Risky busi­ness: Trump’s art of the health-care deal

The Washington Post Sunday - - SUNDAY OPINION - KATH­LEEN PARKER kath­leen­parker@wash­post.com

In a week that felt like a month, Amer­i­cans got a clear view of Pres­i­dent Trump’s govern­ing style and also of his fa­bled deal­mak­ing ap­proach. Or rather, I should say, Trump got a good sense of what govern­ing is like — hard, hard, hard. And it’s bound to get more dif­fi­cult given the pres­i­dent’s tac­tics of con­sent: Do as I say or you’re dead to me.

Even bolder, Trump told con­gres­sional Repub­li­cans that if they didn’t pass the Amer­i­can Health Care Act to re­peal and re­place Oba­macare, he was fin­ished. Done. He’d walk away and move on to other things, he told re­cal­ci­trants. (To per­haps a new re­sort project, many were over­heard pray­ing.)

House op­po­si­tion to the health-care bill came both from mod­er­ates, as well as from hard-core, mar­ket purists, no­tably the Free­dom Cau­cus. The lat­ter didn’t want Oba­macare Lite. They wanted oblit­er­a­tion. As ne­go­ti­a­tions con­tin­ued un­til the vote was called off Fri­day af­ter­noon, the path to re­form be­came in­creas­ingly mud­dled — and the way for­ward more com­plex. Fix­ing health care was never go­ing to be a one-off.

But Trump, who promised re­peal and re­place (as has nearly ev­ery Repub­li­can the past seven years), has no pa­tience with process. As the chief ex­ec­u­tive of his own com­pany for most of his life, and not­with­stand­ing his rev­er­ence for his deal­mak­ing skills, he prefers quick re­sults. And, hey, if things don’t tum­ble his way, well, there are other greens to sow and mow. And, cer­tainly, a 30-foot wall to build.

To the 60-day pres­i­dent, it seemed, get­ting health care out of the way was mostly a means to check­ing a box — an im­por­tant one, to be sure — but noth­ing to be­stir his per­sonal pas­sions. Call it ego. Call it pride. Call it a day, but get it done, he com­manded. Or else: “I’m gonna come after you,” Trump told Rep. Mark Mead­ows (R-N.C.), one of his fiercest foes in the Free­dom Cau­cus op­po­si­tion. The pres­i­dent was jok­ing around, ac­cord­ing to those present, but Mead­ows still might want to keep a close eye on his fa­vorite bunny.

As many have ob­served, Trump’s spin of the wheel was risky busi­ness. He gam­bled on his own power to per­suade (or bluff), the re­sult of which could leave him hold­ing Oba­macare and con­ced­ing fail­ure. What, then, do Repub­li­cans tell their base? And what would this say about the party in power? After years of harp­ing on the col­laps­ing health-care plan in­stalled by Pres­i­dent Barack Obama and the thenDemo­cratic con­trolled House and Se­nate, they had their op­por­tu­nity to gov­ern re­spon­si­bly.

You’d think seven years would be am­ple time to cob­ble some­thing to­gether that could re­place Oba­macare. The fact that Repub­li­cans didn’t con­firms that such an over­haul re­quires the time and pa­tience Trump and Co. haven’t been will­ing — or able — to spare. What we saw th­ese past sev­eral weeks, mean­while, was a fran­tic race to pass some­thing vir­tu­ally no one rec­og­nized as a work­able piece of leg­is­la­tion, and which the Se­nate would prob­a­bly re­ject.

Back in 2010, when then-House Speaker Nancy Pelosi (D-Calif.) said that Oba­macare had to be passed so that we could find out what was in the bill, Repub­li­cans guf­fawed — and never let her for­get it. At least, one ob­serves, the Democrats had a bill. GOP leg­is­la­tors have been rac­ing to pass some­thing that isn’t fully writ­ten yet.

What’s with the rush, any­way? Why not take the time to get things right? While Democrats so­licited in­put from ex­perts in the med­i­cal, phar­ma­ceu­ti­cal and in­sur­ance in­dus­tries, Repub­li­cans have spent most of their time fight­ing among them­selves. The re­sult­ing bill was a patch­work of mar­gin scrib­bles and cross-outs, even in­clud­ing in­struc­tions to the Se­nate to fig­ure out ways to make cer­tain parts work. And the rush was mere drama. Thurs­day, the orig­i­nal dead­line for the vote, was the sev­enth an­niver­sary of the date Obama signed the Af­ford­able Care Act into law.

Once that dead­line passed, Trump be­gan act­ing like a child who didn’t get to have his birth­day party on the pre­cise day of his mirac­u­lous de­liv­ery into the glare. For­get it. I don’t even want a party now.

The truth is, many Repub­li­cans never se­ri­ously thought Oba­macare could be re­pealed and re­placed, prob­a­bly for the good rea­son that it’s nearly im­pos­si­ble to do. The most sen­si­ble so­lu­tion was to fix what was al­ready in place un­til the in­evitable day, com­ing soon, when we be­come a dual health-care sys­tem: Sin­gle-payer for the ma­jor­ity of Amer­i­cans and concierge health care for the wealthy. It’s just a mat­ter of time.

JABIN BOTSFORD/THE WASH­ING­TON POST

Pres­i­dent Trump pauses while speak­ing in the East Room of the White House on Fri­day.

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