Without 60 votes in the Senate, there can be no true, substantial repeal of Obamacare nor replacement with entirely new things like selling insurance across state lines. Even if the Senate lowered the bar to a simple majority to pass substantial legislation, there would be enough defecting Republicans (3 would be sufficient) to prevent the bill from landing on the President's desk.
So the only possible outcome is a superficial reform of Obamacare, and since the structural weaknesses of Obamacare are deep, the reformed version would also implode in short order.
Because the Republicans in Congress would have been the last to have touched the healthcare system, they would be easily blamed for its implosion. "It may not have been a perfect system, but at least Obamacare didn't fall to pieces -- you can thank the Republicans for fumbling the pass, causing the healthcare system to shatter into a million broken pieces."
That's why the Democrats and the media are not pushing that hard against Obamacare 2.0 -- just trash-talking the lack of cohesion on the other team, and trying to brag about how great their own plan has been. But not pulling out all stops as they do when Trump threatens something they truly love, like proposing the Muslim ban.
The enemy wants us to be the last party to be seen on camera handling the healthcare system right before it imploded, so that they can own all of the upside of Obamacare (covering the uninsured) and none of the downside (destined to implode). The Party of Stupid will face the opposite fate -- owning none of the upside (they showed heartless obstruction toward covering the uninsured) and all of the downside (their fault it broke if they touched it last).
Fortunately our President is not that stupid, and actually campaigned on not being the typical stupid Republican with typically stupid Republican solutions. He knows damn well how deadly it would be to own a reformed healthcare system that was still destined to implode because not enough votes in the Senate could be garnered in order to pass true, substantial "repeal and replace".
Nor is Trump, like Congressional Republicans, addicted to losing. And taking the blame for Obamacare's inevitable demise would be the ultimate own-goal.
I'm not the blackpill type, and yet I couldn't see what Trump's longer-term goal could have been, given his apparent support for the GOP's healthcare legislation. I didn't want to rush to publish a downer post about how Trump is being led into the abyss by Paul Ryan et al. Then I ran across this from Daniel Horowitz at Conservative Review:
If this bill does not bring immediate relief, and in fact exacerbates the death spiral, the private market, along with GOP political capital, will be dead by 2020. The new regime will never be in place, especially not during the reelection of President Trump. We will either have a massive bail out or a single-payer system by that point.
Of course he says that like single-payer is a bad thing, and why Trump must reverse course. But then Trump is not an ideologue about single-payer, which the True Conservative (TM) crowd never tired of reminding us during the GOP primary. Take this example from February 2016 at Independent Journal Review (going after the closeted gay young Republican audience): "5 times Donald Trump praised socialized healthcare", with examples going from the late '90s through 2015.
Like Horowitz, he wrote that post like it's axiomatic that single-payer is a bad thing, and that's why no true Republican can vote Trump over Bush, Rubio, Cruz, et al.
Trump has never railed against single-payer, only saying it could have worked in an earlier time but not now, when the country is not that different from 2000 when he was praising it in detail. He used to note how much healthier Canadians are, while paying less, even when you control for demographics. He has recently said he "doesn't want" single-payer, but he's not a puritanical ideologue, so perhaps that only means he'll accept that outcome while not being the biggest fan of it.
And it's also possible that, yet again, Trump is playing dumb and letting his enemies destroy themselves, so that he can get his way easily in the aftermath.
The Democrats are bought off by the drug companies, insurance companies, and healthcare providers, so like hell they would ever advance single-payer on their own. Also, they're such kneejerk partisans that, as Trump keeps saying, they'd vote against their own utopia if Trump were the one who gave it to them.
They are easy to dispatch, by pointing out what a disaster Obamacare had always been and would have continued to be. Skyrocketing premiums and deductibles, shrinking choices, etc. -- those began long before the Republican Congress' attempts at reform.
It's the Republican opposition to single-payer that would prove more difficult. He did not defend the idea against True Con types like Ted Cruz during the primaries because he feels like abstract hypothetical debates would not drive the point home to the voters. Trump can point to the better health and lower costs for Canadians and Australians, but then Lyin' Ted can respond that America is different, we can't go for totalitarian government-mandated socialism in healthcare, and so on and so forth.
Trump would get bogged down in pointless debating, and have little to show for it. He might pick up some sympathetic Democrats in the Senate, but he would alienate many more Republicans, not to mention turn off Republican voters for whom single-payer is an abstract taboo topic.
By letting the Republican Establishment -- both the corporate wing and the libertarian wing -- have their way with the reform of Obamacare, Trump can make the case that he's been not only open to their True Con ideas, but has actively encouraged them. He looks like a negotiator in good faith, not an infiltrator and usurper of the Republican orthodoxy. More importantly, he doesn't turn off legions of Republican voters.
But since any version of Obamacare is destined to fail, Trump can let the Republican Establishment prove directly that their plans are just as disastrous as the Democrats'. It will no longer be a hypothetical debate -- I gave you guys in Congress the chance to come up with something great to replace Obamacare, and this is what happens? Folks, it looks like we can't trust the Establishment's plans for healthcare, no matter which side of the aisle it's coming from.
Then with Obamacare / Ryancare having imploded, Trump can use the emergency atmosphere to propose a bold new direction to lead us away from the failed policies of the past from both parties. "We're going to look into" a system like Australia's -- it's not going to be exactly like that of any other country, but they seem to be doing a lot better than we are, so we're going to look into what they're doing that we are not.*
Trump loathes the endless wheel-spinning of adversarial debate (he's not a lawyer), and prefers to Socratically prove that your so-called genius plan is a total horrorshow -- by letting you go right on ahead with it. Then when it blows up in your face, we'll do something different or even the opposite, and get a much better result. It's an experiential take on arguing from a reductio ad absurdum. You're so against single-payer? OK, you're such geniuses, hit us with your best shot in the opposite direction. Gee, that was an utter disaster -- looks like single-payer it is.
If Trump can lead the charge to push for a bold new system after Obamacare / Ryancare implodes, he might just be able to pick up enough liberal Democrats in the Senate to pass 60-vote legislation, or failing that, rope the Republicans into an Australian system in order to preserve what little credibility they will have after passing failing legislation. At that point, they could lower the bar to 50 + Pence, and afford a few defections. Even if an Australian-style system cost him 5 Republicans who think single-payer is tyranny, he would only need to pick up 3 sympathetic Dems like Bernie to hit 50.
Trump has been saying all along that the best thing politically is to do nothing, let Obamacare implode, and then its creators will come begging to the negotiating table.
But then Trump must be thinking the same about the worthless do-nothing Republicans as well -- let them finally get Presidential approval for their discredited corporate / libertarian plans, and then when it blows up and they face losing the Congress in mid-terms or in 2020, they will come begging for Trump to give them a winning replacement -- like the Australian system he has already had in mind for several decades. They will have no choice but to go along with it, and will be rewarded when voters see better quality at lower prices in their healthcare.
Finally, for the Americans who may have ever had a kneejerk reaction against single-payer: ask yourself why your counterparts outside of America are not agitating to destroy their own single-payer system, and why they either make fun of us or take pity on us for not enjoying such a system? They are otherwise 100% on board with the populist / nationalist movement led by Trump and others. So why aren't they harping on "socialized healthcare"?
Probably because it isn't that bad, and at any rate is better than what we have here -- admittedly not a very high bar to clear. As much as they gripe about their own system, they'd never want our own system, unless they're very rich. For everyone else, "how they do it outside America" sure looks like it gets better results at lower prices.
The working-class voters who put Trump over the top, in particular will not have a kneejerk reaction against single-payer. Not that they're kneejerk in favor of it either, like well-to-do progressives. They're simply willing to give it a try, after so many failures of conventional thinking.
Let this be a corrective to the previous post about not expecting much populism in domains where there is not a natural angle about globalism vs. nationalism. If Trump can let both Establishment sides prove their policies are garbage, he's got carte blanche for a bold new populist solution.
* I think Australia would be the best example to point to, since the Republican voters and politicians do not have a kneejerk association of Australia and the Australians with wimpiness, socialism, tyranny, etc. It would be poison to use France or Sweden as the example, for branding reasons only. It would be easier for them to accept a system that is 90% single-payer and 10% private healthcare, since they have no preconceived notions about Australia's healthcare system, but have dystopian views of "European" healthcare due to lobbyist propaganda here in America.
And certainly he would brand it with something other than "single-payer," which is too toxic among Republican voters. He's an expert brander, though, so whatever the phrase is, it'll sell.