Will Donald Trump Push the GOP Left on Health Care?

“We’re gonna have yuuuge government.”

At his first press conference as president-elect, Donald Trump shocked and awed: It is not every incoming commander-in-chief who denounces the U.S. intelligence community, declares CNN to be a “fake news” outlet, demands Mexico finance America’s infrastructure, and suggests that he couldn’t possibly have paid Russian sex workers to pee in front of him because he is a germaphobe.

Were most viewers not focused on this fusillade of authoritarian declarations and reality-TV provocations, Trump’s remarks would have been a bigger headache for the GOP — because when the president-elect strayed into the realm of policy, he tended to say things antithetical to his party’s agenda.

Early in the presser, Trump was rambling about all the jobs he’d already brought back to our shores, when he found himself denouncing the pharmaceutical industry.

“I think a lot of industries are going to be coming back. We have to get our drug industry coming back,” Trump said. “Pharma has a lot of lobbies, a lot of lobbyists and a lot of power. And there’s very little bidding on drugs. We’re the largest buyer of drugs in the world, and yet we don’t bid properly. And we’re going to start bidding and we’re going to save billions of dollars over a period of time.”

The Republican Party has a lot of ideas about how it would like to reform Medicare. Giving the government the power to negotiate drug prices is not one of them.

Minutes later, Trump said of Obamacare, “You have deductibles that are so high that after people go broke paying their premiums, which are going through the roof, the health care can’t even be used by them because the deductibles are so high.”

The GOP has a few half-baked alternatives to the Affordable Care Act. Virtually all would raise deductibles, not lower them. As House Republicans explained last year, high-deductible plans help patients “understand the true cost of care.”

And right before making the hallucinatory claim that there are 96 million unemployed workers in America (he was referring to adults outside the labor force, which is a different thing), the president-elect announced that his job creation plan would include “a major border tax on these companies that are leaving and getting away with murder.”

Republicans have reconciled themselves to a presidency free of new trade deals. But they have not made their peace with confiscatory tariffs on companies that buck the president’s nationalist policies.

Trump may take these heretical stances as seriously as he takes his pledge to send Mexico the tab for our border wall. Which is to say, these “policies” may be for promotional use only.

And yet, it appears that the president-elect is actually trying to follow through on two of his campaign’s left-of-center proposals: On Thursday, Trump’s transition team will meet with House GOP staffers to discuss his plans to subsidize child care and guarantee women six weeks of paid maternity leave.

According to Politico, Ivanka Trump is already lobbying for these proposals in meetings with female lawmakers.

It’s worth noting that Trump’s approach to social welfare is a distinctly conservative one. His child-care plan is composed entirely of tax breaks. And while he has floated the idea of expanding the Earned Income Tax Credit for impoverished families, the initial draft of his plan would do more to lower the nanny bills of millionaires than to provide day-care funds to the working poor. Further, by restricting his plan for parental leave to mothers, Trump’s most “liberal” policy reinforces traditional gender roles.

Nonetheless, forcing employers to provide female workers with paid maternity leave is a radical departure from the Paul Ryan playbook, as is popularizing the idea that the federal government has a responsibility to control child-care costs.

If Trump is willing to put muscle behind these proposals, it’s possible he’d be willing to push his party left on other issues. After all, he won the GOP nomination while vowing to preserve entitlement spending and establish universal health care. Trump may be fond of the GOP agenda’s spoonfuls of sugar (tax cuts that enrich him and regulatory changes that enrich his friends), but he has little interest in its medicine (unpopular cuts to social spending). And the president-elect’s authoritarian ethos is diametrically opposed to small government conservatism. Ronald Reagan claimed that the nine most terrifying words in the English language were, “I’m from the government and I’m here to help.” For Trump, the five most terrific ones may be, “I alone can fix it.”

What’s more, while there’s little support for price controls on pharmaceuticals among House Republicans, there’s plenty among the American people. A Kaiser Family Foundation poll from late last year found that 78 percent of Americans support new restrictions on high-cost drugs, while 86 percent want the federal government to secure lower drug prices for Medicare recipients through negotiation. Even among Republicans, both proposals enjoy strong majorities.

In an era of stagnant working-class wages and rampant inequality, laissez-faire conservatism doesn’t play that well outside the country club.

But even as Trump’s remarks Wednesday reaffirmed his instinct for government activism, they betrayed an astounding laziness that may render that instinct irrelevant.

The president-elect seems to have put less time into preparing for his press conference then he has into studying the ratings of the new season of The Celebrity Apprentice. His riff on “pharma” Wednesday appears to have been completely spontaneous, surprising both his party and the stock market. His comments on Obamacare repeal — which is to say, the single most pressing issue in American politics today — suggested that he still lacks a rudimentary understanding of the legislative process.

Trump said that Republicans could repeal and replace the Affordable Care Act within the same hour — and that an entirely new health-care system would be put in place before the end of 2017. The former proposal is highly unlikely, the latter, essentially impossible.

It’s hard to see how a deeply unpopular president — who is unwilling to study the basic mechanics of Congress — will be able to force his party to pass laws it doesn’t wish to.

Still, it’s possible that Republicans will turn left of their own volition. Once the GOP secures power, it tends to retain its interest in cutting taxes on the rich, but forget its concern with reducing the deficit. Under George W. Bush, the party increased entitlement spending by adding a prescription-drug benefit to Medicare.

The Republican Party may be more ideologically conservative today than it was then. But it has also spent much of the past seven years stoking anger about problems with the American health-care system that cannot be solved with conservative reforms.

Republicans oppose the ACA because it increased taxes on rich people and entrenched the idea that the government should guarantee Americans’ access to affordable health care. But conservative politicians know those complaints don’t resonate with the public. Very few Americans are outraged that government subsidies have rendered their deductibles artificially low, thereby hiding “the true cost of care”; a lot of voters are outraged that their deductibles are so high they can’t afford to see a doctor.

And so when Mitch McConnell made the case against Obamacare on Face the Nation last Sunday, his grievances were indistinguishable from Trump’s.

“What you need to understand is that there are 25 million Americans who aren’t covered now,” the Senate Majority Leader explained. “And many Americans who actually did get insurance when they did not have it before have really bad insurance that they have to pay for, and the deductibles are so high that it’s really not worth much to them.”

Donald Trump is not going to strong-arm the GOP into socializing medicine. But his disinterest in conservative ideology may enable his party to put the will to power over principle — and ditch its “terrific” plans for making health insurance less affordable and harder to come by.

Will Donald Trump Push the GOP Left on Health Care?