When Mike Cernovich, one of the most prominent alt-right internet trolls supporting Donald Trump, was interviewed on 60 Minutes, he used the platform to spread conspiracy theories about Hillary Clinton's health and to allege that she is involved with pedophilic sex trafficking operations. But he also declared his belief in single-payer health care.
"I believe in some form of universal basic income," he told CBS's Scott Pelley, citing concerns about technological unemployment. "I'm pro-single-payer health care. Is that right-wing or is that left-wing anymore? Well, if you have a lot of people, a large swath of the company, or country, are suffering, then I think that we owe it to all Americans to do right by them and to help them out."
This might seem like a bizarre position for a far-right conspiracy theorist to take. Single-payer health care, after all, entails nationalizing most or all of the health insurance industry and having the government set prices for doctors' services. Conservatives in America have spent the better part of the past century arguing that the idea is socialistic, would lead to long waits for lifesaving treatment, and would give the government power over the life and death of its citizens.
More from Vox:
4 ways states can prevent the Affordable Care Act from 'exploding'
President Trump's approval rating started off mediocre and is now downright awful
A federal court just made a very big decision for gay rights. Seriously, it's huge.
But Cernovich is less a traditional conservative than he is a Trumpist — and Trumpism in its purest, alt-right variety cares more about white working-class identity politics than traditional conservatism. More and more, Trump fans are seeing single-payer as part of that.
Alt-rightists and other Trump-loyal conservatives — Richard Spencer, VDARE writer and ex–National Review staffer John Derbyshire, Newsmax CEO and Trump friend Christopher Ruddy, and onetime Donald Trump Jr. speechwriter and Scholars & Writers for Trump head F.H. Buckley — all endorsed various models of single-payer in recent months and years.
Even elites in the alt-right mold who once deplored single-payer are changing their tune. Pat Buchanan, the paleoconservative three-time presidential candidate whose white identity politics and fiercely anti-trade and anti-immigration stances helped inspire the modern alt-right, had free market views on health care in the 1990s and condemned Obamacare as a scheme to kill Grandma in 2009. This week, he told me in an email he has "not taken any position on single-payer, and [has] pretty much stayed out of the Obamacare repeal-and-replace debate."
Curtis Yarvin, a Silicon Valley programmer whose writings under the pen name Mencius Moldbug helped launch the neoreactionary branch of the alt-right, told me he welcomes the movement's trend toward single-payer, viewing it as a "sincere effort to think realistically in the present tense rather than in abstract ideology."
Insofar as the alt-right, and the Trump-supporting right more generally, have a coherent economic agenda, it's a vehement rejection of the free market ideology crucial to post–World War II American conservatism. While Paul Ryan reportedly makes all his interns readAtlas Shrugged, figures like Cernovich, Spencer, and Derbyshire are trying to build an American right where race and identity are more central and laissez-faire economics is ignored or actively avoided.
This has been most obvious on immigration and trade, where libertarians' opposition to most or any government restrictions is in tension with the alt-right's economic nationalism. But it's also true on health care, where the pure alt-righters are joined by more mainstream pro-Trump voices like Ruddy and Buckley and even some Trump-wary conservatives such as Peggy Noonan.
The Trump-supporting right's case for single-payer is part of a vision of a party where ideological purity on economic issues is much less important, and where welfare state expansion can be accommodated if it serves other goals — like building a political base among working-class whites.
The welfare state has always been more popular with the Republican base than with its elected officials. Trump arguably won the presidency in part by being the first Republican in years to promise to protect Social Security and Medicare. My colleague Sarah Kliff has run focus groups with Trump voters where participants bring up their admiration for Canadian-style single-payer unprompted. The alt-right single-payer fad suggests that elites are finally catching up.