Last week’s health-care fiasco could end up being a positive experience for President Trump if he learns a few obvious lessons. Spoiler alert: He won’t.
The first thing that should dawn on Trump is that the warring Republican factions in Congress have multiple agendas, none of which remotely resembles his own. This is why the bill that House Speaker Paul D. Ryan (R-Wis.) was forced to withdraw on Friday — the abominable American Health Care Act — made such a cruel mockery of Trump’s expansive campaign promises.
A “populist” president who promised health insurance “for everybody” ended up supporting legislation that would have taken away coverage from 24 million people. Many, if not most, of the victims would have been working-class voters — the “forgotten Americans” Trump claimed to champion. Now that he has time, maybe he will actually read the bill (or have someone summarize it for him) and realize how truly awful it was.
You don’t have to be a policy wonk to recognize that replacing income-based subsidies with less generous across-the-board tax credits would mean a net transfer of resources from poorer people to wealthier people. That’s just fine with Ryan and the “mainstream” House Republicans who hung in there with legislation that Ronald Reagan or even Barry Goldwater would have considered extreme.
For members of the Freedom Caucus, however, the bill didn’t go nearly far enough. They wanted to strip away the requirement that health insurance policies cover eventualities such as maternity, hospitalization, emergency care, mental illness — basically, all the reasons anyone would need insurance in the first place. These ultra-radicals believe health care is like any other product and the free market should be allowed to work its magic. To them, it’s irrelevant that the question is not who buys the latest flat-screen television and who doesn’t, but who lives and who dies.
As Trump lobbied House Republicans to support the AHCA, according to The Post, he kept asking aides, “Is this really a good bill?” They assured him it was, but on some level, he must have known the truth was an emphatic no. What happened to those fabled Trumpian instincts?
The president let himself be convinced by Ryan that health care would be an easy win. That should make him wary of going down another garden path with a speaker who can’t even marshal his own chamber, let alone produce important legislation with a chance of making it through the Senate. Yet Trump seems ready to make the same mistake with tax reform.
Note to the president: If Ryan is saying “trust me on this one,” don’t.
The same dynamic is shaping up. House Republicans will all agree on tax cuts, just as they all agreed that the Affordable Care Act should be repealed. The Freedom Caucus, which can only be emboldened by its recent triumph, will make extreme demands. Ryan will accommodate many of them. The end result will be legislation that is more about ideology than policy. The wealthy will benefit enormously, the middle class hardly at all, and the working class will suffer.
Such a bill could never win 60 votes in the Senate. Only more modest changes that don’t balloon the deficit qualify for the “reconciliation” process under which Majority Leader Mitch McConnell (R-Ky.) can pass legislation by simple majority — and if just three Republicans balk, even such a limited bill would fail.
Trump should wonder why someone on his staff isn’t explaining all of this to him and trying to come up with an appropriate strategy. Chief of Staff Reince Priebus and budget director Mick Mulvaney were supposed to know how to get things done in Washington. White House chief strategist Stephen K. Bannon reportedly tried to bully Freedom Caucus members, who instead seem to have stiffened their resolve. Advisers Jared Kushner and his wife, Trump’s daughter Ivanka, went skiing.
Meanwhile, Trump’s approval, as measured by Gallup, stood Monday at 36 percent — a stunning new low. The financial markets seem a bit shaky as investors worry about the administration’s competence. If this were a business, the chief executive would be reading up on Chapter 11.
During the campaign, Trump was nothing if not headstrong. Yet in office he has let others lead — and is getting nowhere. He could still change course. He could get rid of the sycophantic aides who spend so much time blaming each other. He could focus on parts of his agenda, such as infrastructure, that have popular support, including among Democrats.
But that would mean acknowledging his mistakes thus far. Don’t hold your breath.