The president’s embrace of the Republican promise to repeal and replace the Affordable Care Act was and is incompatible with political views he often stated as a candidate. He adopted the rhetoric of repeal and replace, but whenever he talked about health-care policy, he did not sound like a conservative Republican. He wanted coverage for everyone. He didn’t want to hurt people. He didn’t want to make cuts to entitlement programs, whether Medicare, Medicaid or Social Security.

What Trump espoused clashed with what conservative, small-government Republicans long had been preaching. In office, his ambivalence has been evident at virtually every turn in the debate. He complained about the House bill as too mean after publicly praising it. He wanted repeal and replace without any pain. He wanted a victory but could not engineer it.