Like many Republicans, Donald Trump’s position on health care is difficult to identify. “Obamacare is a disaster” is the lodestar of his public stance, but what to do about it, when, and whether the people who use it should be thrown off are questions he has never answered in a consistent way. In recent days, as Republican senators have begun to defect from the GOP leadership’s plan to repeal the law without any replacement, some of them resorted to openly pleading with the president-elect to come out and say what he wants to happen. (“If it is his view, it would be really good if he would consider tweeting it out very clearly,” begged Senator Bob Corker.)
In a new interview with the New York Times, Trump continued to say things that make no sense. Trump stated that the Senate must repeal Obamacare “probably some time next week,” and that “the replace will be very quickly or simultaneously, very shortly thereafter.” That is completely impossible. It takes months to design a comprehensive reform plan for one-seventh of the economy, even if you have a party committed to a shared vision. And Republicans aren’t remotely committed to a shared vision: They’re promising wildly different things, from covering everybody (a promise they have no way to pay for) to a bare-bones dog-eat-dog free-market system where the poor and sick are mostly left on their own.
The one explicable element of Trump’s comments is his claim that Senate Democrats can be forced to vote for a Republican plan:
“It may not get approved the first time, and it may not get approved the second time, but the Democrats who will try not to approve it” will be at risk, warning that “they have 10 people coming up” for re-election in 2018. That alluded to Democratic senators in states he won.“I won some of those states by numbers that nobody has seen. I will be out there campaigning,” he said.
This is a crazy position, but it is at least explicable. Here is what Trump is saying. Republicans can defund Obamacare with 50 Senate votes, but creating a new plan requires 60. This is why Republicans want two votes: a partisan vote to repeal, requiring only Republicans to pass, and then a bipartisan vote to replace it. Trump is saying that he believes he can pressure at least eight Democratic senators to join in supporting a Republican plan to replace Obamacare.
But unless he’s prepared to offer Democrats extremely generous terms, they have no incentive to go along with such a plan. The details of any health-care reform are inevitably unpopular, as they require disrupting the status quo. And the details of Republican plans are especially unpopular, since they entail forcing people into extremely stingy health-care plans with huge deductibles, and unaffordable costs for older or sicker people. (Republicans have finessed this problem by attacking Obamacare from the left, for having too-high deductibles and premiums and narrow networks, but their alternatives all go much farther in that direction.)
Meanwhile, having (supposedly) voted already to repeal Obamacare, the clock will be ticking toward the meltdown of the individual insurance market. So costs will be exploding. Doctors, hospitals, and insurers will be nervous or apoplectic. And in this atmosphere Trump believes he can lay the blame on Democrats for refusing to sign on to some Republican plan that would raise lots of peoples’ premiums. That scenario would be fanciful even if Trump were an unusually popular president, when in fact he is already an historically unpopular one with an approval rating in the 30s.
This strategy is basically nuts — Republicans will blow up the health-care system and bet that the public will blame things on the party that’s out of power, which is completely at odds with how public opinion works. But that is the only path to actually replacing Obamacare with some kind of right-wing alternative that any Republican has managed to come up with. And it’s the plan Trump is going with. Today, anyway.