Commentary: Mr. President, ditch this health care bill

What could be going through President Trump’s mind right now, as he embraces the health care plan his allies have been careful to remind us Paul Ryan is responsible for?

Perhaps, with Tom Price whispering in his ear, he genuinely believes the bill is the best, or only, way forward on health care. Another possibility -- we’re still in Trump’s sounding-out phase, and he’ll drop the thing as soon as it becomes clear that it’s landed with more than a passing thud.

The latter looks like the more attractive option by the day: The bill, as crafted, is bad politics and, more importantly, bad policy. Republican opposition in Congress could sink it. The critiques from right-leaning policy mandarins like Phillip Klein and Avik Roy have been devastating. Over at Bloomberg, Megan McArdle makes a compelling conservative case for why Ryan’s plan is worse than Obamacare. “The incentives intended to keep the individual market sustainable were already failing, and the Republican plan weakens them still further,” she writes.

The Kochs don’t want it; Heritage and Cato and all the Big Conservative think-tanks and action groups don’t want it. Ditto the AARP and the American Medical Association, not to mention every left-leaning policy shop. It seems that just about everyone who knows anything about health care policy in America, with the exception of Dr. Price, thinks this plan is nothing short of awful.

There’s a scenario where the Ryan bill triumphs anyway, one in which tea-party conservatives, deciding they fear the White House more than the Kochs, decide to drop their opposition and let the plan pass the House. That still leaves the Senate, but if Trump should somehow strong-arm this turkey through all of Congress, he’ll get some applause from pundits for his ability to do so.

But what then? Say Trump passes this thing, this dud, larded-up with Ryan’s tax cuts for the wealthy – what does he get then? Another unloved insurance regime, that’s what, which will need its own painful rescuing soon enough.

So why doesn’t Trump just ditch the Ryan plan? Yes, it will cause some embarrassment now that he has sent his surrogates out to say he supports it. And Ryan, of course, will be apoplectic. But if Trump is going to be a successful president, he’s going to need to relearn why he was elected in the first place. Hint: It wasn’t to make Paul Ryan happy.

The sweet spot for Trump politically is embracing an economic agenda that’s a bit left-of-center while governing as a cultural conservative. That is, in so many words, the disruptive message that carried him through the Republican primaries and the general election.

And this is where Trump will still have to part ways with the conservative orthodoxy surrounding health care and its fetish for “free market” solutions. Trump was, after all, the fist major Republican politician to figure out that GOP voters like big government, and that there is no constituency for Medicare reform. His political instincts are shrewd, which makes it hard to believe he’ll keep pushing a bill that hurts voters in the counties that voted for him disproportionately.

From a purely political standpoint, the biggest problem with Ryan’s plan is not that it’s too left, as the conservative wonks insist, but that it’s not left enough. Why should a health care plan, as Ryan’s does, include tax cuts for the wealthy anyway?

On an instinctual level, it’s hard not to have the feeling that Trump intuits all this. In the Republican debates, he often spoke approvingly of the U.K.’s National Health Service, a view no doubt informed by conversations on his Scotland golf course. #NeverTrump conservatives may have hated it when he would insist he would not let Americans “die on the streets,” but Republican voters sure didn’t seem to mind.

Steve Bannon almost certainly understands all this as well, what with his big government dreams of a new New Deal and reindustrialization. According to reports this week, Bannon is very upset with Breitbart News, which he used to run, for coming out swinging against the Ryan plan. But you don’t really need to know all that much about Bannon or Breitbart to suspect that Bannon isn’t all that upset with the blowback. There is simply no way that this administration, with its competing fiefdoms, is fully on board with the Ryan plan.

In reality, it would not be that hard for Trump to quietly pull back support for the bill, either in private or in public, and watch it die. He could go out tomorrow and say that, on second thought, given the complexity of this process, it would be better to start from scratch. He could tell his voters that while he may not always be right, he’s always looking out for them, and any bill that hurts them won’t get his signature.

But then there’d be chaos! Well, sure, but chaos is where we are already, and voters will forgive it in the early days. We’re a long way from the 2018 midterms; a reversal by the president at this stage would be forgiven, if not forgotten entirely, by then. However, if Trump and the GOP push through the Ryan plan, which neglects the real problems of Obamacare in order to ensure a new round of tax cuts for the rich, they will be rightly punished by voters.  

So ditch the bill, Mr. President. Cobble together a new one. Pull together the voices that were shut out from the creation of this one and find something that respects public opinion in a country that may not love its government, but is awfully dependent on public services.

Perhaps that will require stalling on health care for a bit and moving on to other priorities, such as infrastructure or combatting the opioid crisis. Fine. It’s far better, politically and morally, for the White House to buy itself some time rather than to rush another bad health care bill through. 

In:
• Paul Ryan
• Donald Trump
• Health Care