When the Congressional Budget Office released the numbers on Trumpcare—or Ryancare, or whatever you want to call the two-headed boar unveiled by Paul Ryan as a replacement to Obamacare—showing that more than 20 million Americans would join the ranks of the uninsured in a few years, what came to mind was Buck Turgidson making the case for a nuclear first strike in Dr. Strangelove. “Mr. President, I’m not saying we wouldn’t get our hair mussed,” he promises. “But I do say no more than 10 to 20 million killed, tops.” Yes, some of the people losing their coverage would be dropping it by choice, freed up by the end of individual mandates. But many others would be pushed out by a massive increase in premiums. It takes a zealot like Ryan to be “encouraged” by that kind of analysis.

This has been an amazingly speedy descent into Republican self-sabotage. Ryan’s bill is almost universally disliked. Liberals and Democrats hate it for hurting lower-income Americans. Conservatives and Republicans hate it for either hurting lower-income Americans or for not hurting them enough. (Ohio governor John Kasich condemns the bill for reducing Medicaid coverage for the poor, while small-government Republicans like Rand Paul call it “Obamacare Lite.”) Americans who currently subsidize Obamacare would be re-united with their money, while Americans who depend on the subsidies would be out of luck. The Ryan bill seems to promise a replay of hits from the George W. Bush years, when Republicans who preferred zero spending on the poor clashed with Republicans who preferred medium spending on the poor, but found common ground through their shared interest in big spending on the rich.

Much of this was to be expected, because Ryan is Ryan, and the G.O.P. is the G.O.P. What was up for grabs was the stance of Donald Trump. Was he going to insist on doing more to protect the little guy? Or was he going to throw his lot in with Ryan? We now see that, despite some concerns from his friends in the media, he chose the latter. (Or perhaps he chose it after Ryan incorporated some of Trump’s requests to protect the little guy—in which case Trump didn’t get very far.) Trump has been lobbying aggressively to get Ryan’s bill passed, inviting skeptics to meetings at the White House, promising rallies, and generally spending a lot of scarce political capital.

If the bill passes, many of Trump’s voters will get hurt, leaving Trump damaged. If it fails, the White House will have suffered a big defeat, leaving Trump damaged and his agenda weakened. It’s not a favorable set of choices. If nothing else, though, it will be the first big test of Trumpism. Its contradictions could be hidden during a campaign season. Now, they are coming into sharp relief.

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In theory, Trumpism follows the tradition of the European right, which combines nationalism with support for the welfare state. In practice, Trumpism relies on Donald Trump, who is many things to many people, and the Republican Party, which rejects nationalism (apart from the interventionist sort) and seeks to shrink the welfare state. Even if Trump were a resolute ideologue of the Marine Le Pen variety, he’d be stymied on all sides. Democrats, borrowing from Republicans under Obama, would still wish to undermine Trump whenever possible, even if they agreed with his aims. Republicans, who remain the party they were two years ago, albeit with a new boss, would likewise be uncooperative. The main difference between the ideological Trump and the one we have is that the latter is less sure of what he wants and therefore less predictable. But he’s still boxed in.