He could simply mean he wants insurance companies to compete for government contracts when he implements single payer.
“Americans need more options when it comes to purchasing health-care insurance.
One way to infuse more competition into the market is to let citizens purchase health-care plans across state lines.
Health-care costs vary drastically from state to state. For example, a 25-year-old in California can buy an HMO plan that costs him $260 a month. But for a New Yorker to buy a similar plan with equivalent benefits, it will cost him $1,228 a month. Why not allow people to buy health insurance across state lines and make companies compete to offer the best plans at the best rates? This could be easily accomplished if Congress got some guts and did the right thing.
The U.S. Constitution gives Congress control over interstate commerce. But for whatever reason, the Congress has never exercised this power regarding health insurance.
Bills for interstate insurance compacts have been proposed for over six years. As usual, though, the politicians in Washington have done nothing about it. Increasing competition is common sense. We need to pass laws that encourage it.
The proper way to bring the cost of health-care down is to make insurance companies compete nationally and get defensive medicine under control through serious tort reform that includes loser pays provisions."
Trump, Donald J. (2011-12-06). Time to Get Tough: Making America #1 Again (p. 134). Regnery Publishing. Kindle Edition.