This wasn’t supposed to happen. Donald Trump was what America needed. He could get things done, whatever they were. No one quite knew. He’s been all over the map on public policy for decades – at one time even a pro-choice Democrat. Now he was a hard-ass social conservative the evangelicals loved, in spite of his three successive trophy wives and that “grab them by the pussy” stuff. That didn’t matter. His heart was in the right place. The word was that his supporters took him figuratively, not literally – they didn’t expect that giant wall and decided he wasn’t really going to take away their health insurance. Everyone else took him literally, but didn’t take him seriously at all – until all the votes were counted. Then they were scared to death. They were scared he’d actually get something done – something awful. His supporters were happy that he’d get something done. They had no idea what that would be, exactly, but he’d get things done – and even the vaguest something would be better than all the long years of certain nothing in Washington that had infuriated everyone.
There’s a way to sum that up. Something must be done. This is something. This, therefore, must be done. That something was electing this guy.
Anyone familiar with symbolic logic sees the inherent fallacy in that, but Americans aren’t big on symbolic logic, and besides, the guy was a winner. He was a billionaire. He also knew how to make the awful wonderful again. He had lost it all in Atlantic City – multiple bankruptcies with those casinos – and came out smelling like a rose. There may have been mob money involved, but Donald Trump came back, richer than ever. The same thing happened in Manhattan, but Trump roared back again – perhaps with massive funding from assorted Russian oligarchs – Putin’s posse – but he did come roaring back. Just enough voters, in just the right places, found that impressive. America could come roaring back. Don’t worry about the shady funding. Putin’s posse is fine. No more Muslims. No more Mexicans. He’d do something. No one quite knew what that would be, but it’d really be something.
That led to an odd campaign that’s easy enough to sum up too. This man is full of shit! But he’s rich! No, really, he’s full of shit! But he’s rich!
That was tiresome. The election settled that argument. The Trump presidency really would be something.
So far it has been. FBI Director James Comey publicly repudiated Trump’s wiretapping charge this week – Obama hadn’t tapped Trump Tower in any way, and Obama hadn’t used the Brits to try that – and then Comey said that the FBI had been investigating Trump’s ties to Russia since last July. Trump’s folks may have been working directly with the Russians to ruin Hillary Clinton’s chances. There was a whiff of treason in the air, and then there was Trump’s first travel ban – shot down in the courts – and his second revised travel ban, also shot down in the courts. Those were Muslim bans. We don’t ban whole religions. Trump did not end up smelling like a rose in any of this.
This wasn’t the Trump that his supporters expected, the man who knew how to make the awful wonderful again. This was just awful, and then, as the week ended, he failed at that again:
Republican leaders abruptly pulled their overhaul of the nation’s health-care system from the House floor on Friday, a dramatic defeat for President Trump and House Speaker Paul D. Ryan that leaves a major campaign promise unfulfilled and casts doubt on the Republican Party’s ability to govern.
That’s from the Washington Post’s account, but the Post only says what everyone is saying:
The decision leaves President Barack Obama’s chief domestic achievement in place and raises questions about the GOP’s ability to advance other high-stakes priorities, including tax reform and infrastructure spending. Ryan (R-Wis.) remains without a signature accomplishment as speaker, and the defeat undermines Trump’s image as a skilled dealmaker willing to strike compromises to push his agenda forward.
Trump shrugged anyway:
In an interview with The Washington Post, Trump deflected any responsibility for the setback and instead blamed Democrats. “We couldn’t get one Democratic vote,” he said.
“I don’t blame Paul,” Trump added, referring to Ryan.
Trump said he would not ask Republican leaders to reintroduce the legislation in the coming weeks, and congressional leaders made clear that the bill – known as the American Health Care Act – was dead.
That was the ultimate shrug. Let it all go, and that was that:
Shortly after the decision, Ryan told reporters his party “came really close today, but we came up short.” He added: “We’re going to be living with Obamacare for the foreseeable future.”
But there is a plan:
Republican leaders said they would wait for the Affordable Care Act to encounter fatal problems, believing that Democrats will then want to work with them to make changes.
“As you know, I’ve been saying for years that the best thing is to let Obamacare explode and then go make a deal with the Democrats and have one unified deal,” Trump said. “And they will come to us. We won’t have to come to them.”
That’s the plan. Wait. If that’s a plan:
It remains far from certain that Republicans, in control of the White House and both houses of Congress, will be able to credibly foist responsibility for the nation’s health-care woes onto Democrats. What is certain is that Republicans continue to have difficulty turning their campaign promises into legislative action.
And someone spoke too soon, before the bill was pulled:
“Since 2010, every Republican, with the exception of probably a handful, has campaigned from dogcatcher on up that they would do everything they could to repeal and replace Obamacare,” White House press secretary Sean Spicer said Friday. “To get in and say you’re going to do something else would not be fair to the American people.”
Oops. But this was doomed:
Conservative hardliners chafed that the Ryan-drafted bill left too much of the ACA in place and enshrined a federal role in health insurance markets, while moderates feared that cuts to tax subsidies and Medicaid would leave their constituents uncovered and their states with gaping budget gaps.
There was no way to win, and that’s deadly:
Before the bill was pulled Friday, Rep. Bradley Byrne (R-Ala.) called it the “first big vote in the presidency of Donald Trump,” one that would be “a statement, not just about him and the administration but about the Republican Party and where we’re headed.”
“So much about political power is about perception. And if the perception is that you can’t get your first big initiative done, then that hurts the perceptions down the road about your ability to get other big things done,” Byrne said.
Oops. He shouldn’t have said that, but the other guy was philosophical:
At the Capitol, a deflated Ryan said he would confer with fellow Republicans in the coming days about how to proceed, but he made clear health care would no longer be a central agenda item.
“Moving from an opposition party to a governing party comes with growing pains,” Ryan told reporters. “We’re feeling those growing pains today.”
“Doing big things is hard,” he added.
Ryan should have asked Obama about that. Obama did big things with health care. Obama might have had some tips on big things, but then he’s not a billionaire:
Trump said he had no problem waiting for Democrats to seek cooperation with Republicans on health care: “I never said I was going to repeal and replace in the first 61 days.”
In fact, Trump said repeatedly as a candidate and before his inauguration that he would work to repeal the ACA on his first day in office.
The worriers were right. The man is full of shit, but the New York Times tells the story a different way:
When Speaker Paul D. Ryan arrived at the White House on Friday to inform President Trump that the health care bill he had made his first major legislative push could not pass, Mr. Trump had one reaction: He wanted revenge.
Furious at rebellious Republicans who refused to back the measure, Mr. Trump demanded that defectors cast “no” votes for all to see – even if it meant the measure’s high-profile defeat, broadcast live on television.
But over a lunch of chicken, brussel sprouts and twice-baked potatoes in the Oval Office, Mr. Ryan pleaded with Mr. Trump to reconsider.
A loss could do lasting political damage to Republicans who supported the contentious bill, Mr. Ryan argued, especially those in competitive districts who were vulnerable to primary challenges. It would do nothing to isolate or punish the Freedom Caucus, the conservative faction that had resisted the measure all along, he added.
And it could alienate rank-and-file Republicans needed to push through other challenging initiatives in the weeks to come, including an increase in the debt ceiling, a sweeping tax cut and the president’s promised $1 trillion infrastructure package.
Ryan humored trump, calming him down, and that, or the twice-baked potatoes, worked:
Mr. Trump remained unconvinced, but by midafternoon, armed with vote counts showing that the measure lacked a majority to pass, the president called the speaker to agree: You should pull the bill.
With repeal and replace now a hollow vow, Mr. Trump’s anger at the defiant members of the Freedom Caucus was undiminished. But trying to put the best possible face on a major defeat late Friday afternoon, he confined his public criticism to Democrats.
That was nonsense, even if it made Trump feel better, and Jonathan Chait explains his view of why Obamacare Defeated Trumpcare:
The political project dedicated to restoring the pre-Obamacare status quo, in which people too sick or poor to afford their own insurance without the subsidies and regulations of the Affordable Care Act could be safely ignored, is gone forever. And it is dead for the best possible reason, the reason that undergirds all social progress: because a good idea defeated a bad one.
Or maybe it was the cast of characters:
Conservatives have already collapsed into mutual recriminations for their failure. Reporters have blamed Trump’s deal-making skills. Trump’s loyalists are loudly blaming Paul Ryan. “I think Paul Ryan did a major disservice to President Trump, I think the president was extremely courageous in taking on health care and trusted others to come through with a program he could sign off on,” Chris Ruddy, CEO of the right-wing site Newsmax and a longtime friend of Trump’s, tells Bloomberg. “The president had confidence Paul Ryan would come up with a good plan and to me, it is disappointing.” David Brooks blames both Trump and Congress. “The core Republican problem is this,” he writes. “The Republicans can’t run policy-making from the White House because they have a marketing guy in charge of the factory. But they can’t run policy from Capitol Hill because it’s visionless and internally divided.”
Or maybe it wasn’t the cast of characters:
The American Health Care Act is a truly horrendous piece of legislation. But it did not become the vehicle for the Obamacare repeal effort because Trump, or Ryan, or anybody insisted on it over some other option. It became the repeal bill because nobody in the Republican Party had a better idea.
Obama is the only one who solved the essential problem:
What makes health care so resistant to change is that, the worse the system gets, the harder it is to change. More waste means more profit centers with an interest in protecting their income. And more uninsured people means more anxiety for those who do have insurance about losing it, and hence more resistance to change. The political miracle of Obamacare was its ability to design a way to cover the uninsured and to pay for the coverage in a politically viable fashion. The law found a way to solve a political problem that had frustrated would-be reformers for decades.
The other guys didn’t even see the problem:
Republicans have spent eight years fooling themselves about Obamacare. They have built a news bubble that relentlessly circulates exaggerated or made-up news of the law’s shortcomings and systematically ignores its successes. The smartest members of the conservative-wonk set played a more clever game to retain their influence. No serious conservative analyst could argue that Obamacare had actually made the health-care system worse. How could they, when the federal government is now spending less money on health care than it was projected to spend before Obamacare passed, medical inflation is at the lowest level since the government began recording it 50 years ago, and 20 million more Americans have insurance? But admitting Obamacare constituted an improvement in the health-care system, even an imperfect one, would be tantamount to expulsion from the conservative movement, and with it any hope of influencing Republican policy. The closest they might come is pleading that repealing Obamacare was “not enough,” that they must also replace it with something better. This formulation allowed them to neatly sidestep the question of whether repeal alone would make the system better or worse.
So instead of comparing Obamacare to what it replaced, they compared it to the plan Republicans would have passed, if only they had the chance.
They finally got their chance, but there was nothing better:
The existence of the mythical Republican healthcare plan was the foundation for every serious critique of the law. And now that that plan has finally appeared, virtually the entire conservative intelligentsia has been forced to admit it is worse than Obamacare. The single data point that conservatives have repeated with the most relentless frequency is that Obamacare is unpopular. It is true that, for most of its life, the law has polled in the 40s. Republicans deemed all disapproval of Obamacare to be approval for their stance, never acknowledging that much of this disapproval came from those who wanted the law to do more, not less. Now that there is a Republican alternative, it is polling at an astonishing 17 percent. Comically, repeal efforts have pulled Obamacare’s polling above water. The slim reed of public opinion upon which they built their manic repeal crusade snapped immediately under the weight of political implementation.
That may have been the real problem:
The right’s insoluble problem is that people who have insurance like it. Employer-sponsored insurance is popular. Medicare is popular. Medicaid is popular. To the extent that the exchanges in the ACA are not that popular, it is because they are less like those forms of insurance and more like the kind of insurance conservatives prefer – they have higher deductibles, more price discrimination between old and young, and more market competition. Any employer-sponsored insurance plan is going to cover essential health benefits. It’s going to charge the same price to the young and the old alike. In other words, it is going to spread the risk of needing medical care throughout the population it covers.
Conservatives disagree philosophically with the very concept of insurance as most Americans experience it. Insurance means spreading risk, which is a form of redistribution. Republicans postured against Obamacare from the left, denouncing its high deductibles and premiums, and promising a better, cheaper plan that would cover everybody. Their plan, inevitably, did the opposite. All politicians overpromise, of course. But the Republicans did more than overpromise. They delivered a policy directionally opposed to their promises.
That’s because they are who they are:
It is not possible to write a bill that meets public standards for acceptable health-insurance coverage within the parameters of conservative ideology. It is possible – just barely – to write a bill that meets public standards for acceptable health-insurance coverage within the parameters of liberal ideology. The form taken by Obama’s healthcare reform will change over the decades to come. But its central triumph, creating a federal right to access to basic medical care, will never be taken away.
In short, there was no winning this one. They didn’t want to win this one. Winning this one would turn them into bleeding-heart liberals. They’ll be fine with this loss, eventually.
There is, however, another way to look at this. Ezra Klein thinks Paul Ryan played Donald Trump:
Donald Trump promised to be a different kind of president. He was a populist fighting on behalf of the “forgotten man,” taking on the GOP establishment, draining the Washington swamp, protecting Medicaid from cuts, vowing to cover everyone with health care and make the government pay for it. He was a pragmatic businessman who was going to make Washington work for you, the little guy, not the ideologues and special interests.
Instead, Trump has become a pitchman for Paul Ryan and his agenda. He’s spent the past week fighting for a health care bill he didn’t campaign on, didn’t draft, doesn’t understand, doesn’t like to talk about, and can’t defend. Rather than forcing the Republican establishment to come around to his principles, he’s come around to theirs – with disastrous results.
Democrats don’t like this bill. Independents don’t like this bill. Conservatives don’t like this bill. Moderates don’t like this bill. All the energy behind the American Health Care Act is coming from inside the GOP congressional establishment…
That’s the problem Klein sees:
Sixty days into his presidency, Trump has lashed himself to a Paul Ryan passion project that’s polling at 56-17 percent against. As political scientist Ryan Enos drolly observed, “In a hyper-partisan political climate, it’s actually an accomplishment to write legislation this unpopular.” Nor is Trump emerging unscathed: Polls show his approval rating falling into the 30s – and that’s before he’s taken away health insurance from a single person.
Trump seems lost:
The AHCA breaks Trump’s promises to his base so fulsomely, so completely, that when told by Tucker Carlson on Fox News “that counties that voted for you, middle-class and working-class counties, would do far less well under the bill,” Trump was reduced to saying, simply: “Oh, I know.”
Donald Trump has become Paul Ryan with orange hair. How did it happen?
That’s a good question, given the old Trump:
In September, Donald Trump sat down with Scott Pelley of 60 Minutes and told the world he was a different kind of Republican.
“Everybody’s got to be covered,” he said, referring to his health care plan. “This is an un-Republican thing for me to say, because a lot of times they say, ‘No, no, the lower 25 percent that can’t afford private.’ But I am going to take care of everybody. I don’t care if it costs me votes or not.”
“Who pays for it?” asked Pelley.
“The government’s gonna pay for it,” Trump said, and he went on to promise that people on Trumpcare “can have their doctors, they can have plans, they can have everything.”
This was the Donald Trump who unexpectedly won the Republican primary and then beat the odds to become president. He was a Republican, yes, but a different kind of Republican – a Republican who owed Ryan nothing, who wasn’t friends with the Bush clan, who liked construction workers more than he liked Wall Street executives, who wanted the government to give people health care…
Here was a guy who had praised single-payer in the past and promised to protect Medicare and Medicaid from cuts. Whatever Trumpism was, it sure as hell wasn’t Ryanism.
Yes, but there was nothing there:
On Wednesday, the New Yorker’s Ryan Lizza published a series of messages from a House Freedom Caucus source laying out the state of play on the American Health Care Act. “Don’t source to me,” the person wrote, “but Ryan’s astonished how in over his head Trump is. He seems to neither get the politics nor the policy of this.”
Recently, I read every public statement Trump made on health care since the unveiling of the AHCA. It was striking how obviously thin Trump’s knowledge of the issue was. His standard riff veered from complaints about Obamacare to complaints about how Democrats wouldn’t work with him to vague promises about how great everything would be after the House plan passed. To this day, Trump has never made a substantive case for why this bill would make people’s lives better.
Politico reports that Trump doesn’t even like talking about health care.
Ryan saw that:
This is the problem with not knowing or caring much about the details of policy – it’s easy to get spun by people who do know and care, and it’s easy to get trapped in processes that people are building for their benefit rather than yours. And that seems to be what happened to Trump.
It’s an interesting question why the plan Ryan concocted is such a shoddy piece of work, and why Ryan didn’t spend more time building stakeholder support or mapping out a sensible process. But it’s not particularly surprising that once Ryan had a plan, Trump was persuaded to sign off on it – the people to whom he’s outsourced these decisions share Ryan’s instincts and ideology, not Trump’s, and Trump isn’t knowledgeable enough or interested enough to question their judgments.
And then Ryan simply spun Trump:
Ryan’s stroke of genius, however, has been flattering Trump’s vision of himself as a dealmaker through the process, and amping up Trump’s sense of the personal stake he has in the AHCA’s success.
On Monday, Politico reported that “members of Speaker Paul Ryan’s team, trying to appeal to Trump’s ego and deal-making sensibilities, have begun calling him the ‘closer’ or the ‘ultimate closer.'”
In an interview, Ryan amped-up both the flattery and the pressure. “I’ve never seen, since I’ve been in Congress – and this is the fourth president I’ve served with – I’ve never seen a president as deep and involved and engaged on passing the signature legislation as this one,” he said.
And that’s how a bill that Trump didn’t campaign on and didn’t write and doesn’t understand become his “signature legislation,” and that’s how its possible failure could be recast as proof that Trump isn’t the closer he promised to be, even when he’s maximally involved in the effort.
Trump got used, and it was easy:
Even in the best of scenarios, and with the most able of leaders, changing the ideology of a political party is a difficult effort. But Trump didn’t even try, and now he has burnt much of the political capital he had on Paul Ryan’s health care plan – there is no one, after this, who thinks his salesmanship unstoppable or his commitment to his own agenda unshakable, and that weakens his ability to push the Republican Party to places it doesn’t already want to go.
Trump lost, big time. Ryan won, even if it’s not much of a victory now, but Kevin Drum sees something else:
The process toward passing Obamacare began on March 5, 2009, when President Obama convened a “health summit” with various players in the health care industry. It finished 383 days later, on March 23, 2010, when he signed it into law.
Trumpcare began life on February 16, 2017, when Paul Ryan released an outline of what a Republican bill would look like. It was abandoned 36 days later, on March 24, 2017.
And this doesn’t even count the fact that Democrats had been seriously debating and designing health care policy for decades before Obamacare was born. Republicans had never gone much beyond the debating point stage. But policy matters: detailed, messy, real-life policy that makes compromises in order to produce something that works and has the support of all the stakeholders. The problem is that Trump isn’t used to that kind of thing.
In Trump’s past jobs, he could simply move on from failed deals and find new partners, and new markets, and new sectors. But that’s not how the presidency works, and it’s not clear he realizes that.
That means that Trump’s whole strategy was wrong:
“Take it or leave it” works only if you really are willing to leave it. Trump often is, because he can always turn around and do a different deal with someone else. But there’s only one Congress. If Trump gets bored after a whole month of negotiations and gives up, there’s no other Congress he can turn to. That’s why Trumpcare is dead.
Oh well. The election settled matters. The Trump presidency really would be something, and it certainly is. It’s a bit of a disaster – but at least twenty-four million Americans won’t lose healthcare coverage in the next ten years. This man cannot make the awful wonderful again after all – and America should be grateful. He was about to do the opposite. We’ve been saved by his short attention span – this time. It was a fine failure.