Trump, Healthcare and the Art of the Botched Deal

Bill Powell

When Donald Trump was growing up in Queens, the local baseball team, the New York Mets, was the lowliest franchise in the National League. The Mets were so bad that the manager, Casey Stengel, once famously asked of his team: can’t anybody here play this game?

That’s the central question now in Donald Trump’s Washington. On Friday afternoon, the House GOP leadership pulled its bill overhauling Obamacare rather than experience a humiliating defeat. For seven years, Republicans have called for repealing and replacing Obamacare. They passed legislation doing so (knowing then President Barack Obama would veto it). Donald Trump campaigned on repeal and replace, frequently calling Obamacare a “disaster.” During the transition, his people let Paul Ryan and company know that health care would be among their first priorities. The Republicans had time, their policy wonks had plans, the administration had installed a brainy physician and congressman—Tom Price—as secretary of health and human services; they controlled both houses of Congress, and they had the White House.

What could possibly go wrong?

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President Trump reacts to the AHCA health care bill being pulled by Congressional Republicans before a vote as he speaks about the bill in the Oval Office. REUTERS/Carlos Barria

Trump’s presidency is undergirded by two fundamental conceits: that he is a consummate dealmaker and a “winner,” who upon winning the White House, would usher in a new era of American victory. (“We never win anymore folks, we never win…’’ Trump would always say on the stump.)  

The healthcare debacle has destroyed both of those conceits. Trump’s deal making skills were not sufficient to persuade enough members of the GOP’s Freedom Caucus to support the bill. Mainstream Republicans—and some Trump advisors at the White House—are furious at this crew. They are viewed as legislators who simply don’t exist in what Washington calls  the “real’’ world—a place where compromises are made and deals are inevitably cut—in order to get significant legislation passed. These are the same “whack jobs,” as one of their House colleagues puts it, who would have seen the U.S. default during the Obama years rather than raise the debt ceiling.  

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Which is to say, the group has a history, and both Trump and House Speaker Paul Ryan knew they had to do business with the caucus from the start. It was their job to craft a bill that would attract sufficient support to get through the House, while still satisfying the arcane rules that would have it allowed to be taken up under the “reconciliation” process in the Senate (which means it could pass with 51 votes and thus avoid a Democratic filibuster.) Conservative health care thinkers, even in the days before the vote, had mapped out plans that probably would have attracted sufficient Freedom Caucus support. (See, for example here.) That was the art of the deal that needed to be done.

Trump is said to be puzzled by what happened, because he did what he thought engaged presidents should do when pushing for key, legacy defining legislation: he cajoled, he threatened, he brought members in for pizza and bowling. He thought, in the words of conservative radio talk show host Hugh Hewitt, that he was going “full LBJ,” a reference to the legendary persuasive skills of the late President Lyndon Johnson.

But in this first “test of our ability to govern,” as Texas Representative Kevin Brady accurately described it, Trump failed. Ryan pulled the bill because Donald “The Winner’’ Trump was going to lose.

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What happens next is entirely unclear. White House spokesman Sean Spicer said earlier in the week there was no plan B. But now Ryan and the GOP health wonks need to dive back into the bill to see if they can salvage something that might pass, all the while dealing with the knock on effects of their failure (the deficit reduction that came with the repeal and replace bill, for example, gave the GOP some flexibility in fashioning a tax reform bill—which is supposed to be the next big act in Trump’s domestic agenda.) Now, a dispirited Ryan said on Friday afternoon, “we’re going to be living with Obamacare for the foreseeable future.”

When he arrived in Washington, many wondered whether Donald Trump could play this game. Just two months into his presidency, the answer is glaringly obvious: he cannot.

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