1. Republicans saw polling show Obamacare was unpopular as a sign that people wanted less government. In fact, polls show that having seen what a post-Obamacare world would look like, they overwhelmingly want to keep it — or make the benefits more generous. Each time Republicans argued that taking away health care was equivalent to “freedom,” they lost another few percentage points of support.2. No section of the electorate, not even Republicans, thinks Medicaid cuts are a good idea. Using this as an opportunity to whack Medicaid — starving it of resources — was misguided. GOP promises that they were improving Medicaid were hollow and unbelievable.3. Taking benefits away from people to give tax cuts to the rich is a dream target for Democrats.4. President Trump’s campaign rhetoric made it sound as though the GOP was going to give more and take away nothing in health-care reform. When Republicans did the opposite, they made Trump into a liar and alienated his base.5. The White House assumption that it could delegate health-care reform to the GOP leaders who do not share Trump’s populist outlook was dumb.6. The notion that you can run a White House without experienced insiders reflected a fundamental lack of understanding about what the president does.7. Trump seemed to believe that bucking up his base has been productive (by attacking the media, for example). It did nothing to win votes in Congress or to keep independents on his side. His ego compels him to do things unrelated to or damaging to governing.8. Ironically, Senate Majority Leader Mitch McConnell (R-Ky.), the lover of Senate tradition, should have known that you cannot order senators around like House members. Threaten them or put them on deadline — and they will revolt.9. Many Republican lawmakers — I know this is cringe-worthy — likely didn’t realize that Medicaid serves lots of people other than unemployed, poor people. They grossly misjudged the damage that Medicaid cuts would do.10. The entire notion of creating a “free market” for health care is off-base. Government — via Medicaid, Medicare and requirements to treat all urgent-care patients — has already big-footed the market. Reforms around the edges are possible, but there is no free market for health care and there hasn’t been for 50 years or so. (Even at the state level, strict insurance regulations do not allow insurance companies to operate like other private businesses.)11. Republicans seemed to forget that people fear change, especially when it comes to health care.12. Republicans on Capitol Hill never enlisted GOP governors who are far more influential and popular than they are. Governors are not going to stand idly by while Congress wrecks their states’ finances.13. They should have done infrastructure first.14. Rolling out a half-baked tax plan with supersize cuts for the rich only intensified the perception that the GOP cares only about tax cuts for the rich.15. The idea that taking people off Medicaid wouldn’t cause suffering because they could buy insurance was economically questionable and politically untenable. If your income is so low as to qualify for Medicaid, you cannot afford the premiums and/or the big deductibles (if you choose a plan with lower premiums).16. Plotting in secret never works, especially when the people in the room have a poor grasp of health-care economics.17. Republicans intentionally exaggerated the problems with the exchanges, assuming that alone would make anything they proposed acceptable.18. Claiming Democrats only wanted single-payer health care didn’t match reality. They are fighting to keep Obamacare, which isn’t single-payer health care. (A segment of the Democratic Party certainly wants single-payer health care, but for now that is not what they are advocating.)19. Standing up for “hardworking taxpayers” could not disguise the fact that the overwhelming amount of tax relief was going to the richest Americans.20. You cannot pass major legislation with a policy-illiterate president who cannot explain what’s in it and therefore cannot persuade voters and lawmakers of its merits.
June 28, 2017 at 12:17 PM EDT