Early on in the Trump campaign, I discussed how the nationalist focus would take precedence over the populist focus. That's how it unfolded during the previous incarnation of where we are now, the shift away from the Gilded Age and into the Progressive Era -- from laissez-faire and open borders to closed borders and economic nationalism.
See earlier posts here and here about income tax and the minimum wage, both of which only took off during the New Deal, after the nationalist goals had been largely achieved during the Progressive Era.
The basic logic is that the government will only be able to deliver populist outcomes when there is a high level of civic cohesion, which requires a nationalist rather than globalist focus. When millions of foreigners were pouring into the country during the Gilded Age, the founding stock Americans did not want to blow taxpayer money on subsidizing their job competitors and cultural replacements. Only when the Ellis Island people were assimilated (to the degree they were) did the founding stock feel OK with using the government to provide nice things to "all Americans".
History cannot be reversed, for example going from the neo-Gilded Age back to the New Deal. It can only run through phases of a cycle. If it goes A-B-C-D, you cannot go from D "back to" C. You have to run through A and B all over again before you find yourself in C again. This is what we ought to expect regarding the rebirth of populism and nationalism. The pure populist phase comes after the nationalist phase.
Concretely, that means we should not expect much to improve in healthcare, which is more of a pure populist battle of the general public against the greedy mega-corporations that control pharmaceuticals, insurance, and hospitals.
Trump is making major gains on economic nationalism, for instance stopping the TPP dead in its tracks and threatening big companies to bring back their manufacturing jobs and plants rather than exploit cheap labor abroad. If they refuse, they side with the anti-American side of the anti vs. pro American fault-line -- putting them in league with those who want open borders even for violent gangs and terrorists.
Already without a stiff tariff being levied, many big players are moving production back to America so that they do not run afoul of the nationalist movement. They would rather have a decent profit than no profit, if sky-high profits are no longer possible because of public hatred of off-shoring and the government now willing to act strongly on behalf of such nationalist fervor.
And it's not only the senior management at big companies who are bending to the nationalist will -- Trump can threaten any Republican in Congress with their job if they side with greedy globalist corporations over the American worker and middle class. All he has to do is launch a broadside on Twitter and roll into their home district or state -- and poof, there goes their career. No Republican can take the anti-American side, when Republican voters have chosen nationalism as their primary focus, so they will gradually come around to tariffs and other measure to re-patriate manufacturing jobs.
But what is the pro vs. anti American angle to healthcare? It's not as though white Americans have pathetic healthcare for their money compared to other white Westerners because we're being taken advantage of by foreigners or foreign governments. It's an entirely domestic battle between sociopathic big corporations and isolated citizens who have no weight to throw around at the bargaining table.
The Trump administration and the Trump movement will have little success in trying to spin the healthcare battle as one between America-first vs. globalist camps. Likewise, Trump will not be able to bully Congressional Republicans very much by painting them as anti-American, in the sense of globalists callous to the needs of their countrymen, for siding with the greedy corporations rather than the people. And given that it's the corporate lobbyists who pay Congress' salaries, they have every motive to obstruct pure populism in legislation.
There are some Democrats and Independents in Congress, such as Bernie Sanders, who would align more with Trump than the Congressional Republicans would on pure populism. However the numbers are not that great, and could be off-set by defecting corporate elitist Republicans. In general, though, there is such a high degree of partisan polarization that Trump has to choose either the Democrats or the Republicans to work with, being unable to build a big coalition between the parties. And since the Democrats are sworn enemies of Trump, they will not be the side in Congress that he works with.
Trump could only get pure populist outcomes from executive orders and the federal agencies (e.g., antitrust division of Justice Dept). If it involves actual legislation in Congress, including substantial repeal and alteration of existing laws, populism will have to wait until we achieve the nationalist goals and build a greater civic cohesion. It's conceivable that on some economic matters -- tax cuts on the ill-gotten wealth of our parasitic elites -- we will get worse outcomes in the short term.
My advice is to temper expectations about matters of pure populism, and focus more on the "intersectionality" between nationalism and populism. Issues that lie along the fault-line of America-first vs. globalism is where we currently hold the leverage against the enemy.