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Could 'single-payer' be Trump's trump card?

Op-ed: Replacing Obamacare with a single-payer system will unite the country.

At his press conference Wednesday at Trump Tower, President-elect Donald Trump said that as soon as the Senate approves his pick for health secretary, he will unveil a "repeal and replace" plan for the Affordable Care Act, known as "Obamacare." He gave no hints at the details of Trumpcare, other than to say the country would be "very proud" of his proposal, which offers "health care that is far less expensive and far better" than the current options.

But his actions thus far — including his nomination of Tom Price for secretary of Health and Human Services — suggest a direction that isn't good. Both Mr. Price and Seema Verma, Mr. Trump's pick to run Medicare, are proponents of health care market competition, which suggests he's leaning toward a less effective replay of Romneycare/Obamacare that would only burden us with more of the empty profits to insurance and pharmaceutical companies that currently plague America's health care system. That would be devastating for many millions of Americans, Trump voters included.

To fulfill the promise of his campaign to be an unfettered agent for real change committed to being "a president for all Americans," Mr. Trump must change course. Americans for Trump, along with all other Americans, need freedom for patients and doctors from insurance denials and useless government meddling. These are practical issues that can be solved in only one way: We need a "single payer" national health plan to stop excessive profits and cover everyone.

Dr. Howard Bauchner, editor of the Journal of the American Medical Association, appears to have recognized this, declaring in the Jan. 3rd issue that "health care is a basic right for every person, and not a privilege to be available and affordable only for a majority."

Single payer will serve this idea. It will fund health care for everyone with taxes, freeing us from the expensive overhead of profit-based insurance; and it will provide for government control to lower pharmaceutical and other costs.

Liberals may think this will be impossible in a conservative Republican administration. But perhaps this election is the transformative political change that many single payer advocates have been waiting for. The states may be prospective allies in health care reform. Massachusetts, through increasing the fraction of its citizens covered by Romneycare, and Maryland, with its federal waiver to bill every health care payer equally, are halfway there. Colorado and Vermont have striking political support for single payer. And California and New York have threatened to fight any regulations they deem harmful.

But we can save money while we provide access to quality care for every American through a single-payer system. Doctors will have to do their part. As New Yorker staff writer James Surowiecki wrote in a recent issue of the magazine, "After decades of using their political leverage to kill reform, it might be time for doctors to use that power to keep it alive."

To do this, I propose to have a national, secure, convenient Electronic Medical Records system and, instead of private insurance profits and government regulation dictating care, a transparent national Doctors Board powerfully sheltered from politics to oversee health care options, trends and quality.

Savings, quality and freedom from regulation: Isn't it possible that these conservative values might overcome conservative distaste for a national entitlement?

Perhaps many Americans who supported Mr. Trump will object: "We didn't vote for this." Oh, yes you did. Mr. Trump's platform proudly and consistently promised not only a repeal, but a replacement of Obamacare. That makes sense only if the replacement is a good new idea. Modern medicine is too complex and expensive to return to the wild west of unregulated fee-for-service that existed back before Medicare.

The surprise election of Donald Trump, therefore, presents an unexpected opportunity to create a new health care system for all — one that bridges the chasm dividing America politically. Single-payer is a Trumpcare model we could all support.

Dr. James Burdick ( is a professor of surgery at the Johns Hopkins Medical Institutions and author of "Talking About Single Payer: Health Care Equality for America."

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