The Republican effort to overturn the Affordable Care Act was hanging in the balance when Vice President Pence issued a challenge to GOP senators: “Inaction is not an option,” he said. A couple of hours later, however, his boss took a different view.

It was time, President Trump said, to give up and “let Obamacare fail.”

For Trump, the inability of Republicans to repeal President Barack Obama’s signature legislative accomplishment represented a stinging political defeat Tuesday. But it also was a chance, in the heat of the moment, for a president prone to bluster and hyperbole to move the debate immediately to the most extreme potential outcome.

This was not, as Sen. John McCain (R-Ariz.) had suggested a day earlier, a moment to pursue compromise with Democrats — to Trump, it was a signal to predict mayhem and chaos.

“The Dems scream death as OCare dies!” Trump tweeted Wednesday morning.

(Bastien Inzaurralde/The Washington Post)

It’s a style that worked successfully for Trump during his campaign, when he spoke to voter anxieties by warning, in often apocalyptic terms, of the dangers of illegal immigrants, threatening to pull out of an “obsolete” NATO and promising to blow up multilateral trade deals and climate pacts painstakingly negotiated by his predecessor.

But in the White House, Trump’s preference for governing in extremes has left him, in the wake of his health-care defeat, with narrowing options to improve a system that now has states and consumers struggling to cope with rising insurance premiums. His withdrawal of the United States from the Trans-Pacific Partnership (TPP) trade deal and Paris climate agreement has led governors to open direct talks with foreign governments and to pledge emissions curbs that contradict the White House approach. And his continued demonization of immigrants as threats to public safety has closed off potential compromises with Democrats on a comprehensive immigration overhaul bill that the president said last week he would like to pursue.

Fellow Republicans and presidential historians said Trump’s view of politics as a zero-sum, black-or-white grudge match has boxed him in six months into office with fewer tools at the negotiating table and diminishing returns with voters. Trump’s approval ratings have tumbled to 36 percent in a recent Washington Post-ABC News poll, the worst among presidents at this point in their tenures in 70 years.

“He’s a man with the disposition of someone who is inclined to burn down the village,” said Peter Wehner, a George W. Bush administration official who has warned of Trump’s extremism. “If Obamacare fails, people will not blame Barack Obama so much as they will blame Trump and Republicans. He was elected to try to take care of problems. For him to stand up and say, ‘Let it fail and they’ll crawl back to Trump to fix it,’ is an alternate reality.”

White House aides have defended the president’s approach by suggesting that Washington is not used to a political outsider who is truly willing to disrupt business-as-usual. When attacked, they said, Trump will hit back harder. During the campaign, he did not apologize for even some of his most outlandish behavior, and he has attacked cable news hosts in recent weeks in often-personal terms.

Aides said this approach is reflected in a political strategy that aims to keep opponents off balance and to go around the mainstream news media to leverage his large social media following into a potent political force. Despite the conventional wisdom in Washington, internal polling from the White House’s political operation has shown broad public support for the president’s hard-line approach to immigration, aides said.

“I’m not going to own it,” Trump said of the prospect of the health-care system collapsing. “I can tell you the Republicans are not going to own it.”

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But critics have pointed out that Trump’s threats and bullying did little to move the needle on the health-care repeal-and-replace effort. The House needed two attempts to pass a version of the legislation, after which Trump feted GOP members with a Rose Garden ceremony, but he was unable to persuade enough wavering senators to get on board. On Wednesday afternoon, Trump urged Senate Republicans to stay in Washington this summer until they pass a health-care bill, but that exhortation appeared to have little impact, with GOP leaders saying they were sticking with their existing plan.

“Immoderate people tend to view the world in black and white, as uniformly bad or good, and they are unable to appreciate positions in the middle,” said Aurelian Craiutu, a political science professor at Indiana University and author of “Faces of Moderation: The Art of Balance in an Age of Extremes.”

“No doubt on health care, the final outcome will be something in the middle,” Craiutu said. Trump’s “inability to appreciate that is a sign of immoderation. There are moments in history, where we are fighting against Hitler or Stalin, when that works. But there are certain issues, such as health care, where compromise is part of the democratic process.”

To that end, Trump’s rhetoric has contrasted sharply with that of his predecessor. Obama often used the bully pulpit to call for bipartisan compromise, although Republicans accused him of pursuing liberal policies with little patience for their input.

The Affordable Care Act was passed in 2010 by a Congress controlled by Democrats with no GOP support. And in his final two years, after Republicans won full control of Congress, Obama moved rapidly to enact executive actions.

But on immigration, Obama supported a bipartisan bill that passed the Senate before failing in the House. On trade, Obama worked to win support from Republicans and some Democrats for the TPP, a 12-nation trade pact in the Asia-Pacific.

Craiutu said Obama, as a former law professor, at times exuded the sense that “I have the right way and others who disagree do not see the light.” But far more than Trump, he added, “President Obama did try to be a tightrope-walker. To do that, above all, you need balance. The balance is the most difficult thing to achieve when you have crosscurrents and winds blowing from each side.”

Republican critics of Trump say that having lost support from moderates, he appears willing out of desperation to appeal strictly to his base, which still responds to his extreme rhetoric. Trump reportedly wanted to label Iran in violation of the nuclear deal but was talked out of it by advisers only at the last minute Monday.

Geoffrey Kabaservice, who left his role as a consultant at the Republican Main Street Partnership this year over disagreements on the health-care strategy, said Trump tapped into authentic economic angst among voters who believed Washington no longer worked for them.

But, Trump “seems to present nastiness and tweets as his governing strategy,” Kabaservice said. “There’s an opportunity for the Republican Party or the Democratic Party or Trump himself to recover his message and what has been to some degree a needed populist emphasis. But at this point, it seems Trump has lost any idea what he once seemed to stand for. It’s all been posturing and transactionalism. That’s the point we’ve reached, which is not to say it can’t get worse.”