(Getty/Jim Watson)

Donald Trump doesn't care about health care — or anything else: He just wants a "win" after so much losing

The president has no policy goals and doesn't understand health care — he just wants to put his name on something


Gary Legum
May 3, 2017 8:30PM (UTC)

As Republicans and Democrats argued over who got the bigger win this week on the budget deal to keep the government operating through September, NBC News’ Benjy Sarlin asked a pertinent question about Trump’s negotiating skills in general and the GOP’s continued efforts to repeal and replace the Affordable Care Act specifically.

“Trump can only learn if he’s been rolled or not after a deal, because he doesn’t have clear policies heading in,” Sarlin tweeted. He then added, “Take health care. What is a ‘win’ for Trump when there doesn't seem to be a single policy demand he can articulate? Does such a thing exist?”

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Reading this, I was reminded of a story I wrote not long after Trump announced his campaign almost two years ago. The outcome tells us something about Trump that the Republican majority in Congress has not yet figured out how to make work for it.

Back in the mid-1990s, Trump was in a race with his rival, Steve Wynn, to see which man could expand his casino empire into southern Connecticut. Trump’s effort was really a reaction to Wynn, as the future president thought that a rival’s casino along that state’s wealthy Gold Coast would undercut his operations in Atlantic City.

One major barrier to both men was a state law that limited casino ownership to Native American tribes. Wynn was lobbying the Connecticut legislature to change the law for him. Trump, seeing that Wynn had a head start on him in putting all the pieces in place, worked furiously to torpedo the legislation and was ultimately successful. One of Trump’s business partners in his Connecticut efforts later said that the mogul’s attitude was “If they give me the casino I’ll take it. If it’s not mine I wanna kill it.”

In the end, Trump got his way. The bill to change the casino law failed. Neither Trump nor Wynn ever opened a casino in the Nutmeg State.

Keep this story in mind when you read an interview like the one that Trump gave to Bloomberg early this week:

President Donald Trump said Monday the Republican health-care bill being negotiated in Congress ultimately will protect Americans with pre-existing conditions as well as Obamacare does.

“I want it to be good for sick people. It’s not in its final form right now," he said during an Oval Office interview Monday with Bloomberg News. "It will be every bit as good on pre-existing conditions as Obamacare."

Every analysis of the current Republican health care bill, like the party’s last health care bill that failed to come up for a vote a few weeks ago, fails on this “protect those with pre-existing conditions” metric that Trump insists is all but nonnegotiable. Yet the White House has been insisting that it expects the House of Representatives to vote on this bill no later than Wednesday of this week. That date could slip, but the GOP would need to make massive changes to the bill to mandate the protections on pre-existing conditions. At which point, it would lose the votes of the ultra-right conservatives that House leadership has spent weeks cajoling into supporting the measure by watering down those protections.

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Another strange element of Trump’s insistence on these protections is that he continues to paint Obamacare as a failing law, trapped in a death spiral that will soon blow up the nation’s entire health care system. The protections of patients with pre-existing conditions— that keep insurers from gouging them when it comes to premiums — are an integral part of this law. Why repeal all of Obamacare if it already does a good job on something that Trump wants?

The answer is simple enough. Trump only cares about the win, and a win to Trump has nothing to do with a bill’s particulars or its ideology. A win is something that Trump can stamp his name on, be it a building or a bill. He doesn’t care about an object’s function, so long as it has the name Donald Trump on it — and not that of Barack Obama or Steve Wynn.

On the other hand, Republicans in Congress are ideologically committed to repealing Obamacare, either out of a genuine antipathy to government-supported health care or simply because they want to shed the law’s tax increases on the wealthy. Trump, as journalist Ana Marie Cox once observed, is too lazy to have an ideology, so he pays others to have one for him.

If the Democrats had congressional majorities, they might be able to head off Trump simply by passing a bill renaming the ACA as "Trumpcare." Unfortunately for Republicans — and fortunately for the rest of us, perhaps — their ideology will always lose out to Trump’s ego if he thinks that a new health care bill might result in people saying that the last guy to hold his job did it better.

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Gary Legum

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