Opinion

Will Trump's random outbursts kill the GOP effort to destroy ObamaCare?

Health care reform is a careful, painstaking process. Does that sound anything like Trump?

As a politician, Donald Trump is intuitive. He doesn't stay up late studying briefing books, or carefully craft messages with multiple layers of meaning. He gets in front of a crowd, throws some stuff out, and sees what gets a response. He jumps on Twitter and says whatever pops into his head. He goes by his gut.

Which is, you can argue, how he got to be president (or at least part of the story). But now that impulsiveness and desire to say whatever will produce applause could be the thing that undoes Republicans' plan to destroy ObamaCare.

Consider what Trump said on the topic at his Wednesday press conference:

It'll be repeal and replace. It will be essentially, simultaneously. It will be various segments, you understand, but will most likely be on the same day or the same week, but probably, the same day, could be the same hour.

So we're gonna do repeal and replace, very complicated stuff. And we're gonna get a health bill passed, we're gonna get health care taken care of in this country. You have deductibles that are so high, that after people go broke paying their premiums, which are going through the roof, the health care can't even be used by them because their deductibles bills are so high.

ObamaCare is the Democrats' problem. We are gonna take the problem off the shelves for them. We're doing them a tremendous service by doing it. We could sit back and let them hang with it. We are doing the Democrats a great service.

So as soon as our secretary is approved and gets into the office, we'll be filing a plan. And it was actually, pretty accurately reported today, The New York Times. And the plan will be repeal and replace ObamaCare.

We're going to have a health care that is far less expensive and far better. Okay. [Donald Trump]

That's essentially an incoherent string of sentence fragments from someone who obviously has only the vaguest idea about what ObamaCare might be, and — even more critically at the moment — what congressional Republicans are doing or are worried about when it comes to this topic.

Republicans have an impossibly delicate task to perform here, one that presents so many profound political risks that seven years since the law was passed they still can't quite figure out how to accomplish it. They first thought they could do something called "repeal and delay," wherein they'd repeal the ACA with a delay of a couple of years, then use that time to figure out what they want to replace it with. That got so much pushback — including the assurance that it would cause the individual health insurance market to collapse pretty much right away — that they seem to have abandoned it.

So they'd rather have a replacement plan ready to go right along with repeal, but the problem there is that they can't agree on one. As they wrestle with the upheaval they're about to initiate and the tens of millions of people who are going to be screwed over by repeal, they're almost paralyzed with fear. What to do about the millions who will lose coverage, the millions who will lose security, the PR nightmare that will ensue? Will the GOP base tolerate them working it out over the course of months or years, or will they demand immediate action? Are they going to need to eliminate the filibuster to overcome Democratic opposition? What happens when they unveil their plan and people discover that not only won't they alleviate those unpopular deductibles, they're actually going to increase them, by design? Can they survive the political blowback?

These are incredibly difficult questions, and if Republicans manage to answer them, it will only be with a fragile legislative house of cards, one vulnerable to even the slightest breeze of opposition before it comes tumbling down. Now along comes their president, shooting off at the mouth with no understanding of the substance or politics of the issue, threatening to destroy everything with an ill-considered remark or tweet, promising something they can't deliver — like a quick and easy legislative solution that gets wrapped up in a matter of hours — and raising hopes that will inevitably be dashed.

At this point it's almost hard to imagine that Trump won't screw this up for them. Throughout the campaign he promised that he would replace the ACA with "something terrific," not bothering to say what it was. And it was obvious that, as on almost every policy issue, Trump just couldn't be bothered with the details. It'll be great, believe me, you'll love it.

The biggest problem, though, is that health care reform involves tradeoffs. You want to cover everyone and give them comprehensive insurance? Sure, but it's going to cost a lot of money. You want to cut taxes? Okay, but that means you're going to leave a lot of people without coverage and lots of the rest paying out of pocket — bigly, as the president-elect would say. You may recall that during the Democratic primary eight years ago, Barack Obama and Hillary Clinton had an intense debate about this topic and which of those tradeoffs were acceptable. She insisted that an individual mandate was necessary, while he said it wasn't. But when the plan was written, he came around to her view, and the mandate is the only part of the ACA that's unpopular — but it's the part that makes the whole thing work.

Trump doesn't deal in tradeoffs. When he talks, he tells the crowd what it wants to hear, and the crowd wants to hear that they can have fantastic insurance that will barely cost a thing. All the stuff you like about the ACA? You'll still have that. Anything you don't like? Gone. It'll be no problem.

Not only that, what he says about it today has no relationship to what he'll say about it tomorrow. Whenever he says something new, congressional Republicans have to scramble to reconcile what he says with what they're trying to do. That makes their task even harder. It may just make it impossible.

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