GOP leaders have reached the cusp of passing a health care bill paradoxically: by making it crueler. To set aside their reservations and line up behind the legislation, conservatives insisted that the American Health Care Act include a politically toxic provision that would allow states to charge people with pre-existing conditions unlimited sums of money for health care coverage. Their leaders obliged.

The GOP’s new theory of victory rests on this provision surviving, and persuading moderate Republicans—the most vulnerable, but most easily bullied, Republicans in the House—to vote for it despite the political danger.

Enter President Donald Trump, who, over the weekend, muddied the House position in a way that threatens to scramble the leadership whip count, then turned around and (you may have heard this story before) pushed Republicans to vote on the bill this week anyhow.

This kind of policy schizophrenia—marked by mixed messages, over-promises, bluffs, and self-defeating deadlines—has typified the first months of Trump’s presidency. It created obvious problems for Trump himself as his 100th day in office approached, but it should also have Republicans in Congress asking themselves whose interests they’re serving by returning to the health care trough over and over again. After all, they will be held responsible as much as Trump for the ensuing chaos when the work of legislating is over and the technically challenging job of implementation begins.

If Republicans in Congress send Trump a bill, they won’t simply be replacing Obamacare with Trumpcare. They will be entrusting the administration of a major federal program to a man who won’t understand the most basic facts about the legislation he is signing.