Matthew Yglesias claims Donald Trump had the best policy idea of anyone in last night's debate. He makes a reasonable case and teaches me a term I didn't know (in this context at least) "path dependency".
Single-payer health-care systems are ones in which the government acts as the insurance company for everyone. That's how Medicare works in the United States, and it's how the Canadian health-care system (conveniently also called Medicare) works for everyone, not just senior citizens.
'It works in Canada,' said Trump, and 'it works incredibly well in Scotland.' He even went so far as to say that 'it could have worked in a different age' in the United States but is not currently suited to our problems.
What Trump is talking about here is path dependency, and it's a reasonable point. It's one thing to set up a National Health Service in the wake of World War II. It's another thing entirely to come 75 years later and completely upend a system that is working pretty well for most people and that enormous institutions have made deep investments in. It's easy to dismiss this message when coming from Trump, but Atul Gawande has written brilliantly about path dependency in health-care reform and my colleague Sarah Kliff's masterful profile of Vermont's failed effort to build a single-payer system further underscores the concerns about path dependency.
It did sound reasonable to me during the debate that health insurance companies should be able to sell nation-wide and not just state-wide. (I think McCain proposed something similar in one of his runs for president). I was thinking about just the size of the market (or pool as insurers like to say) and Trump brought it up from his position as an interstate company trying to simplify bids. If there had been more time and if others could question him, it would lead to an interesting debate. Here he's saying that insurance should be nation-wide or federal. The standard GOP line is that virtually everything should move from the federal level to state level. An interesting question would be "What kinds of policies are better at the federal than state level and why?" Then if I were really dreaming they could argue about what the General Welfare clause means.
Yglesias' list of the other policies candidates mentioned last night is pretty hilarious.