On the one hand, the president has made clear that the Ryan bill must be the vehicle for repeal and replace, and that the consequences of failure would be severe. His rally planned for Monday in Kentucky (cue Rand Paul again) is designed to demonstrate the pressure he can exert on Republican holdouts.

On the other hand, Mr. Trump has wisely refrained from publicly committing to the specifics of the bill, instead using behind-the-scenes meetings to listen, negotiate, nudge. He has, to his credit, ignored all those putative allies telling him to ditch Mr. Ryan & Co.

Speaker Ryan is avoiding his predecessor’s mistakes, too. During the Obama years, Speaker John Boehner struggled to control his conference and the legislative process. True, Mr. Ryan is negotiating, but he’s also relentlessly driving the bill through the chamber. By Thursday, it had cleared three committees, with only three GOP defections. Next up is the Rules Committee, and then it comes to the floor. Mr. Ryan is banking on these deadlines to drive Republicans to make their final deals and then get behind the bill.

He also seems to understand his chamber’s outsize role here. The bill can pass the House only with conservative support. Once gained, that support will make it much harder for GOP senators to balk. Leadership will be able to focus on the demands of a much smaller number of skeptics, and Mr. Trump will be able to target his considerable powers on defectors.