doctor be in charge of deciding their healthcare. Give people more choices, more insurance competition ... Whoever one of these three become our nominee, I think they're going to be comfortable with this. So I'm really not that worried about it."
Waldman said Ryan has good reason to be confident. “Paul Ryan can deliver him one bill after another written and passed by the GOP Congress,” he wrote, “and Trump is likely to say, 'Sure, whatever' and sign them.”
But would Trump reverse himself on Medicare and risk older voters' wrath by embracing Ryan's cost-cutting Medicare voucher plan? That's one issue where behind-the-scenes discussions between the presumptive nominee and his party could get interesting.