Gail Collins is a columnist for the New York Times.

Gail Collins is a columnist for the New York Times.

Gail Collins: Trump’s health mandate: Don’t die on the streets

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Sometimes in a particularly awful presidential race, you are forced to take the most bleak and cynical view of the candidates running for the most powerful job in the world. And then you discover you are overestimating.

Today we will consider the upside of Donald Trump.

OK, it was never huge. Possibly not even nugget-size. But people, was there not a moment when you thought that he could think outside the normal conservative box? True, his riff against the power of big political donors was just another way to brag about being rich. And he was awful on ... so very many things.

But once in a while, as Trump ranted about the Republican insiders, some actual outsider remarks did pop up. Do not mess with Social Security. Planned Parenthood is a good thing. And everybody ought to have health care.

Earlier in the campaign, he seemed to support a single-payer health care plan, sort of like Bernie Sanders. Wow.

“I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody is going to be taken care of,” he told Scott Pelley on CBS.

Now it was pretty clear Trump had not actually thought things through. This happens so very frequently, you have to wonder what he talks about on all those plane rides. Schedules? Golf scores? Dinner plans?

This month, Trump still seemed to be moving in the same general health care direction. In a CNN town hall, Anderson Cooper mentioned the Obamacare mandate that everybody must have insurance. The Republicans hate this idea. They believe all Americans have a God-given right to refuse to get health coverage and throw themselves on the mercies of expensive hospital emergency rooms if they get ill.

“Well, I like the mandate,” Trump said. “OK, so here’s where I’m a little bit different. I don’t want people dying on the streets and I say this all the time.”

This is how far we have fallen. The leading candidate for the Republican presidential nomination keeps bragging that he does not want people dying in the streets.

“Now some people would say, ‘That’s not a very Republican thing to say,’ ” he told Cooper.

Wow, Trump clearly has a very low opinion of Republicans. As well as insurance companies. Do you see why a desperate citizen might think he is the lesser of three front-running evils? Remember, right now the party’s sensible establishment candidate is a person who does not want to allow abortions for rape victims and who basically believes that the only people who should have to pay taxes are the ones who worked for the money.

Trump said the poor people could be taken care of “through maybe concepts of Medicare. ... That’s called heart.”

Fast forward three days. Trump is back at CNN talking with Jake Tapper, denying that he wants any mandate.

Pop quiz. After Donald Trump said he did not want a health care mandate after all, he added that he also did not want:

A) Any more hard questions.

B) People dying in the streets.

You’re right! The answer is B, and in case anyone missed his big-heartedness, Trump added that people would not be “dying on the sidewalks” either.

One of the most universally popular parts of Obamacare is the requirement that insurance companies cannot discriminate against people who have pre-existing conditions like diabetes or a prior bout with cancer. The problem is how to keep everybody from waiting until they get sick to insure themselves. You can just create a kind of Medicare for all. Or you can require people to buy insurance, and help the low-income pay the cost.

“I don’t like the term mandate, personally, because that sort of means mandatory,” Trump explained.

So what the heck does he want? Well, I checked with his campaign. He wants people to be able to establish health savings accounts. He is also looking into the possibility of letting the states run Medicaid with federal block grants, and making health insurance premiums tax-deductible.

People will not die in the streets because there are, you know, emergency rooms.

We will skip over the part where Trump is this far down the road and still working on a basic plan. The more important point is that he is coming down to a health care policy that is the same as Marco Rubio’s and Ted Cruz’s.

“If most Republicans did not agree on most of the features of reform then you’d have a story. The fact that they agree should not be a surprise to anyone,” Sam Clovis, the campaign’s senior policy adviser, said in a phone interview.

The bottom line is that once you really pin him down, Donald Trump is a mail-order conservative Republican, except more trash-talking about Muslims and Mexicans. Surrender hope and be careful not to die in the streets.