Donald Trump, the great negotiator, failed to talk Republicans into voting for a Republican health-care bill. A few thoughts:
One, Trump’s reputation as a maker of great deals has been oversold. Replacing decades of bad health-care law and bad health-insurance policy with something that is market-oriented — while also addressing the risk aversion of Americans worried by the unpredictable nature of health insurance and health-care costs — is, as it turns out, not very much like negotiating a zoning variance in Atlantic City.
Two, Trump still doesn’t seem to understand this. Reactions to Paul Ryan’s opening gambit on health-care reform were pretty negative. Trump insisted that “we’re going to have tremendous support.” Speaking about congressional Republicans, he said, “I’m already seeing the support not only in this room, I’m seeing it from everybody.” He was wrong about that. Bluster only goes so far when the campaign is over, and Trump doesn’t have what it takes to bully conservative representatives from safe districts in Texas and Oklahoma into voting for legislation that doesn’t meet their standards. He doesn’t seem to have done enough thinking about the basic policy questions to really even understand what those standards are. Congressional Republicans would do well in the future to assume that the president’s only real role in health-care reform is going to be signing the bill in a big, beautiful Rose Garden ceremony.
Three, Republicans — incredibly — haven’t figured out what they want. Sean Hannity, on his radio program this afternoon, faulted Republican health-care reformers from failing to consult “the best and brightest” at the Washington think-tanks and policy shops, i.e. the very “Establishment” that he and Trump and other conservative populists have been raging against for more than a year. The course of action that will provide conservative populists with their cherished moment of closure — “Ding dong, Obamacare is dead!” — is different from the course of action that will create a consumer-oriented and market-driven health-care regime that is popular not only among true believers but also in the rather larger demographic of Americans not working at Cato or AEI. Maybe next time around they should try sorting that out before offering the bill.
Paul Ryan has an impossible job. But it is his job, and it is going to be up to congressional Republicans to provide the real leadership on this issue.
But this is not the first time a bill has failed. And it was not a very good bill. Republicans still have time to do better, if they can figure out what exactly it is they actually want to do.