What We Learned from the GOP Health-Care Debacle

The failure of the Trump administration to keep its promise to repeal Obamacare will not merely change the order of President Trump’s legislative priorities, nor will it prove to be the cause of all that ails the GOP and the White House going forward. Instead, it has revealed what really ailed this Republican government to begin with — and conservatives like me have every reason to be deeply concerned by those ailments.

On one hand, there is the Freedom Caucus, whose members succeeded in derailing the AHCA, unphased (if not somewhat amused) by President Trump’s threats to go after them. Talk in recent days that they might lose their seats to Trump-backed primary challengers in 2018 should seem laughable to anyone who understands the nature of their districts, especially in light of the financial backing they just earned themselves from conservative groups opposed to the bill.

Were a good portion of them driven by what they found unpleasant in the bill? Of course, and rightly so: There was much within it to find unpleasant. But had the bill’s substance been 20 percent better, or 50 percent better, or 80 percent better, would the Freedom Caucus have supported it en masse? Unlikely. In fact, a perfect bill would have presented HFC members and outside groups with an existential crisis, since their fundraising efforts depend on stoking a permanent sense of grievance with the government. Every single member of the Freedom Caucus knew darn well the math of reconciliation vs. overcoming a filibuster, and the political concessions necessary to make repeal and replacement a reality; they simply had no intention of getting anything done, because not getting anything done is what they live for. Ideologically, I am in near-complete agreement with them, yet I find contemptible the manner in which they exploit others who share their beliefs for their own fundraising objectives, and what the vast majority of them are willing to let get done and willing to let not get done for their own political gain.

Now, they have beaten Trump badly, and yet remain no closer to enacting any of their agenda. Heads no one wins, tails we all lose.

On the other hand, there is what this bill itself reveals about the state of our politics more broadly. I adore my friends who complain that we are acting as if health care is a right. I get the angst over the establishment of a new “entitlement.” I find the idea of waiting to sign up for insurance until one gets sick mathematically preposterous. And I also recognize the coverage of pre-existing conditions does require a risk-pool methodology to be made fiscally sustainable. But if we believe that, as a political matter, our society will tolerate roughly 10 million people losing coverage overnight, we live in a fantasy world. There was never, ever, ever going to be an unwinding of Obamacare that made everyone happy; even if we manage to get rid of it, it’s unpleasant aftereffects will linger. I don’t like it any more than you do, but I don’t deny its reality.

The worst part of all this is that President Trump stands revealed as something less than the magical wand-waving, deal-making savant his supporters built him up to be. To anyone who has been paying attention, this was already obvious: In reality, he has thus far mostly gotten played like a fiddle, and currently looks weak, ill-prepared, humbled, naive, and silly. His charm offensives have fallen flat. His threats have been batted away like flies. The narrative that I have heard from Trump supporters ad nauseum — that he is a businessman who “gets things done” — fell apart so badly when faced with its first test, and their response was . . . to blame Speaker Paul Ryan in the most cowardly way imaginable. To be sure, Trump himself has done the exact opposite of his base, reiterating over and over again that the AHCA’s failure was not Ryan’s fault, that they support him, that the White House supports him, and that he was implementing the agenda the president gave him to carry out. Trump very well could have taken the highly disingenuous way out and tried to blame “GOP leadership” for this; he hasn’t, and for that I give him a lot of credit. But any objective reading of the facts reveals that Trump’s cabinet wrote this bill. He campaigned repeatedly on the idea that coverage for those up to age 26 and coverage for those with pre-existing conditions would not be rescinded. He told Ryan that the bill must not result in millions losing coverage. He set the parameters of the bill, and Ryan took them into committee and constructed a proposal that eliminated hundreds of billions of taxes, de-funded Planned Parenthood, and did a lot to improve the wretched conditions thrust upon us by the ACA. The result was, of course, deeply flawed in other ways, leaving much to be desired on the questions of mandates, regulations, and Medicaid.

In the big picture, it was a strategic mistake to start with health care. Trump promised that within minutes of taking office he would fix everything wrong with America, and an unusually naïve voting public believed him, just as it believed Obama’s promises in 2008. Coming into office, recognizing the election was already won and no one really thought Obamacare would just be repealed and replaced with the stroke of a pen, the President and the GOP would have been far better served to start with corporate tax cuts, which they’ve now turned to as a plan b in the wake of the AHCA’s failure. An initial win — any initial win — would have built political momentum for repeal-and-replace, not to mention Trump’s other priorities. The low-hanging fruit of corporate tax cuts would have set the table for more complex tax reform later, and also for a more constructive approach to health care.

Many of my friends have an optimistic take on all this. They argue that Trump will learn from the bill’s failure and that he still has plenty of time to implement the rest of his agenda. I do not disagree — there is time, and there are lessons that may be learned. But if I were a betting man, I would say the president will learn the wrong lesson from this, which is that it’s easier to play ball with Democrats than with the Freedom Caucus.

The messianic status accorded Trump by his supporters was always dangerous; now it has been discredited. Those of us who love country and cause should pray that it becomes a distant memory, that the actual work of thoughtful governance is about to begin, and that policies that advance the causes of growth and freedom will ultimately win the day.

— David L. Bahnsen is a trustee of the National Review Institute and the founder and chief investment officer of The Bahnsen Group, a wealth-management firm in Newport Beach, Calif.