Blame Donald Trump for the collapse of health care reform

Let’s be clear and up front: President Donald Trump is primarily responsible for this week’s collapse of Obamacare reform.

There are other suspects: Sen. Rand Paul, who demanded full repeal and would not compromise. And Senate Majority Leader Mitch McConnell, who cloaked reform efforts in single-party secrecy.

Moderates such as Sen. Susan Collins played a role, as did Sens. Mike Lee of Utah and Jerry Moran of Kansas, who drove stakes into the heart of the preferred reform bill Monday night.

And, of course, the liberal mainstream media. Might as well throw us in.

But the failure is Trump’s.

Not because the president lacks political or persuasive skills. On some days, he can be pretty convincing, at least among Republicans. And he clearly knows how to communicate with the public.

No. The health bill failed because the president is utterly uninformed about health care and has no desire to learn about it. When health care is the issue, Trump simply does not know what he’s talking about.

Normally, this would not be a fatal problem. No president can be expected to understand every detail of every policy — that’s why presidents hire smart people to give them advice.

But reforming nearly 20 percent of the nation’s economy requires the president to understand fundamental concepts and goals. He can then guide lawmakers through the thicket of policy options by keeping the focus on the ultimate results.

President Barack Obama’s health care reform goal was clear: Insure more people. There were long, difficult disagreements over how to achieve that goal. Mistakes were made. But the objective was understood.

What was Trump’s goal? Just repealing Obamacare? Some Republicans argued for that, claiming Americans would save billions of dollars in taxes and premium payments.

But that isn’t what Trump had in mind. He promised “terrific” health care coverage for every American, with more access and lower costs.

“We’re going to have insurance for everybody,” he said.

Trump promised to leave Medicaid alone. The House health care bill was mean — “I want to see a bill with heart,” he said.

He claimed reform would have to include coverage for pre-existing conditions, a goal nearly impossible to address without some type of individual mandate for insurance.

“Nobody knew health care could be so complicated,” Trump said in February. Then, in March: “It’s going to be so easy” to get health care “at a tiny fraction of the cost.”

No one with even a rudimentary understanding of health care policy would have said the things Trump has said during the past two years. His commitments have been contradictory as a matter of simple mathematics.

Health care reform is hard because it involves trade-offs: Some people have done better with Obamacare, others worse. The ACA has insured more people, but some pay much higher premiums. Some have gained access to care; others have lost it.

Obamacare addressed these problems one way, in order to cover more people. A replacement will address them another way, to save money. Either way, some people will be angry.

The president comprehends none of this. That has left members of Congress with the impossible task of cobbling together an overhaul package that tries to make everyone happy, including Trump, who doesn’t know what he actually wants.

Well, except for this: He wants to win. The specifics of the bill are utterly unimportant. He’ll sign anything.

At a Monday night dinner, the president said party members would would look like “dopes” if they failed to pass a health care bill.

There are hundreds of superbly talented Americans in both parties working on health care policy every day. They don’t agree on the answers, but they understand the questions.

They aren’t dopes. They sure know more about health care than Donald Trump.

This story was originally published July 19, 2017 at 6:43 PM with the headline "Blame Donald Trump for the collapse of health care reform."