Terminal patient: Why Trump and GOP couldn't revive the health bill

In the end, the math was impossible—and so were the politics.

There was no health care bill that could pass the Senate, in part because President Trump insisted on a more moderate version that the most conservative Republicans wanted. And any tweaks that made the ill-fated measure more acceptable to the right risked hemorrhaging moderate support.

Some in the media are blaming Trump for not being more fully engaged—for instance, giving speeches devoted to health care. But he was certainly involved in persuasion—in fact, he had a group of GOP senators over for dinner Monday night as two others were about to defect—even if not at LBJ levels.

Some are blaming Mitch McConnell for doing the negotiating in secret and not allowing a single committee hearing.

Some commentators are blaming the Republican Party itself for vowing and voting to repeal ObamaCare for seven years, only to have no workable plan when it really counted.

And some are blaming the Democrats for their unbroken wall of opposition, though the GOP did nothing do include them in the process—just as their party stiffed the Republicans in ramming through Barack Obama’s legislation.

But whatever tactical missteps were made, it came down to that old Washington adage: it’s extremely difficult to take away federal entitlements once they’ve been established.

ObamaCare remained highly unpopular until the threat of abolishing it became real. Many Republican lawmakers were worried that if they did pass the bill and millions lost insurance coverage, they would pay a heavy price in next year’s midterms.

In a Washington Post/ABC poll the other day, 50 percent preferred the existing law, while 24 percent favored the Senate bill.

The bill’s goals—smaller government, kill Obama taxes, abolish the mandate, slow Medicaid expansion, yet make sure 20 million-plus people don’t lose coverage—could never be reconciled.

Now McConnell wants to move to a repeal now/replace later vote, which turned out to be the president’s fallback position: “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!”

But it’s hard to see that going anywhere. If he couldn’t get 50 votes for the compromise bill, why would the holdouts want to do a straight repeal with the prospect of an ephemeral fix in the future?

The reaction on the right hasn’t been sympathetic to Republicans, who have been promising to kill the Obama law for seven years. National Review’s Rich Lowry, noting the previous repeal votes, accused the party of political bad faith:

“Winston Churchill said that nothing is so exhilarating as getting shot at without consequence. For Republicans, nothing was as exhilarating as repealing Obamacare without consequence.”

Townhall said the health care failure is “Giving Conservatives a Good Reason Never to Vote Republican Again”:

“Right now, the ship is taking on heavy water and the GOP seems incapable of getting this done without also getting bloodied, bruised, and beaten from their side of the aisle. It’s becoming increasingly more embarrassing by the day.”

Even Breitbart acknowledged the magnitude of the mistake: “Republicans in Congress wasted nearly seven months of the Trump administration–Thursday will mark seven months exactly since Trump’s inauguration–fiddling around with repeal and replace at the same time.”

And Drudge put it more succinctly: “MOST UNPRODUCTIVE CONGRESS IN 164 YEARS.”

The president also tweeted: “As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!” But is that really an option?

Politics, of course, never stands still. What seems like a calamity now could be a faded memory a year from now. If Trump and the Republicans can cut taxes and get an infrastructure bill, and the economy continues to improve, their standing could be much higher than it is now.

The question facing the president’s party is whether to work with Chuck Schumer’s party, with all the compromises that entails, or try again to govern using muscle alone.