The House Republican conference has unveiled a health-care bill that pleases just about no one. Ross Douthat, writing in the New York Times on Wednesday, described the “American Health Care Act” this way:
It’s a piece of legislation caught betwixt and between: It includes enough in the way of tax credits and regulation to be labeled “Obamacare lite” by the party’s would-be ideological enforcers, but it also promises to throw many people off the insurance rolls — many Trump voters included — for the sake of uncertain policy goals. . . . So it’s a bill that nobody on the right much likes: Not libertarians and not reformocons, not right-wing donors and not mushy moderates, not the Tea Party senators who promised full repeal and not the swing-state senators who well know that their own voters want the coverage expansion to endure. As for Americans who aren’t ideologically committed, forget about it: Passing the bill would be an invitation to a political beheading.
It’s difficult to explain charitably what is taking place. It’s not as if Republicans had cloaked their intentions toward Obamacare. House Republicans voted several times during the Obama administration to fully repeal the former president’s signature law. They passed dozens upon dozens of measures to cripple the law. Time and again, in no uncertain terms, they promised repeal and a better system — better than Obamacare, and better the regulatory patchwork that preceded it.
Nor was time short. The Affordable Care Act was signed into law seven years ago this month. There has been no lack of debate during that time about the best strategies for reform, policy-wise and politically. Republican legislators have proposed several alternatives, and they have had ample time to hammer out a pleasing compromise.
But something else has happened: Finally in control of the White House and both chambers of Congress, the GOP has proven gun-shy. Afraid of a strident reform that upsets anyone, they’ve put forward a timid reform that upsets everyone.
This is the kind of thing that happens when a party has no leaders. Under normal circumstances, that would be Donald Trump. But the president forged his path to the White House by unabashedly smashing certain conservative idols — not all of which needed wrecked — and alienating allies, and he has expressed little interest in figuring out how to marry his unusual electoral coalition’s interests to conservative principles. Erratic, undisciplined, and self-absorbed as he is, he is not well-equipped to envision, or shepherd, an agenda that can bridge that divide.
The Republican party doesn’t know what it believes right now.
And if the Republican president can’t lead the Republican party, who can? On key issues, such as immigration, House speaker Paul Ryan is out of step with the majority of his party’s voters, and he has not articulated a robust policy agenda that can appeal to those who found a champion in Trump; his “Better Way” agenda, for all of its merits, has no traction in the Trump White House. Senate majority leader Mitch McConnell is second to none in parliamentary subterfuge. But a leader of men he isn’t. What of the savior-senators of yore, Ted Cruz or Marco Rubio? The 2016 election exposed their opportunism. Ben Sasse is a thoughtful, articulate proponent of a civic republicanism of which we’re much in need. But his legislative record is sparse, and he has no obvious allies. Who else?
But, of course, this leadership crisis is at root a crisis of faith. The Republican party doesn’t know what it believes right now. If traditional conservatism is not selling, maybe it’s a lousy product — so goes the thinking. Donald Trump’s rise was not a cause but an effect of that loss of confidence; this bill is another.
That crisis can be overcome. What’s needed is not to dispense with conservative principles. What’s needed is the political imagination to adapt conservative principles to changing conditions in the lives of millions of Americans.
But that will be difficult, and it’s not at all clear that Republican leaders are up to the task.