Trumpcare Collapsed Because the Republican Party Cannot Govern

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Republicans celebrating the House health-care vote in May. Photo: Mark Wilson/Getty Images

In 2009, David Frum, the former Bush administration speechwriter whose ideological apostasy was in its formative stages, met with conservative intellectuals to discuss the policy response to the great recession. Faced with evidence that only massive government action — a financial rescue coupled with fiscal stimulus — could have prevented a complete economic meltdown, one conservative made a startling confession: “Maybe it was a good thing we weren’t in power then — because our principles don’t allow us to respond to a crisis like this.”

The financial crisis is hardly the only issue for which conservative principles turn out to be incompatible with the practical demands of governance. (Climate change leaps to mind.) The collapse of the Republican plan to repeal and replace Obamacare is an especially vivid demonstration of the broader problem. The cohesion Republicans possessed in opposition disintegrated once they had power, because their ideology left them unable to pass legislation that was not cruel, horrific, and repugnant to their own constituents.

Donald Trump promised during the campaign that he would quickly and easily replace Obamacare with an alternative everybody would love. “You’re going to have such great health care at a tiny fraction of the cost,” he said. “It’s going to be so easy.”

One might dismiss this kind of rhetoric as a typical Trumpian boast. But the candidate was merely translating into the vernacular the somewhat more carefully hedged promises his party had made for years into terms in which they were meant to be understood. Paul Ryan’s “A Better Way” road map offered what it called “a step-by-step plan to give every American access to quality, affordable health care. … more choices and lower costs.” And why wouldn’t Republicans believe this? After all, Obamacare was, supposedly, a train wreck, a complete failure of design. It therefore followed that they could easily replace it without significant harm to anybody.

In truth, it was never possible to reconcile public standards for a humane health-care system with conservative ideology. In a pure market system, access to medical care will be unaffordable for a huge share of the public. Giving them access to quality care means mobilizing government power to redistribute resources, either through direct tax and transfers or through regulations that raise costs for the healthy and lower them for the sick. Obamacare uses both methods, and both are utterly repugnant and unacceptable to movement conservatives. That commitment to abstract anti-government dogma, without any concern for the practical impact, is the quality that makes the Republican Party unlike right-of-center governing parties in any other democracy. In no other country would a conservative party develop a plan for health care that every major industry stakeholder calls completely unworkable.

Every attempt to resolve the contradiction between public demands and conservative ideology has led the party to finesse it instead. That is why Republicans spent years promising their own health-care plan would come out very soon. It is why their first and best option was repeal and delay. And it is why they are returning to that option now.

The Trump administration might lash out at Obamacare by continuing to sabotage its functioning markets. They will find, however, that sabotaging the insurance exchanges will create millions of victims right away, as opposed to the luxury of delaying the pain until after the elections. The power to destroy remains within the Republican Party’s capacity. The power to translate its ideological principles into practical government is utterly beyond its reach.

Trumpcare Collapsed Because Republicans Cannot Govern