Reconciliation. Senate Parliamentarian. The Byrd Rule. As President Trump has found out, process is a fetish in Washington D.C. And of course, now there are indignant howls from critics on the right about how process was botched by Ryan, Price, and The White House. You should have moved slower. You should have held more meetings. You should have taken more notes. You should have especially taken notes when Freedom Caucus members of Congress talked at those theoretical meetings.

You should have followed the norms of process! (apologies for the tautology). See what happens when you don’t spend at least a year?! Joe Klein at the Washington Examiner, for example, gazes back fondly at how the Obama administration handled and manipulated and fondled and rammed the Affordable Care Act through Congress with nary a GOP vote. Ramming slowly it seems is best when it comes to healthcare in America. Other critics are demanding that the process be more transparent next time. Transparent ramming. Done slowly. Now that’s process!

Wonderful. Conservative critics are lambasting the Trump administration for not being more like the Obama administration when it comes to how they manage the legislative process for healthcare legislation.

But here’s the problem. Or at least, here’s one of main questions that arise from the smoldering ashes of the GOP’s quick-march to the exits on AHCA: has the substance of healthcare policy become so divisive that no process in 21st century America can cover the enormous divide between a moderate GOP member of congress and a House Freedom Caucus member? Never mind Bernie supporters and their push for Canadian-style universal coverage.

Everyone is very eager to remind poor President Trump how complex healthcare policy is. But why is that the case? Isn’t the complexity all about covering up the harsh trade-offs that must be made when any democratic legislature has to put together a broad healthcare plan? Cheap, available, good quality. You get 2 of 3 at best. But why tell voters that?

Theoretical solutions flourish like so many weeds, each cultivated by an eager over-informed wonk who just knows she or he has the solution to all that ails America’s healthcare system. But every one of those individual theoretical solutions would have an impossible chance of ever being the basis of a successfully propagated piece of legislation, signed into law by the president. It’s about aggregating the trade-offs between competing players with conflicting interests. And that is becoming an almost impossible task. Yes, Obama managed to do it, but barely and with loads of goodwill. And he sank his own party as a result.

Insurance companies vs. doctors vs. hospitals vs patients vs state governments vs House members vs Senators vs Senior administration officials vs HHS bureaucrats vs FDA vs big pharma vs large employers with benefit plans vs small to mid-size employers vs independent workers vs young people vs wealthier older people vs poorer older people vs veterans.

Healthcare in America has become the planet’s most elaborate entitlement scheme, a jigsaw puzzle that’s always a few pieces short of being finished. Or falling apart. It could be – and is by some – viewed as catastrophe insurance. It could be – and is by some – viewed as a universal right. But maybe the only way to resolve it will be to devolve down to the state level. And let individual states internally fight and bargain to find their own solutions. But for now, don’t expect any big plans for a new health policy by the GOP. Too tough a puzzle to solve. For just about anyone. Let alone a bipartisan congressional committee.

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