Health Care

Trump Buries Paul Ryan Under Expensive Promises

The new president has delusions on health care. The speaker has designs on it.

Seeing is not believing.

Photographer: Zach Gibson/Getty Images

“Pick a Republican with enough working digits to handle a pen to become president of the United States,” Grover Norquist advised in 2012. Norquist, who has devoted his life to the cause of reducing taxes paid by the wealthiest Americans, was making a simple point. The next Republican president wouldn't need a brain. Paul Ryan had already mapped out the perfect GOP agenda. All a GOP president had to do was pick up a pen and sign it into law.

That, of course, was before a Republican famously derided as a "short-fingered vulgarian" won the 2016 presidential election. And the more Donald Trump talks, the more his working digits look like monkey wrenches.

Over the weekend, Trump gave an interview to the Washington Post in which he reiterated, and expanded on, his completely untenable promises on health-care reform.

"We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better."

What Trump is describing is not the Ryan agenda. What he is describing is a more generous and expansive version of Obamacare, the sort of thing Republicans routinely dismiss as "socialized medicine."

Like others before him -- students at "Trump University," investors in bankrupt Trump casinos -- Ryan thought he could piggyback on Trump's self-interest. Trump would get the White House. Ryan would get his ambitious agenda: large tax cuts for the wealthy, huge spending cuts in anti-poverty programs, such as food stamps and Medicaid, and the replacement of Obamacare with a less-regulated system that reduces subsidies for the needy, leaving millions without reliable access to health care.

The tax cuts still seem certain. But Trump keeps mucking up the Obamacare business so profoundly that it's hard to see how Ryan can extricate himself from the mess. "Everybody's got to be covered," Trump previously told Fox News. And the coverage is going to be "terrific."

Trump never gets around to explaining who's going to pay for it. On Monday, his incoming White House press secretary, Sean Spicer, tempered Trump's wild promise by insisting that covering everyone is Trump's "goal." But Republicans relentlessly exploited Obama's much more reasonable vow that, "If you like your plan you can keep it" (which was true for the vast majority of Americans who have insurance coverage through an employer). Trump's words are no more likely to disappear from the record than Obama's did. And Trump shows no inclination to stop making promises that Ryan can't keep.

Health care is expensive, which is why health insurance is expensive. If the poor, working-class and sick are not subsidized, many won't be covered. Ryan has never acknowledged that inescapable fact. But he has carefully avoided Trump's depiction of the future of American health care as a Big Rock Candy Mountain.

When Ryan was asked recently if the GOP replacement plan would cover everyone, he would only say: “Look, I’m not going to get ahead of our committee process. We’re just beginning to put this together.” Ryan's replacement plan may be as gaseous, rocky and inscrutable as Trump's, but it's orbiting in an entirely different galaxy.

Trump had already blown up the original Republican plan to repeal Obamacare and replace it with a verbal promise, redeemable at a distant date after the next election, of something wonderful. Instead, Trump said, he wants a replacement "very quickly." So far, the only hint of funding comes from unspecified and politically fraught cuts to drug-industry prices and profits. Meanwhile, in addition to huge tax cuts for the wealthy, Trump told the Washington Post that there would also be "great middle class tax cuts."

Ryan was always going to face a political challenge when a Republican president (with Republican digits) brought Ryan's harsh budget plans out of the realm of theory. Cutting programs for the poor and working class to fund tax cuts for the wealthy has never been popular. With Obama in the White House, it was also never feasible.

But instead of figuring out how to make his own agenda more palatable, Ryan must now make sense of Trump's Big Rock Candy Mountain. He can only fail. At least Trump isn't the type to look for scapegoats when things go awry.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

    To contact the author of this story:
    Francis Wilkinson at fwilkinson1@bloomberg.net

    To contact the editor responsible for this story:
    Katy Roberts at kroberts29@bloomberg.net

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