Donald Trump has spent the bulk of his time in office livetweeting cable news, playing golf, and flirting with constitutional crises. During that time, he’s displayed an understanding of legislative procedure on par with the average fifth-grader’s command of quantum mechanics, and all the tact and message discipline of a stone drunk Archie Bunker.
Meanwhile, the Republican Party’s legislative agenda has gone nowhere. After seven years of promising to repeal Obamacare, and half a year of trying to, the GOP’s health-care bill was taken off life support this week — a loss that has discredited the party’s congressional leadership, and sown division in its ranks.
Many Republicans suspect there might be a connection between the president’s gross incompetence, and his party’s legislative woes. And they’re right about that — but only because a more competent president would have put less faith in Paul Ryan’s policy judgment.
To the extent that GOP lawmakers blame the president for Trumpcare’s untimely death, they do so on the grounds that he was a poor salesman for the legislation. This is obviously true: Trump called the House bill “mean” and “coldhearted”; undermined congressional leaders by publicly endorsing alternative legislative strategies without their consent; and put far more energy into convincing Republican voters that CNN is FAKE NEWS than into persuading them that the American Health Care Act would improve their lives.
But there’s little reason to think any president could have had much success in doing the latter.
Paul Ryan’s bill was the least popular piece of legislation in living memory. Its only coherent policy goal was to transfer resources away from health care for the poor and into wealthy investors’ bank accounts — a proposition that garners little support, even among self-identified conservatives.
Beyond its cuts to Medicaid and taxes, the bill made Obamacare’s benefits less generous, and its regulations of the insurance market less sweeping. But because the GOP leadership lacked policy imagination and feared gargantuan coverage losses, they retained the existing law’s basic structure. Which is to say: The GOP bill, in all its iterations, aimed to keep what people love about Obamacare — the technocratic complexity — while dispensing with all the things people hate about it — the excessively generous subsidies for middle-income families, excessively low deductibles, and needless guarantee that nonaffluent cancer patients won’t be priced out of chemotherapy.
And by “people,” I mean Avik Roy and his patrons.
There is virtually no constituency for the legislation Paul Ryan and Mitch McConnell aimed to pass. Right-wing Republicans are not interested in Obamacare lite, but in a fantastical free-market system that provides affordable health care to all through the beneficence of the invisible hand (or, failing that, one that lets the poor die, so that the rich may live their best lives).
Moderate Republicans, by contrast, just want to get out of the corner they’ve put themselves in by cynically opposing a law they have no coherent critique of, while hurting as few of their constituents as possible.
GOP voters, for their part, either believe in Ayn Rand’s utopia; or want the more affordable coverage Trump promised them; or have no strongly held views on health-care policy at all.
No Republican health-care bill could have satisfied all these factions — or, really, any of them. And what Trumpcare lacked in friends, it made up for in enemies, among them, hospitals, doctors, insurers, the disabled, the AARP, the existence of a nonpartisan Congressional Budget Office, and a critical mass of GOP governors.
Even the most competent physician can’t save a terminal patient. And Trumpcare was dying from the complications of its preexisting conditions from the day Paul Ryan birthed it.
But while Trump’s incompetence didn’t kill the GOP’s health-care bill, it did prevent him from aborting it.
Were Trump no more corrupt than your average president — and just as politically savvy and diligent — he might have recognized that his interests and Ryan’s were not aligned. Trump has no ideological commitment to shrinking the welfare state, or reducing government’s role in the provision of health care. He did not campaign on a promise to cut Medicaid, but on a pledge to make affordable, comprehensive health care universally available.
As unpopular as he was with the public at large on Inauguration Day, he boasted overwhelming support from his party’s rank and file — far more than Ryan or McConnell could claim. The past six months were Trump’s honeymoon — his opportunity to dictate terms to his party. He could have opened his presidency with an infrastructure stimulus, one that included funding for border structures that he could call “a wall,” and that was funded by a one-time tax holiday that encouraged corporations to repatriate their overseas earnings.
Sure, the House’s fiscal conservatives might have balked. But the bill would have enjoyed the support of big business, nativists, and the public writ large. A competent Trump could have made it politically untenable for congressional Republicans not to play ball — while, simultaneously, dividing the Democrats against themselves. The great fear of Team Blue’s red-state senators, circa December, was that Trump would start his presidency by fixing America’s crumbling roads and bridges.
At the very least, Trump could have kicked things off with a middle-income tax cut, or a package of technocratic improvements to Obamacare. The president could have used his lying skills to brand such a bill as Obamacare “repeal” — while allowing the bill’s substantive virtues to attract Democratic votes. Then, he could have declared the kind of bipartisan, deal-making success that eluded his feckless predecessor.
Alas, Donald Trump is far too intellectually limited and lazy to dictate policy to his party — and far too corrupt to risk attracting Paul Ryan’s ire.
And, thus, his agenda was thwarted by the Republican Party’s incompetence.