Medi-whatever

Does Trump Know the First Thing About Health Care? Aide: ‘He Understands Winning.’

No one—not even Trump’s own aides—thinks he’s ‘totally engaged on health care.’

On Wednesday morning, the president woke up and then began angrily tweetstorming about his allegedly deep knowledge of the American health care system.

“Some of the Fake News Media likes to say that I am not totally engaged in health care,” Donald Trump tweeted from his personal @realDonaldTrump account. “Wrong, I know the subject well & want victory for U.S.”

The president’s close aides and political advisers, six of whom spoke to The Daily Beast on the condition of anonymity in order to speak freely, would beg to differ. Some of them simply laughed at the very suggestion that the president knows much, or even cares, about health care policy in this country.

Trump’s Wednesday hate-tweets came the morning after a story was published at The New York Times that stated that one Republican senator who supports the Senate’s Trumpcare legislation exited a Tuesday meeting with President Trump at the White House with the strong impression that “the president did not have a grasp of some basic elements of the Senate plan.” Furthermore, Trump appeared “especially confused when a moderate Republican complained that opponents of the bill would cast it as a massive tax break for the wealthy,” according to the Times’ account.

This report, and the unnamed senator’s suggestion of Trump’s ignorance and policy confusion, irked the president and, according to one White House official speaking to The Daily Beast, made him noticeably “furious again” in his ongoing, obsessive feud with various media outlets, which he habitually knocks as “failing” and “FAKE NEWS.”

Multiple senior administration and White House officials all independently described Trump as either detached from or barely interested in the complicated details and tricky politics of subsidies, Obamacare markets and taxes, the Medicaid expansion, and the safety net.

Following the Trump administration’s failure at managing an aggressive, threat-filled push to pass the initial House version of the Obamacare repeal in March, White House officials privately concede that it is actually better for Republicans when the president disengages more from being a policy negotiator.

When asked if the president understood or had a solid grasp on the important facets of the Senate or House incarnations of repeal-and-replace, one official—who who works closely with the president on health-care policy, replied initially with a few moments of light chuckling—before answering “not to my knowledge.”

“The president understands winning,” another official noted, adding a stuck-out-tongue emoji to the correspondence.

This notion was once again reinforced by the president’s own words this week. On Wednesday, he told reporters that "we're going to have a big surprise…a great, great surprise" regarding health care, and has routinely spoke of finally "winning" and "victory" at last for Republicans on gutting Obamacare.

The fact that President Trump is about as far from a policy wonk as you can get in politics isn’t some new revelation. Few involved in the president’s political rise in the Republican Party, or his current administration, will be shocked to hear that Trump is disengaged with, or straight-up bored by, policy minutiae.

One former senior Trump campaign aide recalled to The Daily Beast several instances throughout 2016 when the Republican presidential contender would privately appear to confuse Medicaid and Medicare, and the functions and purposes of each. He would at times conflate to the two and had to be reminded of which one was which.

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"There would be times when he would describe what was clearly Medicare...but say Medicaid, and when we pointed that out, he would say, 'That's what I said, Medicare and Medicaid,'" the source recounted.

Sometimes Trump would be on the ball regarding the key distinctions—and sometimes he’d conspicuously fall off.

The former aide added that campaign staff would move on instead of lecturing or drilling in the policy specifics with Trump because those details weren’t important to the debate prep or his rallies, and that no one wanted to risk making him look "dumb."

Asked about the president’s inattention to policy details, including the detail that he would repeatedly confuse the country’s two largest federal health care programs, Principal Deputy White House Press Secretary Sarah Huckabee Sanders only would reiterate Trump’s general commitment to rolling back the Affordable Care Act.

“The President has been talking about repealing and replacing Obamacare since the campaign started,” Sanders told The Daily Beast in an email. “He has made it a priority in his administration and he is committed to reforming health care to make it better for all Americans.”

On the campaign trail, Trump pledged repeatedly and emphatically that he would not cut Medicaid, Medicare, or Social Security, in contrast to nearly all of his Republican opponents. However, Trumpcare would take a sledgehammer to Medicaid, in particular.

For President Trump to go back on such a major campaign promise makes more sense when considering that candidate Trump didn’t have much commitment to these ideas or principles in the first place.

A second former Trump campaign aide said the details of proposals on health care—and virtually every other policy area with the exceptions of trade and immigration—weren’t much of a consideration.

“It wasn’t really a policy oriented campaign—policy wasn’t on our radar,” the former aide said. “The sense was, say what wins and figure out the details later.”

The health care policy proposals that emerged from a campaign so unconcerned with policy minutiae had right-leaning wonks and think-tank fellows aghast.

When the Trump campaign rolled out a health care policy blueprint in the spring of 2016, Michael Cannon, an issue expert at the libertarian Cato Institute and a vehement Obamacare foe, panned the proposal.

“This isn’t a health reform plan,” Cannon wrote at the time. “It’s a campaign operative copying and pasting a bunch of stuff from the around the web, without knowing what it means or even realizing that he’s describing current law. It shows Trump is as unserious about reforming health care as ever.

“He doesn’t have a plan,” Cannon added. “He has paroxysms.”

Trump’s health-care proposal, wrote Republican health policy adviser Avik Roy, at the time an adviser to Trump primary rival Sen. Marco Rubio, “has the look and feel of something that a 22-year-old congressional staffer would write for a backbencher based on a cursory review of Wikipedia.”

And The New York Times is hardly the only news outlet corroborating this assessment this week. Earlier this week, the neoconservative publication The Weekly Standard reported that “several senators who have spoken with Trump about the evolving legislation describe an executive with little apparent understanding of the basic principles of the reforms and virtually no understanding of the details” of Trumpcare.

Trump’s apparent disdain, or aversion, towards tackling the specifics or nuances of his own administration’s policies goes far beyond health care.

Less than a month after Trump assumed the presidency, Mother Jones reported on leaked classified guidance that had been sent to intel analysts tasked with compiling material for the president’s daily briefing on national-security threats. The guidance showed how President Trump’s daily nat-sec briefing intentionally contains less nuance and far less information than reports presented to Trump predecessors—“about a quarter of the information President Barack Obama received,” MoJo reported.

“It is fair to say the president takes [a] similar approach to health care,” a White House official told The Daily Beast. “[It’s] ‘less is more.’”