It was a political drubbing of the first order. A new Republican president and a Republican Senate and House put everything they had into a bill to repeal and replace ObamaCare, and couldn’t do it. The leadership is rocked. The president looks confused and hapless, while publicly enacting determination and a scolding tone toward those who’d let him down. He rarely showed signs of fully understanding the details or even the essentials of the plan he backed. His public remarks were all over the place: He’ll let ObamaCare collapse of its own weight; he’ll replace it with something big and beautiful; just repeal it; no, let it collapse. He criticized Hill Republicans: They “never discuss how good their healthcare bill is.” But neither did he, not in a persuasive way.
Republicans on the Hill need a popular president with the quasi-mystical clout presidential popularity brings. Mr. Trump does not have it. They need someone who has a serious understanding of his own policies and can gently knock heads together. I remember the story of a GOP senator whose vote President Reagan badly needed. Reagan met with him privately, pressed hard, the senator squirmed: I just can’t do it, Mr. President. You know I’d jump out of a plane if you asked me, but—
Reagan leaned in and said: “Jump.” The senator laughed and gave up. I’m going to tell anecdotes like this until I feel better.
It is true that a central dynamic of the failure was the truism that once people are given an entitlement, they aren’t keen to see it taken away. But another reason some senators voted to repeal ObamaCare in the past and refused now is they believe the ground has shifted. Back in their home states, in the almost-decade since the economic crash of 2008, and since the Obama era, what they’ve seen is more need, not less, more anxiety and dysfunction, and more public skepticism that change will constitute improvement. In politics you have to know how to read the ground, the real topography. You can’t just go by the work of past mapmakers, you have to see clearly what’s there now. It’s unconservative not to.
As for Mr. Trump, the first six months of his presidency suggest many things, including that what made him is thwarting him. He is a man alone, independent and ungoverned. He freelances not because circumstances dictate it but because he is by nature a freelancer. He doesn’t want to be enmeshed in an institution, he doesn’t want to have to bolster and defend it and see to its life. He wants to preserve his freedom—to tweet, to pop off, to play it this way or that. One of the interesting things about his New York Times interview this week was that he met with the reporters alone save for his aide Hope Hicks. Afterward members of his own White House reportedly had to scramble to get tapes so they’d know what the boss said.
But presidential leadership involves being to some degree an institution man, upholding not only a presidency but a government, even its other branches. He doesn’t understand this. In any case he doesn’t do it. It is all a personal drama. This aspect of his nature will probably make further legislative failures inevitable. In time, though no one in the White House seems to fear this, it will lead to his diminished support. His supporters will likely never hate him, and won’t be severely disillusioned because they weren’t all that illusioned. They’ll probably always appreciate him for blasting open the system and saving them from normality—i.e., the dumb, going-through-the-motions cynicism of Washington. They are sympathetic because of everything he is up against—every established power center in Washington—with no one behind him but his original supporters.
But at some point baseline political competence is going to become part of the story. If the president continues to show he doesn’t have the toolbox for this job, he’s going to go from not gaining support, which is where he is now, to losing support. He’s not magic and they’re not stupid.
As for health care, Sen. John McCain, recovering from surgery, had it right: “One of the major problems with Obamacare was that it was written on a strict party-line basis and driven through Congress without a single Republican vote,” Mr. McCain said in a statement. “As this law continues to crumble in Arizona and states across the country, we must not repeat the original mistakes that led to Obamacare’s failure.” Congress, he said, must return to regular order, hold hearings, work across party lines, “and heed the recommendations of our nation’s governors.”
Mr. Trump should have done this from the beginning.
Is there any legitimate hope of a bipartisan solution? It can be fairly argued, as Jim Geraghty does in National Review, that a Democratic Party that relentlessly lied to pass ObamaCare—you can keep your plan, you can keep your doctor, premiums will go down—is unlikely to consider conservative reform ideas in good faith. Democrats will press to keep individual and employer mandates and the status quo on Medicaid; they’ll want billions in higher subsidies to get insurers back into failing exchanges. Some will want more money to offset larger-than-expected claims for insurance companies in the state and federal marketplaces, some will want single-payer. Mr. Geraghty: “Conservatives who oppose government mandates, subsidies, bailout and state-run health care won’t like any of that.”
And yet no fix or improvement in health care is going to be broadly accepted unless it comes from both parties. No reform will be accepted unless it’s produced in a way that includes public hearings in which representatives make the case and explain it all. And any fix, because of America’s current political nature, will be temporary. Democratic presidential hopefuls will be campaigning two years from now on single-payer, whatever happens with this bill.
And health care in battered, anxious America will continue to play against Republicans.
Sen. Joe Manchin, a West Virginia Democrat, beats the drum for the bipartisan approach. His logic: The ACA is wobbly; if nothing is done “prices will get outrageous and people will revolt and rebel.”
“Why inflict this much pain?” he says in a telephone interview. “The elderly, the vulnerable—you’re scaring the bejesus out of them.” The Republicans, he says, have tried everything else. “Why don’t you sit down and work with us?” He too asks for regular order.
Yes, he says, some Democrats see this as an opportunity to go for single-payer, but that would be “a big change”: “If you want to talk about that, do a working group.” For now, Mr. Manchin says, both parties should focus on Medicare, Medicaid, the private market, pre-existing conditions—issues on which quick or clear progress can be made. He notes that the Senate has 11 members who are former governors. As executive branch veterans with on-the-ground experience, they’ve learned what works and what doesn’t. They’re mostly moderate, not extreme. Get them in on this, he urges. “We still have some reasonable people here,” he says. “Some are just a little too quiet.”