Donald Trump is wrong about a lot of things. But in his ongoing war of words with congressional Republicans, he’s right about one big thing — the failure of Affordable Care Act repeal efforts is fundamentally the failure of the Republican Party’s House and Senate leaders.
Republicans on Capitol Hill like to complain that on health care, Trump didn’t really understand the issue, wasn’t engaged with the substance, and didn’t do a very good job of marketing their plans. That’s all more or less true. But the larger issue here is that Republican leaders — both Mitch McConnell and Paul Ryan, as well as Ryan’s predecessor John Boehner, and the chairs of all the relevant committees — spent years and years lying to everyone in sight about Republican health plans.
Ryan’s “A Better Way for Health Care” document promises as its very first chapter heading that it will offer “High-Quality Health Care for All.” And congressional Republicans claimed — over and over again — that they had ideas on the shelf to replace the Affordable Care Act with a new program that would address the public’s main concerns with the law. In GOPtopia, premiums and deductibles would be lower, with more competition and lower copayments. Narrow networks would be a thing of the past too. All thanks to the magic of tax cuts and deregulation.
Trump believed Republican leaders
If that were true — or even vaguely in the neighborhood of being true — then it would have been really easy for concurrent Republican majorities to pass a law and for President Trump to sign it.
And while of course it’s easy for a political sophisticate to mock Trump for his naiveté on this point, at the end of the day his view that Republicans wouldn’t spend years claiming to have such a plan unless they actually had one wasn’t all that crazy. McConnell and Ryan don’t go around advertising themselves as huge liars, after all. In my experience, their staffers tend to get pretty angry if you assert that they are huge liars. Consequently, they’ve done a pretty good job of getting most media outlets to report on their health care assertions as if those assertions are not huge lies.
Not everybody believes them, of course. But there are certainly some demographic groups — white male senior citizens who watch Fox News are constantly high on the list — that are very prone to believing them.
Trump, of course, very much falls into that core audience for Republican Party spin. So when Republican leaders said over and over and over again that they had a plan to replace Obamacare with something better, Trump naturally developed the opinion that they had a plan to replace Obamacare with something better. And if they had had such a plan, it wouldn’t have been difficult to pass it. The legislation turned into a long, hard slog that Trump was unprepared to lead because nothing they said about their plan was even remotely close to true.
Republicans want people to have worse health insurance
The fundamental reality is that the Republican Party does not believe in providing people with generous social assistance.
GOP budgets would spend less on nutritional assistance, less on housing assistance, less on home heating assistance, less on Pell Grants, less on disability insurance, and generally speaking, less, less, less, less on everything the federal government does to try to support the living standards of the needy.
Health care is not an exception to that rule. So every iteration of Obamacare replacement that Republicans considered would spend less money on helping people get health insurance and consequently leave sicker people and people with higher financial needs worse off.
This is a legitimate issue to argue about — obviously the government can’t provide unlimitedsocial assistance across every possible dimension of human need. But in the specific case of health care, Republicans have struggled to find a politically defensible way to articulate their viewpoint. The idea that sick people should forgo useful care — or that healthy people should forgo preventive treatments — because they happen to not be rich enough to pay for it is not very popular, which is why they hit on the strategy of lying about it. That strategy paid enormous electoral dividends, but it eventually backfired through the election of a president who believed in the lies. But that is really much more Republicans’ fault than Trump’s.
Trump should stop whining and govern
Where Trump is at fault, however, is with his purely backward-looking view of this.
It’s true that GOP congressional leaders created this mess through their own dishonesty. It’s also true that they then proved unable to clean up the mess.
All that said, Trump is president now. On the campaign trail, he outlined some humane and politically popular ideas about health care policy like that Medicaid shouldn’t be cut and that the United States should have a system that covers everybody even if that means the government needs to pay for it. A responsible president would move beyond peevish anger at congressional Republicans for failing to help him fulfill that vision and start reaching out to people who can help him. McConnell and Ryan aren’t going to get the job done, but Trump’s failure to even try to work across party lines on health policy is staggering — and his anger at Republican leaders only makes it more glaring.