U.S. President Donald Trump talks to journalists at the Oval Office of the White House after the AHCA health care bill was pulled before a vote, accompanied...
CARLOS BARRIA

On public policy, Trump combines ignorance and indifference

Updated
The day before the Republican health care plan collapsed, Donald Trump met at the White House with some of the bill’s House critics. As Politico noted, the president knew that the members had substantive concerns, but he didn’t care.
Donald Trump had heard enough about policy and process. It was Thursday afternoon and members of the House Freedom Caucus were peppering the president with wonkish concerns about the American Health Care Act – the language that would leave Obamacare’s “essential health benefits” in place, the community rating provision that limited what insurers could charge certain patients, and whether the next two steps of Speaker Paul Ryan’s master plan were even feasible – when Trump decided to cut them off.

“Forget about the little s**t,” Trump said, according to multiple sources in the room. “Let’s focus on the big picture here.”
This posture, not surprisingly, failed spectacularly. The “little s**t,” as the president called it, referred to the substantive details of the health care debate that stood between success and failure. But Trump was dismissive, in part because he knew effectively nothing about the policy he was trying to pass, and in part because he didn’t care to find out.

And it was the president’s indifference that ultimately contributed to the outcome. The Politico piece added that while Freedom Caucus members found Trump charming, “it became clear … that no serious changes were going to be made, because the president didn’t have sufficient command of the policy details to negotiate.”

It’s hard to overstate how frequently this assessment has served as a foundation that explains the failure of the GOP plan. We’ll talk a little later about the broader blame game, but as the dust settles on the Republicans’ health care collapse, perhaps the most important takeaway is that the party is proving itself completely incapable of governing, led by a post-policy president whose ignorance is standing in the way of his own agenda.

The New York Times’ David Brooks, noting Trump’s “lifelong indifference toward the mechanics of governance,” spoke to one House Republican who conceded the president “did not have the greatest grasp of health care policy or legislative procedure.” The New Yorker’s Ryan Lizza spoke to a GOP lawmaker who was less subtle: Republicans were generally astonished how “over his head” Trump was, understanding neither “the politics nor the policy” of the debate.

It’s not that Trump didn’t care about the bill’s passage, it’s that all he cared about was that a bill passed. It apparently never occurred to him to become fluent, or even conversant, in the details – of the legislation, of health care policy in general, in the legislative process, or really in much of anything.

It led to presidential appeals to lawmakers that combined superficiality with cynicism: vote for the bill, not because it would improve the lives of any Americans, but because it’d be good for him and party messaging. Trump wanted to be able to say something passed, without any regard for what that something entailed.

At one point in early March, Trump and Ryan spoke about the legislation, and the president said he had had a problem with the bill: Ryan had used the word “buckets” to describe the additional steps of health care reform that would follow this initial bill. “I don’t like that word buckets,” Trump reportedly said, preferring “phases.”

The House Speaker obliged, but the anecdote was telling: Trump’s focus was on branding and sales pitches, not how American families’ lives would be affected by the legislation he was purportedly eager to sign.

Nobody knew health care could be so complicated,” the president told governors in February, apparently annoyed by details that everyone but him were already aware of.

The challenge for Republicans, however, extends beyond their incurious leader in the White House. What GOP officials need to come to terms with is how this dynamic affects the entire party’s ability to govern. One Republican staffer on Capitol Hill last week said, “I’m starting to think that while we’re pretty good at winning elections, we’re not great at the whole governing thing.”

That’s not just some throwaway line; it’s an assessment that strikes at the heart of what ails contemporary Republican politics. Rep. Tom Rooney (R-Fla.) added, “I’ve been in this job eight years, and I’m wracking my brain to think of one thing our party has done that’s been something positive, that’s been something other than stopping something else from happening.”

According to Ryan’s remarks to reporters on Friday afternoon, Republicans serving in a governing position is still quite new, so little should be expected as the party finds its footing. That’s nonsense. The GOP won its House majority in the 2010 midterms. The party won the Senate majority in the 2014 midterms. Republicans have had plenty of time to start taking governing seriously; they’ve simply chosen not to.

Trump obviously deserves a great deal of blame for his failures on health care, but neither he nor his team wrote a ridiculous piece of legislation opposed by the public and practically every stakeholder in the health care system. That was done by House GOP “wonks” who also had no idea what they were doing.

The Washington Post’s Greg Sargent explained the other day, before the official collapse of the GOP bill, “The overarching problem here has been that the White House and Republicans never took the policy seriously and had utter contempt for the process.” Greg added that GOP leaders on both ends of Pennsylvania Avenue “thought they could render the policy specifics and procedural challenges meaningless through sheer force of bluster.”

By late last week, even leading GOP officials were lost as to what was in the bill, and whether those details mattered or not. The fact that roughly 200 House Republicans were prepared to vote for this monstrosity anyway – without hearings, a CBO score, public support, or any apparent policy benefits – only adds further proof of a party that’s abandoned the pretense that substance still matters.

Until the party comes to terms with why it failed so spectacularly, it shouldn’t expect to make progress on any aspect of its agenda, nor should it expect to be seen as a credible governing party.

Donald Trump, Health Care and Paul Ryan

On public policy, Trump combines ignorance and indifference

Updated