The Republican health-care crack-up

But it’s also true that Republicans could have done better. A presidential candidate who ran on a health-care plan might have been able to unify his party behind it in the process of winning the election. Trump, who has never shown much interest in health-care policy, was not going to be that candidate. During the campaign he had a brief outline of a plan that made little sense, and he dropped it in favor of letting the Congress come up with something. He consented to putting the bill at the top of the agenda even though he lacks interest in it, because he also has no serious legislative agenda on anything else. Ryan and McConnell, meanwhile, should have adopted a slower and more deliberate pace. The House Freedom Caucus, while it made some reasonable arguments against the leadership’s bill, leaned too heavily on its not being a full repeal. That was true, but a bill could have been a major improvement without meeting that description.

The party’s worst mistake on health care, though, would be to quit at the first sign of difficulty. Flawed as the bill was, it did help to bring the Republicans closer to a common policy. The most conservative Republicans accepted a tax credit, and the least conservative ones accepted a restructuring of Medicaid. Nothing is stopping the Republicans from spending the next year hammering out a bill that they like better, refining it as they go so that it enables more people to buy coverage they actually want.

Many Republicans, including President Trump, are rationalizing inaction on health care on the ground that Obamacare is collapsing as it is. Republicans have used this excuse before. But it’s not clear that Obamacare’s exchanges are collapsing, as opposed to performing badly. And if they are, it is all the more important to have legislation ready to limit the damage their failure can inflict on vulnerable people. Medicaid, meanwhile, is capable of continuing indefinitely to deliver poor results for the money spent.