Though congressional Republicans agreed last week to back off the contentious politics of the Affordable Care Act this year, President Trump began Monday morning by stirring the health-care policy pot anew.
In a tweet shortly after 7 a.m., the president lashed out at Democrats, saying they “are pushing for Universal HealthCare while thousands of people are marching in the UK because their U system is going broke and not working.”
The president's broadside essentially reprised an accusation that prompted Senate Republicans to block the confirmation of President Barack Obama's 2010 nominee to lead the Centers for Medicare and Medicaid Services. Don Berwick, a researcher on health-care quality and efficiency, ended up serving 18 months as CMS administrator through a recess appointment before resigning. His offense from the GOP perspective? An interview he had given before arriving in Washington in which he praised aspects of Britain's National Health Service.
Yet while Trump's theme was familiar, his tweet was inconsistent with his own messages during his campaign and after winning election. In January 2017, five days before he was sworn into office, Trump said in an interview with The Washington Post that he was finishing a health-care plan that had the goal of “insurance for everybody” — a synonym for universal coverage. The White House never produced any such plan as part of the GOP's intense and unsuccessful efforts last year to dismantle much of the ACA.
His accusation of Democrats' favor for universal health care was a twist on the typical conservative attack on liberals' policy leanings. Conservatives usually go after those at the other end of the ideological spectrum because some favor a single-payer health system, as Sen. Bernie Sanders (I-Vt.) advocates. Under single-payer, the government would provide all health insurance, replacing the patchwork system of employer-based health benefits, a private insurance industry and various public programs, including Medicare and Medicaid. Other Democrats favor a less far-reaching “public option,” in which more Americans would gain access to government insurance alongside the private health plans.
In contrast, universal health care simply means that everyone has insurance, regardless of whether it is public or private. It is generally not a controversial concept.
Monday morning's tweet did, however, catch the attention of Britain's secretary for health and social care. The secretary, Jeremy Hunt, tweeted out a defense of the British system: “NHS may have challenges but I’m proud to be from the country that invented universal coverage — where all get care no matter the size of their bank balance.”
Correction: An earlier version of this post incorrectly characterized Don Berwick's position at CMS. President Barack Obama named him the agency's administrator through a recess appointment in the summer of 2010 – a process that bypassed Congress and allowed Berwick to serve until the end of that Congress in late 2011.