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 once bragged that he was the only GOP candidate to promise not to touch Social Security, Medicare or Medicaid. He never would give particulars.
After Thursday's embarrassing failure to round up enough votes for passage of the GOP-sponsored American Health Care Act, the White House insisted 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 (such as 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?
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 really had no idea what he was doing.
Once in office, Trump still had no idea how to make good on his promise, so he delegated everything to House Speaker Paul Ryan and Tom Price, his health and human services secretary. Ryan never promised to protect Medicaid.
Trump promised something "wonderful" to members of his base, and Ryan gave them a right-wing fantasy plan.
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.
Editorial on 03/27/2017