WSJ Editorial Board
House Republicans pulled their health-care bill shortly before a vote on Friday, and for once the media dirge is right about a GOP defeat. This is a major blow to the Trump Presidency, the GOP majority in Congress, and especially to the cause of reforming and limiting government.
The damage is all the more acute because it was self-inflicted. President Trump was right to say on Friday that Democrats provided no help, but Democrats were never going to vote to repeal President Obama’s most important legislation. And that’s no excuse. Republicans have campaigned for more than seven years on repealing and replacing ObamaCare, and they finally have a President ready to sign it. In the clutch they choked.
Speaker Paul Ryan and Mr. Trump worked together and to their credit to broker a compromise between the GOP’s moderate and conservative wings. Their bill worked off the reality that the U.S. health system has changed under ObamaCare and thus an orderly transition is necessary to get to a free-market system without throwing millions off insurance. The GOP also is a center-right coalition with competing views and priorities. The bill had flaws but was the largest entitlement reform and spending reduction in recent decades.
That wasn’t good enough for the 29-or-so members of the House Freedom Caucus who sabotaged this fragile legislative balance. When one of their demands was met, they dug in and made another until they exceeded what the rest of the GOP conference could concede. You can’t have a good-faith negotiation when one party doesn’t know how to say yes—or won’t.
The Washington chorus now claims Mr. Ryan made a mistake by leading with health care, and perhaps in retrospect he did. But he was responding to demands for immediate repeal by the same conservatives who later abandoned him. They wanted a repeal-only vote that had no chance of passing, which is why Mr. Ryan and Senate Republicans worked on the compromise of repeal and replace.
The critics assailed the bill as “ObamaCare Lite,” but the result of their rule-or-ruin strategy will now be the ObamaCare status quo, and Mark Meadows (North Carolina), Jim Jordan (Ohio), Louie Gohmert (Texas) and the rest own all of its problems. Please spare everyone your future grievances about rising health spending or an ever-larger government.
The grand prize for cynicism goes to Senator Rand Paul, who campaigned against the bill while offering an alternative that hasn’t a prayer of passing. “I applaud House conservatives for keeping their word to the American people and standing up against ObamaCare Lite,” said Dr. Paul. “I look forward to passing full repeal of ObamaCare in the very near future.”
There will be no such repeal in this Congress, and probably not in any other. Republicans run the government and that means they are responsible for what happens in health care. Trump and Ryan are right that the ObamaCare markets are imploding, and prices will rise and choices will shrink again next year on present trends. Republicans can try to blame Democrats, but they’re in charge.
Health and Human Services Secretary Tom Price can use regulation to improve insurance markets at the margin, but the bill would have given him more reform tools. The Trump Administration is inevitably invested in improving ObamaCare instead of standing up a replacement, and the voters harmed by rising premiums and declining choices may punish Republicans in the 2018 midterms.
This failure also reveals the unfortunate skills gap between Democrats and modern Republicans in practical legislative politics. Democrats have their Bernie Sanders faction, which claimed to “oppose” ObamaCare in 2009-10 for lacking a government-run public insurance option. But the far left voted for the bill anyway because they concluded, rightly, that a new entitlement was a great leap toward single-payer national health care.
An ideal free health-care market is never going to happen in one sweeping bill. The American political system is designed to make change slow and difficult, thank goodness. Republicans have to build their vision piece by piece, carefully gauging how to sustain their policy gains politically—the same way Democrats expanded the welfare and entitlement state over the last century.
But much of the current conservative establishment profits from fanning resentments, not governing. Legislative compromises don’t help Heritage Action raise money for its perpetual outrage machine. An earlier generation of leaders at Heritage understood that the goal of winning elections was to achieve something. The current leaders seem happy with failure.
Heritage was joined in opposition by the Club for Growth and the Koch brothers’ political machinery, also on grounds that the bill was imperfect. But good luck finding any comparable chance to shrink government. This demonstration of GOP dysfunction will make Members even more skittish about taking other difficult votes, including tax reform.
Mr. Trump said Friday he wants to move forward on cutting taxes, and Ways and Means Chairman Kevin Brady wants to do the same. We wish them luck and support the effort. But health reform is about a single industry. Tax reform implicates every industry and its denizens are the definition of the Washington swamp. Success on health care would have produced momentum and confidence that Republicans could fulfill their promises. Now Democrats and the swamp rats smell blood.
Perhaps Mr. Trump and the GOP can recover from this debacle, but as an opening act to a new Presidency the collapse of his first legislative campaign is ominous. In business Mr. Trump liked to “get even.” He’s got some scores to settle with the Freedom Caucus.