Is Donald Trump still 'for single-payer' health care?

For all his success firing up the GOP base, Republican presidential frontrunner Donald Trump may be a Republican in name only when it comes to health care, says former Texas Gov. Rick Perry.

Perry -- at 11th place in the polls and currently just shy of making it into the first Republican debate Aug. 6 -- has been trading jabs with Trump for weeks. Trump mocked Perry’s glasses in July, and Perry responded by calling Trump "a cancer on conservatism" and challenging him to a pull-up contest.

Perry switched up his attacks from the physical to the political on Aug. 2’s Fox News Sunday.

"He's for single payer," Perry said. "How can anyone who's a conservative stand up and say I am for single-payer health care?"

Perry’s campaign referred us to a Buzzfeed piece and a PunditFact article that noted Trump’s past support for a Canadian-style, single-payer plan.

Perry’s claim goes further to suggest Trump, like Vermont socialist and Democratic presidential candidate Sen. Bernie Sanders, currently supports a single-payer system, which is a specific type of universal health care in which the government foots the bill for all residents.

We wanted to know if Trump still supports that model.

Trump’s campaign did not respond to our inquiry, and his campaign website does not outline any of his positions on major issues, including health care. So we scoured transcripts and videos from Trump’s public statements and interviews.

Trump has been a vocal opponent of the Affordable Care Act, but his general stance on health care is much murkier.

On the medical record

Trump has said multiple times that he would "get rid of Obamacare" as soon as he takes office. He’s also repeatedly attacked the Healthcare.gov website as a $5 billion failure that "has never worked" (which rates False).

But disliking the Affordable Care Act, which is not a single-payer system, is not the same thing as condemning the concept of health care for all.

During his short-lived flirtation with a 2000 Reform Party presidential bid, Trump supported universal health care without ambiguity, and he voiced support for a single-payer system in several instances.

• "If you can’t take care of your sick in the country, forget it, it’s all over. ... I believe in universal healthcare," Trump told CNN’s Larry King in October 1999.

• "I would put forth a comprehensive health care program and fund it with an increase in corporate taxes, " Trump told The Advocate right before he dropped out of the race in February 2000.

• "The Canadian plan also helps Canadians live longer and healthier than America. … We need, as a nation, to reexamine the single-payer plan, as many individual states are doing," Trump writes in his 2000 book The America We Deserve.

Trump has said very little about single-payer health care since 2000, according to our search of the LexisNexis database.

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Reading between the lines

Trump’s more recent comments about health care systems contradict each other, which experts say suggests he hasn’t formed a clear position.

While bantering with David Letterman on Jan. 8, 2015, Trump voiced admiration for Scotland’s publically funded health care system and suggested that the problem with the Affordable Care Act is its implementation. Here’s a transcript of their exchange:

Letterman, recounting how cheap it is to treat injuries abroad: "In one case, I had my arm reattached and at the end of the procedure ... it was like $12 dollars!"

Trump: "A friend of mine was in Scotland recently. He got very, very sick. They took him by ambulance and he was there for four days. He was really in troubl,e and they released him and he said, ‘Where do I pay?’ And they said, ‘There’s no charge.’ Not only that, he said it was like great doctors, great care. I mean we could have a great system in this country."

Letterman: "Are people afraid of socialism?"

Trump: "Well, people are afraid of a lot of things. But it’s mostly incompetence. … How do you spend $5 billion on a website, just the creation of the site itself, and it doesn’t work?  … There are things you could do to give unbelievable healthcare and a much better healthcare system. It’s a complicated topic, unfortunately."

Experts told us Trump is either implicitly supporting a single-payer system or putting his foot in his mouth.

"The Scottish system is a classic single-payer system, like the English system, except better funded," said Timothy Jost, a professor of health care law at Washington and Lee University.

"He should stop citing Scotland," said Gail Wilensky, a health economist and former head of Medicare and Medicaid under President George H.W. Bush. "He doesn’t seem to know what the Scottish system is. Most market-oriented people are not real keen about it."

In a July radio interview, Trump came short of rejecting his previous position for a Canadian-style plan and instead talked about a totally different approach.

He called himself a "conservative with a heart" and described his alternative to the Affordable Care Act: "Great (private) plans" made through "deals with hospitals" that allow the government to help people "at the lower levels."

On July 31, a spokesperson for Trump clarified to Forbes that he’s "never supported socialized medicine" but is for "a universal ‘market-based’ plan that would offer a range of choices."

The sort of system Trump is alluding to — a universal, market-based system with a mix of public and private funding — is essentially what the Affordable Care Act establishes, Jost said.

More teased-out conservative alternatives with less government regulation than the Affordable Care Act can be found in John McCain’s 2008 proposal or Wisconsin Rep. Paul Ryan’s reform bill, Wilensky said.

Our ruling

Perry said Trump is "for single-payer health care."

Fifteen years ago, Trump was decidedly for a universal healthcare system that resembled Canada’s system, in which the government pays for care for all citizens. Recently, he's said he admires Scotland’s single-payer system and disses the Affordable Care Act as incompetently implemented.

However, a Trump spokesman denied that the candidate supported "socialized medicine" and suggested Trump prefers a "free-market" solution. Other than that, though, the Trump campaign has been silent about what his specific health care policies are; perhaps Trump will be pressed on this point during the Aug. 6 debate.

Given the current evidence, Perry's attack is partially accurate, but leaves out details. We rate the statement Half True.