The closest President Barack Obama came to fully breaking faith with progressives was in 2011, when he and then-House Speaker John Boehner inked a plan to cut trillions of dollars in Medicare and Social Security spending in exchange for a relatively trivial tax increase on wealthy Americans. Boehner ultimately scuttled the deal when he realized his fanatical GOP conference would likely depose him over it, and Obama ended up pocketing his tax increases for free after winning re-election. 

The failure of this “grand bargain” saved Obama from himself, not least because there was little justification at the time for a multi-trillion dollar austerity measure. The economy was weak, interest rates were low. Obama would have made good in some metaphysical sense on his pledge to “unite” the parties, but at great political and substantive cost.

It was a bad idea, but at least it was an idea. It isn’t impossible—it’s pretty easy, in fact—to imagine a national policy environment that called for considered, phased-in budget consolidation that, for political reasons, required buy-in from both parties.

What’s remarkable about the Republican health care bill—whether it’s the updated Senate draft, or the one that passed the House two months ago—is that it can’t even be supported on those narrow grounds. Trumpcare, of course, isn’t right for the moment. There is no clamor for millions to lose insurance, for Medicaid to be gutted, for enormous risks and costs to be placed back on sick individuals, to finance tax cuts for wealthy people. But beyond the current milieu, it is hard to think of any hypothetical pressing national need that Trumpcare would address.

Republicans used the right’s opposition to Obamacare, mostly propelled by forces of reaction, as a mobilization tool. Their pandering to that base, mixed with their fanatical commitment to tax cuts, has brought them to the cusp of passing a bill that is a political and substantive orphan.


It is not a coincidence that nobody in the Republican Party can mount a defense of Trumpcare on the merits.

It is, more than any legislation I have ever covered, a solution in search of a problem.

The Affordable Care Act was devised to address the problems of widespread uninsurance and excessive health care inflation by regulating and subsidizing the individual insurance market, and phasing in health care delivery reforms. The 2009 stimulus was a response to a massive, abrupt demand shortage in the economy. Various, failed carbon tax and cap-and-trade bills are meant to reduce carbon emissions, toward the end of reducing the risk of runaway climate change. More recently, House Speaker Paul Ryan and Minority Leader Nancy Pelosi teamed up to pass a permanent “doc fix” law, so that physicians wouldn’t face abrupt Medicare reimbursement cuts every year.

Even when legislation addresses more proximate need, there’s usually some plausible excuse for it. When George W. Bush was a candidate for president, he proposed tax cuts as a means of returning budget surpluses to taxpayers. When a recession hit, he proposed the same, permanent tax on the grounds that deficits would stimulate the economy.

The GOP health care bill doesn’t even have pretextual justifications. Republican leaders like to claim that Trumpcare is necessary because Obamacare is “collapsing” into a “death spiral,” but not only is Trumpcare non-responsive to a death spiral, the death spiral they posit as the basis for Trumpcare is wholly fabricated.

Trumpcare is responsive only to Republican commitments to repeal Obamacare and pass large, regressive tax cuts, but those goals are artifacts of unprincipled political campaigning and a tax-cut fanaticism that is entirely divorced from the public interest.


It is possible to imagine a suite of conservative health reforms that both addressed real national needs and introduced a more ideologically congenial policy construct to our national health care system.

The problem is that a justifiable theory of the conservative health care case isn’t so radically different from Obamacare that it requires all this doomsaying and urgency.

“Passing an Obamacare replacement is difficult because the existing system is fundamentally a collection of moderately conservative policies,” the Republican health policy professor Craig Garthwaite wrote this week. “I have many problems with Obamacare, but they don’t stem from a belief that any government intervention in markets is a nonstarter. Such a belief cannot be, and frankly has never been, the litmus test for policy in the Republican Party. If it is, the inability to solve the big problems facing our great nation will be the beginning of the end of the party.”

Conversely, if Trumpcare fails, it might finally focus the Republican mind on something other than venal nonsense. Like when Obama’s grand bargain collapsed, their failure might save them from themselves.