WASHINGTON — If President Trump and House Speaker Paul D. Ryan, R-Wisconsin, had paid attention to Mitt Romney, they could have avoided the fiasco of their now dead and unmourned health-care bill. They would not now face a situation in which both of them are being blamed because they both deserve to be. And the Republican Party would not be engulfed in a festival of recriminations.

I speak here of the Romney who, in 2006 as governor of Massachusetts, saw government’s job as coming up with business-friendly solutions to problems the market couldn’t solve on its own. Believe it or not, Republicans once upon a time believed in more than tax cuts and deregulation.

And so Romney worked with Democrats to pass the Massachusetts health-care plan which, he explained, was entirely within his party’s philosophical wheelhouse: “The Republican approach is to say, ‘You know what? Everybody should have insurance. They should pay what they can afford to pay. If they need help, we will be there to help them, but no more free ride.’”

Yes, requiring everyone to buy health insurance on the private market and providing adequate subsidies so lower-income citizens could afford it really was a conservative idea. It was an alternative to liberal calls for a government-run single-payer system.

The mandate was seen not as oppressive, but as an endorsement of personal responsibility. If you can be required to buy car insurance (because everybody is at risk of getting into an accident), why not require people to buy health insurance (because everybody is at risk of getting sick)? But because health coverage is financially out of reach for so many, the fair thing is to ask them to pay what they can and have government fill in the rest.

The debacle that was Trumpcare, a.k.a. Ryancare, is a reminder that conservatism has gone haywire. It has abandoned trying to solve social problems, except for offering free-market bromides as if they were solutions.


There are many reasons the Republicans’ health proposal failed (beyond the fact that it was an awful mess of a bill). They include Trump’s breathtaking contempt for policymaking, to the point where, as Tim Alberta recounted in Politico, the president used a barnyard epithet to deride the serious and thoughtful policy questions put to him by a group of House Republicans.

Trump once again revealed himself to be a fraud who really doesn’t give a damn about the lives of those who voted for him. As recently as January, he said in an interview with The Washington Post: “We’re going to have insurance for everybody. 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.” But then Trump fought for a bill that would have done just what he said he wouldn’t by throwing 24 million Americans off health insurance.

This is Ryan’s mess, too. He was equally unconcerned about the suffering his bill might create. He thought he could slap together old ideas pulled off the GOP policy shelf and not face any pushback from his colleagues.

And there was the inspiring citizen mobilization that forced Republican legislators to confront the reality that millions of Americans have benefited from a law that Ryan, Trump and company, with a stunning indifference to fact, falsely insist is a failure. Trump’s opponents learned that they can win. This will only energize them more.

But the bill’s collapse was, finally, testimony to the emptiness of conservative ideology. Romney himself, remember, had to play down his greatest achievement because President Barack Obama had the nerve to learn from the Massachusetts experience: The Affordable Care Act is rooted in the principles and policies of Romneycare. To win the 2012 presidential nomination, Romney could not afford to be seen as the progenitor of Obamacare because conservatism now has to oppose even the affirmative uses of government it once endorsed.

Democrats can celebrate, but they cannot be complacent. They will have to expose and fight any efforts by the Trump administration to sabotage the Affordable Care Act through regulation. They should propose a package of improvements to make the ACA work better and dare Trump — and the dozen or so non-right-wing Republicans who helped block the Trump-Ryan bill — to join them.

But above all, the GOP needs an appointment with its conscience. In every other wealthy democracy, conservative parties think it’s heartless to leave any of their citizens without health insurance. Do Republicans really want to be the meanest conservatives in the world?

E.J. Dionne Jr. is a columnist with The Washington Post. His email address is: ejdionne@washpost.com. Twitter: @EJDionne.

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