During the presidential campaign, then-candidate Donald Trump said he would replace Obamacare with “something terrific.” In February, he assured us he was putting together something “wonderful.” He would cover “everybody,” he said in an interview with The Post. He once bragged that he was the only GOP candidate to promise not to touch Social Security, Medicare or Medicaid. He never would give particulars, other than to say he would allow insurers to sell plans across state lines (which has never been feasible since it involves the upfront challenge of setting up a network of doctors).
After Thursday’s embarrassing failure to round up enough votes for passage of the GOP-sponsored American Health Care Act, the White House insists the House vote on a bill that:
- Knocks 24 million people off coverage
- Increases the costs for many older, rural voters
- Removes requirements to include 10 basic items (e.g. pediatric care)
- Cuts Medicaid by $880 billion
- Is silent on selling insurance across state lines
How did this happen? How did the populist president who appealed to “the forgotten” men and women wind up with a bill that’s so harmful to his base, something that is aimed at cutting and de-federalizing Medicaid and giving huge tax cuts to the rich?
One is tempted to say Trump never intended to make good on his promises. Perhaps he always planned on betraying his base and was interested only in big tax cuts for the rich. The man who conned customers into buying inferior products (a “university” education, vodka, steaks) may simply have said whatever he thought people wanted to hear — with no intention of following through.
There is, however, a more nuanced explanation. Trump, he admits, never thought he would win the presidency. He never cared for nor developed detailed policies, because he saw the race as a giant media show in which substance was irrelevant. He never dreamed he would actually have to figure out what “terrific” insurance looked like. He was candid when he said recently that “nobody [i.e. Trump] knew health care could be so complicated.” He really had no idea what he was doing.
Once in office, Trump still had no idea to make good on his promise, so he delegated everything to House Speaker Paul D. Ryan (R-Wis.) and Tom Price, his health and human services secretary. Trump paid no attention, nor did Stephen K. Bannon (who helped birth Trump’s populist message but became obsessed with immigration and other matters). Ryan, of course, never promised to protect Medicaid. He told us that he had dreamed of block-granting it to the states since he was in college (!). Ryan was intent on re-privatizing health care (which was impossible because we have laws requiring people to be treated, and we have government-paid health care for the elderly and very poor) and slashing taxes (most of which had been put on the rich). Ryan was intent on using Trump to help push through an unprecedented rollback of an entitlement, a more radical goal than anything his party had ever tried.
Ironically, Ryan pulled a bait-and-switch — Trump promised something “wonderful” to members of his base, and Ryan gave them a right-wing fantasy plan. Ryan’s plan turned out to be in populist terms atrocious and exceedingly unpopular. In the latest Quinnipiac poll, it gets only 17 percent support.
Sure enough, Trump is beginning to blame Ryan, letting it be known that Ryan was the one who insisted on going first on health care. He might be accurate in fingering Ryan, but in that case, Ryan conned Trump. Had Trump paid attention (rather than fixating on a false claim that President Barack Obama had wiretapped him), cared one whit about policy or hired competent staff, he might not have gotten “played.” He can try to shift the blame to Ryan, but he has only himself to blame for getting trapped in the quagmire of health care.
