Last night’s epic collapse of Obamacare repeal on the Senate floor was the death knell for what has been, from the beginning, a highly disorganized and ineffective effort. Democrats, who deserve plenty of blame for the failures of the current health-care system, were undoubtedly wrong to refuse to even discuss reforming it. Republicans, meanwhile, promised for over seven years to repeal and replace Obamacare, and they had all of that time to craft a workable plan for doing so. Instead, they developed one that split the caucus into irreconcilable wings.
But the failures of the Senate do not excuse Donald Trump’s shameful lack of leadership throughout this process. With a more competent, more popular Republican president, some kind of agreement almost surely could have been brokered.
Trump has never once demonstrated that he had a concrete idea of the health-care policy he wanted his party to enact. To be sure, he put forward a written health-care agenda during the campaign, but he repeatedly failed to show that he knew the first thing about it — or even that he had read it.
Before the election, Trump’s contributions to the health-care debate were mainly limited to bombastic attacks on the “failing” Obamacare during rallies and interviews. His only suggested solutions were dissolving the “lines around the states” and funding entitlements by reducing “waste, fraud, and abuse.”
Once he became president, his understanding of the substance seemed to devolve even further. After vowing to repeal Obamacare on his first day in office — a promise he wouldn’t have made if he had even the vaguest understanding of the Constitution or how the three branches of government function — he has instead spent his time in office tweeting about Obamacare’s impending doom and the “great” and “amazing” health care that the GOP would give Americans.
His lack of knowledge and political capital became even more evident in March, as the House worked feverishly to pass its American Health Care Act, a bill that disappointed many Republicans, especially conservatives who wanted to see drastic changes to the regulatory structure of Obamacare. While House leadership frantically attempted to rally its members before a March 24 vote, Trump hosted a number of meetings with the holdouts. If they wouldn’t get on board, he said, the party would have to abandon health-care reform altogether. The result of this tactic? House speaker Paul Ryan was forced to cancel the vote at the last minute because too many congressmen still refused to support the bill.
Trump, who insists that he is the nation’s preeminent dealmaker, couldn’t broker an agreement to push the House bill over the finish line, despite having a huge GOP majority. He lacked the policy acumen and, with his low approval ratings, the political influence to convince Republican members to support the legislation. Instead of renewing his efforts to understand the nuances of health-care reform, Trump responded to this initial failure by, in essence, giving up. The House was eventually able to pass its bill, but with no help from the president, who mostly confined himself to posting threatening tweets about representatives who refused to get on board.
When it came time to push an even more unpopular bill through the Senate, Trump again came up short. He wasn’t even involved in the negotiation process, because he had nothing of substance to contribute and his dismal approval ratings precluded him from effectively leveraging any kind of power against senators who wouldn’t support the legislation.
If Republicans had even a marginally more popular president, the bill likely wouldn’t have been so unpopular. Instead, they have Trump. Not even the minority of Americans who approve of him were willing to support it. Very few Americans of any sort were: It had an atrocious 17 percent approval rating.
It was always clear how little substance lay behind Trump’s overblown, empty rhetoric, but this debacle is the latest evidence that anyone who expected substance and success from him was sorely mistaken. There is plenty of blame to go around, but last night’s failure proved how essential it is to have a president with public support and the ability to rally that support to achieve policy success.