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On health care, Trump descends deeper into incoherence

On health care, Donald Trump isn't just inarticulate; he's also completely lost when describing developments that the president thinks have already occurred.
Pedro Rojas holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare, before the February 15th deadline on Feb. 5, 2015 in Miami, Fla.  (Joe Raedle/Getty)
Pedro Rojas holds a sign directing people to an insurance company where they can sign up for the Affordable Care Act, also known as Obamacare, before the February 15th deadline on Feb. 5, 2015 in Miami, Fla. 

At face value, it's tempting to think the health care fight that dominated much of 2017 will not return in 2018. Senate Republican leaders, for example, who'll next week see their majority shrink from 52 members to 51, have already suggested they'd prefer to focus attention elsewhere.

But Donald Trump insists there's more work to be done. "We can make a great health care plan," the president told the New York Times on Friday. "Not Obamacare, which was a bad plan. We can make a great health care plan through bipartisanship."

Got it. So, what kind of plan does Trump have in mind? Here's the rest of his pitch from the same interview:

"So now I have associations, I have private insurance companies coming and will sell private health care plans to people through associations. That's gonna be millions and millions of people. People have no idea how big that is. And by the way, and for that, we've ended across state lines. So we have competition. You know for that I'm allowed to [inaudible] state lines. So that's all done."Now I've ended the individual mandate. And the other thing I wish you'd tell people. So when I do this, and we've got health care, you know, McCain did his vote. [...]"Now here's the good news. We've created associations, millions of people are joining associations. Millions. That were formerly in Obamacare or didn't have insurance. Or didn't have health care. Millions of people. That's gonna be a big bill, you watch. It could be as high as 50 percent of the people. You watch. So that's a big thing. And the individual mandate. So now you have associations, and people don't even talk about the associations. That could be half the people are going to be joining up. ... With private [inaudible]. So now you have associations and the individual mandate."

I've read this several times, and in each instance, it's hard not to marvel at the incoherence. Trump has never been able to discuss health care policy beyond a junior-high level, but his comments to the New York Times suggest the president's ability to speak about the issue in complete sentences may actually be getting worse.

What's more, Trump's claims suggest he's not just inarticulate; he's also completely lost about developments that the president thinks have already occurred. He insisted, for example, "[W]e've ended across state lines." He appears to be referring to an executive order that does not do what he thinks it does.

Trump added that "millions of people are joining associations" to get health care coverage. The actual number is zero -- the policy he's thinking of hasn't yet been implemented -- and he doesn't appear to have any idea what association plans actually are.

But to fully appreciate how amazing all of this is, note that in the same Times interview, Trump said he knows "more about the big bills ... than any president that's ever been in office.... I know the details of health care better than most, better than most." Referring to those who argue that he doesn't know the details of policy debates, the president added, "These are sick people."

They're really not. A Republican senator conceded over the summer, in reference to Trump, "His vocabulary on health care was about 10 words."

Vox's Ezra Klein added on Friday, "Over the course of reporting on the Trump White House, I have spoken to people who brief Trump and people who have been briefed by him. I’ve talked to policy experts who have sat in the Oval Office explaining their ideas to the president and to members of Congress who have listened to the president sell his ideas to them. I’ve talked to both Democrats and Republicans who have occupied these roles. In all cases, their judgment of Trump is identical: He is not just notably uninformed but also notably difficult to inform -- his attention span is thin, he hears what he wants to hear, he wanders off topic, he has trouble following complex arguments. Trump has trouble following his briefings or even correctly repeating what he has heard."

The more the president tries to disprove these assessments, the more he ends up confirming them.