All things considered, he probably preferred the notion of more people having health insurance than fewer people having it. He was even, when push came to shove, rather more for Obamacare than for repealing Obamacare. As well, he had made a set of rash Obama-like promises, going so far as to say that under a forthcoming Trumpcare plan (he had to be strongly discouraged from using this kind of rebranding—political wise men told him that this was one instance where he might not want to claim ownership with his name), no one would lose their health insurance, and that preexisting conditions would continue to be covered. In fact, he probably favored government-funded health care more than any other Republican. “Why can’t Medicare simply cover everybody?” he had impatiently wondered aloud during one discussion with aides, all of whom were careful not to react to this heresy.
It was Bannon who held the line, insisting, sternly, that Obamacare was a litmus Republican issue, and that, holding a majority in Congress, they could not face Republican voters without having made good on the by now Republican catechism of repeal. Repeal, in Bannon’s view, was the pledge, and repeal would be the most satisfying, even cathartic, result. It would also be the easiest one to achieve, since virtually every Republican was already publicly committed to voting for repeal. But Bannon, seeing health care as a weak link in Bannonism-Trumpism’s appeal to the workingman, was careful to take a back seat in the debate. Later, he hardly even made an effort to rationalize how he’d washed his hands of the mess, saying just, “I hung back on health care because it’s not my thing.”
It was Ryan who, with “repeal and replace,” obfuscated the issue and won over Trump. Repeal would satisfy the Republican bottom line, while replace would satisfy the otherwise off-the-cuff pledges that Trump had made on his own. (Pay no attention to the likelihood that what the president construed as repeal and replace might be very different from what Ryan construed as repeal and replace.) “Repeal and replace” was a useful slogan, too, in that it came to have meaning without having any actual or specific meaning.
The week after the election, Ryan, bringing Tom Price—the Georgia congressman and orthopedist who had become Ryan’s resident heath care expert—traveled to Trump’s Bedminster, New Jersey, estate for a repeal and replace briefing. The two men summed up for Trump—who kept wandering off topic and trying to turn the conversation to golf—seven years of Republican legislative thinking about Obamacare and the Republican alternatives. Here was a perfect example of an essential Trump paradigm: he acceded to anyone who seemed to know more about any issue he didn’t care about, or simply one whose details he couldn’t bring himself to focus on closely. Great! he would say, punctuating every statement with a similar exclamation and regularly making an effort to jump from his chair. On the spot, Trump eagerly agreed to let Ryan run the health care bill and to make Price the Health and Human Services secretary.
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