The Republicans had one job: repeal Obamacare. Since 2009, the American Right has been defined by its opposition to the expensive, messy, barely constitutional Affordable Care Act. Trump said that if he were elected, he would repeal and replace it "quickly." The voters gave him a Republican majority to do it. But when D-Day finally came, Trump choked. The vote was pulled from the House floor. Obamacare lives.
Trump benefits from this turn of events. If Obamacare had been repealed, poor and older whites would’ve been among those who would’ve suffered the most – Trump’s key constituency
But is Trump entirely to blame? Absolutely not. The Donald cannot take responsibility for the profound divisions in his party or the decline of good governance. These predate him by many, many years.
Trump has tried to blame the Democrats. That's outrageous. It's true that not one of them backed the Republican alternative to Obamacare, which some call Trumpcare - but the GOP has a majority in the House and should, theoretically, have been able to get it passed without outside help. No, the problem didn't lie with the Left but with the Right. All the years that the Republicans were united by opposition to Obamacare disguised the fact that they couldn't agree on what to replace it with.
The chief problem with US healthcare is cost. Prices are insanely high: for decades, the poor have gone without. Obamacare tried to address that by saying that everyone has to have medical insurance and the government will pick up the tab for those who can't afford it. The Republicans said that Obamacare meddled with coverage that the middle-class was quite happy with and drove prices up, so they pledged to repeal it.
However, once the state has instituted a massive new welfare programme it becomes very hard to undo: it means taking government money away from people who have come to rely on the support. And this moral question is at the heart of Republican divisions. Moderates say repeal Obamacare a little but keep the subsidies for the poor and old. Conservatives say that piecemeal repeal leaves the most expensive aspects of Obamacare in place - that only by getting government almost completely out of healthcare can America build a competitive private market that cuts prices. Nobody wants to hurt the poor in this debate, everyone has good intentions. But the differences between the principles and constituencies of various lawmakers are almost irreconcilable.
Enter Trump. On the one hand, the failure of Trumpcare is obviously an embarrassment to the great deal maker. Take this vainglorious tweet from 2014: “Deals are my art form. Other people paint beautifully or write poetry. I like making deals, preferably big deals. That's how I get my kicks.”
On the other hand, this is a defeat that fair-minded people cannot pin on The Donald. Divisions over Obamacare long predated Trump. The conservative Freedom Caucus, which was primarily to blame for the legislative failure, was a product of the Tea Party revolution and represents a militant, anti-big government attitude that any Republican president would’ve had trouble winning over. Do you think Mitt Romney – dismissed as a "Massachusetts moderate" in 2012 – would’ve done any better? No.
I could go one step further and say that Trump actually benefits from this turn of events. If Obamacare had been repealed, poor and older whites would’ve been among those who would’ve suffered the most – and that’s Trump’s key constituency. This way, Trump gets to keep them happy and, hopefully, move the congressional agenda on. That said, the White House had factored healthcare reform into its wider economic package. Yesterday, the administration told reporters that savings made by repealing and replacing Obamacare were intended to finance bigger tax cuts. How can Trump justify massive new defence outlays, tax reductions, an infrastructure revolution and a growing healthcare budget? It’s going to be difficult.
The Republican Party’s challenges are not unlike those faced by the Tories in Britain. They appear triumphant: they have a majority and the opposition is impotent. But they can’t entirely agree on what their core philosophy is – you’ll find libertarians, classical liberals, social conservatives in the mix – and the narrowness of their legislative majority grants those divisions real power. Most importantly, they are torn between the populist impulse to defend the welfare state and a rationalist impulse to tear it up and start again.
Trump on the campaign trail didn’t really offer America a “deal” in the sense of reconciling these two contrasting positions. It was a deal in the sense of offering everyone what they want – more spending, lower taxes, smaller deficit etc. This is an impossibility. Failure to deliver will only erode faith in government even further. So while Trump is not to blame for this debacle, he most certainly is not the cure for America’s sickness.