Trump Appears to Not Understand What Health Insurance Is

We're seeing the limits of how little a president can know or care about an issue before things go haywire

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Trump Appears to Not Understand What Health Insurance Is

The U.S. Constitution does not set a high bar when defining who is eligible to serve as president. Its authors saw the job as something any reasonably competent adult of ordinary intelligence could do, because the president is only one part of a larger system with broadly distributed powers. Our government is designed to keep functioning regardless of whether the president is a person of staggering genius or of no particular distinction.

But now, the theory that our government can function even if the president is clueless is being tested.

In last week's exclusive interview with The New York Times, President Trump had this much-tweeted exchange with reporter Maggie Haberman (emphasis added):

"HABERMAN: That's been the thing for four years. When you win an entitlement, you can't take it back.

"TRUMP: But what it does, Maggie, it means it gets tougher and tougher. As they get something, it gets tougher. Because politically, you can't give it away. So pre-existing conditions are a tough deal. Because you are basically saying from the moment the insurance, you're 21 years old, you start working and you're paying $12 a year for insurance, and by the time you're 70, you get a nice plan. Here's something where you walk up and say, 'I want my insurance.' It's a very tough deal, but it is something that we're doing a good job of.

"HABERMAN: Am I wrong in thinking — I've talked to you a bunch of times about this over the last couple years, but you are generally of the view that people should have health care, right? I mean, I think that you come at it from the view of …

"TRUMP: Yes, yes."

This passage leads to a question most of us never thought we would need to ask: Is the government's effort to legislate health care policy potentially breaking down in part because the president does not actually know what health insurance is?

This interview suggests he does not. If anything, what he describes here is whole life insurance, which typically is extremely inexpensive for young people and escalates as one ages (and the statistical risk of death increases). Perhaps, given Trump's fondness for television in the wee hours, he is confusing health coverage with the frequently advertised Gerber Grow-Up Plan for kids.

Even Trump allies recognize his attention to detail is sometimes lacking. From the perspective of the presidency, that's not a deal-breaker. In his well-regarded essay "Presidential Competence," political scientist Paul Quirk argues persuasively that large amounts of knowledge and brainpower are not prerequisites for the office. Ronald Reagan, for example, was also seen as light on substantive knowledge yet was able to get legislation through Congress by delegating responsibility to capable aides and exercising "strategic competence" – knowing what he needed to know, and ignoring what he did not.

Trump, on the other hand, has surrounded himself with hangers-on and relatives rather than people with expertise in relevant areas. While the Trump family has proven successful at making money in real estate, his sons, daughter and son-in-law have no prior experience in government and lack any background in the issues the president has delegated to them. "Strategic competence" is not being accomplished, either. Trump all but brags about his distaste for reading, and he seems incurious to learn any more about these issues than he already knows – which, in many cases, appears to be nothing.

While the GOP health care bill was on life support the weekend before last, Trump spent two days golfing at his resort, followed by a photo-op event that featured him in a fire truck. This weekend, he prepared for a potentially crucial health care vote by once again traveling to one of his golf resorts. On Monday morning he tweeted about the GOP "repeal and replace" mantra despite the fact that not even members of Congress appear to have any clue what they might vote on this week. 

These are not the actions of someone committed to an issue or even especially interested in its outcome. If the president's wide variety of conflicting statements about what exactly he intends to accomplish on the issue of health care is confusing to the public, the problem is not the media or the voters. The problem appears to be that Trump himself has no idea what he is trying to do. Now he's urging Congress to repeal the ACA as if the events of the past week did not even happen. Presidents can be effective without deep knowledge, but not bothering to figure out what Congress is voting on is really pushing it. The office is designed to function with a person who is not brilliant; one who is totally clueless is another matter.

If Trump does not understand the health care debate, it's because he has chosen not to. If he took an interest in learning what the various congressional Republican proposals aim to do and what aspects of Obamacare are popular with the public, he could do so. It is becoming obvious, unfortunately, that he lacks any interest in trying to learn more.

Presidents need not be experts on everything, and it is possible for our system to produce legislation without everyone in Congress or in the White House attaining PhD-level mastery of an issue. It is necessary, though, for people like the president to have a basic grasp of the fundamental questions and problems involved and what each of the opposing sides wants.

Without that, the system begins to break down. In six months, this Republican president has yet to succeed in getting any legislation through a Republican-controlled House and Senate. That is unprecedented. There are many factors that explain the failures of the proposed legislation so far, but a major factor appears to be Trump's maddening lack of consistency. We are seeing, in other words, the limits of how little presidential knowledge and interest there can be before the system ceases to function properly.

Trump refuses to delegate tasks to competent people or to learn more about the issues so he can engage with them directly. That is his choice. The only reason he's unable to get anything done as president, then, is himself.