I have a couple of major takeaways from the glorious failure of TrumpCare. The first is that while Trump and Ryan are both bad at their jobs, the failure of Republican health care anti-reform was was probably inevitable:
Many of the juicy postmortems have focused on failures of leadership on the part of President Trump and Speaker Paul Ryan. And, indeed, both seem in over their heads in ways that will complicate passing the Republican agenda going forward. Ryan’s alleged mastery of policy was revealed as a complete fraud, and Trump’s various efforts to persuade recalcitrant lawmakers were ineffective. But it’s extremely unlikely that even stronger leadership could have gotten a replacement for the ACA passed. The votes were never going to be there.
The reason the votes weren’t there is simple: The proposed legislation was unimaginably terrible. And this isn’t just because it was a hastily cobbled together mess that even wonks sympathetic to conservative health-care ends generally wouldn’t defend. The central problem is that taking health insurance away from more than 20 million people and making insurance worse and/or more expensive for those who retain it in order to pay for a massive upper-class tax cut is an idea with no popular constituency. To pass a statute that would directly affect the lives of many voters and was supported by less than 20 percent of the public would have been political suicide.
As University of California political scientist Paul Pierson has shown with extensive evidence, repealing major social programs is enormously difficult, even in political systems with fewer barriers to changing the status quo than the American one. The weak Republican leadership didn’t help, but particularly given the relatively small Republican House majority and the even narrower margin they had in the Senate, the AHCA was probably always destined to be stillborn.
This should give liberals a new appreciation for what Barack Obama, Nancy Pelosi, and Harry Reid were able to achieve when they passed the Affordable Care Act in 2010. Democrats needed the vote of each and every one of their 60 senators. That meant Reid and Obama needed the support of more than a dozen moderate Democratic senators from red states. But they also needed the plan to maintain support from liberal senators who were well aware that the ACA fell short of the universal systems common to other liberal democracies (even though it was a substantial improvement on the status quo). Last week’s GOP debacle is an excellent illustration of how quickly attempted compromises can unravel from both ends. Both the left and right of the Democratic caucus deserve a great deal of credit for holding together under intense pressure to give up in 2010.
The quick collapse of TrumpCare portends very serious short-term problems for the Republican caucus, who appear likely to accomplish less than many people (including me) anticipated. Does this mean that this Republican coalition is doomed? I don’t think so:
From a Democratic standpoint, the optimistic take would be that this trainwreck represents a GOP coalition in its death throes. Just as the repeated failures of the Democratic Party to reach a consensus and enact its agenda under Jimmy Carter signaled the collapse of the New Deal/Great Society coalition, the failure of Trump and Ryan to execute what has been a rallying cry for Republicans for seven years could signal the cracking up of the Reagan coalition.
This is certainly possible. But I think reading a major realignment into the failure of RyanCare would be premature. I think it’s more likely that, despite this failure, the Reagan coalition will remain resilient. Comprehensive health-care reform has always been extraordinarily difficult. Harry Truman’s proposal for national health insurance never got off the ground, but this didn’t mean the New Deal coalition was dead. The failure of Bill Clinton’s health-care plan, which was similar in some ways to the failure of the AHCA, although the process was much more serious and protracted, did not end the liberal aspiration to attain universal health care. And given the extent to which both Congress and state legislatures are structurally titled in favor of the Republican Party, they have little incentive to moderate despite this failure.
The Democrats just won a major battle. But the war is still on.
The failure of the Freedom Caucus to play ball is a product of our current polarization, combined with the structural advantages Republicans have in national elections. Most Republicans, including virtually all of the most right-wing elements in the House and Senate, have completely safe seats, and the party can win national elections with a relatively homogeneous coalition. The leadership has no real leverage over the far right, so they can render the government dysfunctional if they want to — and they do! — but (unlike Republicans during the New Deal or Democrats after the election of Reagan) the party has no real incentive to move to the center because it was almost always be competitive in House elections and in a majority of statehouses, and it’s nearly impossible for any major party to be permanently shut out of the Electoral College. And, in addition, if Republicans get hit by a wave in 2018 it will be whatever moderates are left and not the Freedom Caucus that pays the price. So I see the failure of TrumpCare as a reason to be more optimistic in the short term, but not necessarily in the medium term.