Has President Trump already lost the health-care fight?
Even if the American Health Care Act becomes law, Trump will lose
Congress' push to repeal and replace ObamaCare is about to wallop working-class Trump voters. That's a terrible economic and medical problem for these voters, an enormous political problem for the GOP and President Trump, and an awfully dangerous democracy-destabilizing problem for the rest of us.
That the Republican Party may be willing to pass a bill, the American Health Care Act, that leads the total number of people covered by health insurance to drop by 24 million over the next decade, and all so that a small number of wealthy families can enjoy a sizable tax cut, is bad. But that they would pass a bill that inflicts considerable pain on the very voters who propelled Donald Trump to victory last November is far more than the cruel irony that some critics are saying it is. It's the political equivalent of throwing lit matches on a powder keg — an act that could end up blowing up core aspects of American democracy itself.
Trump won the Republican primaries and then the presidency because a significant portion of the American electorate is angry about the status quo over which both parties have presided in recent years. The anger these voters direct at the GOP has many sources, but among the most significant is frustration about the tendency of party leaders to talk like populists but pursue plutocratic policies that benefit rich donors while leaving most Republican voters behind.
Trump's populist appeals resonated with these voters because the candidate directed them at the leaders of his own party, and not just at the Democrats. The real estate mogul sounded like an (unlikely) champion of the long-suffering working class, which suggested that he might actually call the rhetorical bluff of party elites and govern like the populist he claimed to be during the campaign.
At times, President Trump seems to understand that this is the core of his appeal — when he talks about turning the GOP into a "workers party," when he denounces globalism, and when he promises to renegotiate trade deals, impose import taxes, protect entitlements, stop low-skill immigration, spend generously on infrastructure, and persuade CEOs to stop outsourcing jobs.
Whether Trump will follow through on these promises, whether doing so would actually improve quality of life for the white working class in a noticeable way, and whether any of it is compatible with his typically Republican (plutocratic) desire for cutting income taxes — all of this remains unclear. But regardless of the results, the very fact that these voters came together in support of Trump, helped to carry him over the finish line, and see him making an effort to help them is significant. For the first time in a long time, these angry, neglected members of the electorate have an outlet, a tribune, someone who's convinced them that their grievances are being heard and responded to at the highest levels of government.
Or at least they did until Trump decided to tie himself to House Speaker Paul Ryan's American Health Care Act.
Nothing we know about Ryan suggests that he cares about the bill's likely consequences for Trump voters — except in the completely abstract sense that his ideological certainties lead him to presume (without evidence) that showering the rich with tax breaks will automatically benefit everyone else. In the real world, cutting insurance subsidies and state Medicaid allocations will actually hurt a lot of the very people whose anger led them to support Trump in the first place. Some of these voters will lose the ability to pay for insurance, while others will end up without insurance when the ObamaCare exchanges collapse, as they're likely to do over the next year or so, in large part due to uncertainty and instability injected into the system by the GOP.
It would be one thing if Trump recognized how awful the GOP's plan will be for the very people he was elected to help and vowed to fight it. He could turn his ire on Ryan and the factions of the House GOP that support his plans or who think they don't go far enough in gutting ObamaCare. At least these voters would feel like their champion was going to the mat for them. They might even reasonably hope that the president would lead a charge to reform the GOP even further, by supporting "workers party" candidates to challenge Ryan and his ideological allies in the 2018 midterm elections. Such a shrewd, genuinely populist Trump might even come out in favor of a single-payer reform of the health-care system to provide security to American workers (as opposed to the greater health-care "choice" that very few outside of the House GOP's Freedom Caucus seem to be clamoring for).
But instead, Trump is pushing to pass Ryan's bill. That means he will own it — and if it passes and inflicts immense pain on these already angry voters? Then they will likely turn on the law and on Trump for supporting it.
Yes, it's bad to pass legislation that hurts millions of people. But you know what's worse? Passing legislation that stokes anger and resentment that could, in turn, end up blowing the whole system sky high. That's what Trump is doing by supporting this sadistic bill. He's risking cutting his own supporters loose, in search of a new, even more radical tribune who will finally put their interests first, no matter how many rich donors stomp their feet like spoiled children and channel cash to the Ryan wing of the GOP.
What might such a post-Trump populist be like? If we're lucky, he'll be a Bernie Sanders-style democratic socialist. But it could also be someone like Trump, only worse — someone who consciously weds nationalism and socialism to create a "national-socialist workers party." (If that sounds vaguely familiar, it should.)
We should all hope it doesn't come to that. But the fact is that Trump's foolish, reckless decision to screw over his already angry supporters is setting up conditions that will be ripe for further exploitation and radicalization over the coming years. That's very dangerous.
There are worse political possibilities than President Trump. Pray we don't encounter them.