The depth of the loss is probably exaggerated.  It is still very early in the term of this administration and the humiliation will subside. Still, there are some harsh lessons that should be learned .

President Trump may have found the limits of bluster.  When it comes to critical policy, the details do matter; you cannot just declare that your bill will be great.

The ACA front loaded the benefits and rear loaded the costs. The Republicans found it tough to take away benefits.  Like bricks on a pickup truck, we keep adding bricks beyond the load capacity and then only blame the last few bricks when the axle snaps.  The problem with health care is an accumulation of mandates, regulations, perverse tax incentives, and wishful thinking. It is a Rube Goldberg cluster of attempts to hide the true costs of health care, so that politicians can make promises without paying for it.

Apparently, the Republican opposition to this bill was that they were not removing enough bricks from the truck.  Perhaps they need a heavier duty truck with a bigger load capacity. For the left that means single payer, but that only further hides true costs by removing the function of prices and incentives. For me it means restoring consumer power and facing economic reality. Insurance is not health care, mandates cost money, and restricting supply while increasing demand and money flow will cost you somehow.  This is the economic equivalent of gravity.

Perhaps the mistake was to take a systemic approach rather than address the component problems in separate bills.  Cost and access are related, but require very difference approaches.  In the focus on cost and access we do not want to sacrifice  innovation, quality and service.

The Republicans who have swept state governments and shown much fiscal success in that arena are facing much greater obstacles with national power.  The difficulty of assembling a collation on a national level is much different. Lawmakers must address fears and concerns that may be much less prevalent in their district. Senators and Congressmen face a powerful national media that local lawmakers usually avoid.  This is a fact to be accepted and requires an exceptional ability to communicate concepts of policy in commonly understood language.  Coverage with no providers is not a solution.  Lower premiums with outrageous deductibles is not cheaper.

As Glenn Harlan Reynold notes, the Republicans should have their health care bill, their tax reform plan, and their infrastructure bills lined up like planes on a runway. The reality of passing legislation is more complicated, but they are better off failing early, if they learn from it and keep pushing.

They will not succeed by rushing, blustering, and sacrificing transparency.  If they repeat the mistakes of the last administration they will reap the same rewards.

Other recommended readings on health care reform

It’s time to drag healthcare out of the 19th century

Supply Side Health Care Reform

Ditch Obamacare and Don’t stop there

Republicans Should Kill Obamacare or Let it Die