Health-care policy, Donald Trump has admitted, is more complex than he once assumed. “Nobody knew that health care could be so complicated,” he said in February as he struggled to cobble together a plan to repeal and replace Obamacare. Still, he was optimistic about his chances. “Costs will come down, and I think the health care will go up very, very substantially,” he told insurance company executives, explaining that the current system was a “disaster” that would only get worse. “I think people are gonna like it a lot. We’ve taken the best of everything we can take.” In an interview in May, shortly after the House passed a bill that would cause an estimated 23 million people to drop or lose their insurance coverage, Trump boasted that he had become an expert on the subject. “It was just something that wasn’t high on my list,” he told Time magazine. “But in a short period of time I understood everything there was to know about health care.”

Nearly everything Trump has said, however, suggests that his understanding of the $3 trillion U.S. health-care sector remains dangerously limited. In closed-door meetings with Republicans to negotiate the House bill, he reportedly urged them to focus on the “big picture” and to “forget about the little shit.” Weeks after he struck up a brass band in the Rose Garden to celebrate the passage of that bill, Trump told a group of senators that the American Health Care Act was actually “mean,” “coldhearted,” and a “son of a bitch.” Lawmakers who stuck their necks out to vote for the bill, which the White House promoted, were furious. He seemed to forget his earlier criticism this week when he endorsed Senator Mitch McConnell’s own legislative vision for repealing Obamacare, which would have nearly identical results.

When a Republican insurrection on Tuesday forced McConnell to delay the vote on his bill, the unfortunately titled Better Care Reconciliation Act, Trump once again took up the mantle of dealmaker. “I just finished a great meeting with the Republican Senators concerning HealthCare,” he tweeted Tuesday, after inviting the entire caucus to the White House for a cheerleading session. “They really want to get it right, unlike OCare!”

What the president thinks it means for the Senate to “get it right” is unclear. On the campaign trail, he repeatedly promised that everyone would be covered under his yet-undefined health-care proposal. As recently as March, the administration was claiming that “nobody will be worse off financially” under the G.O.P. plan, and that costs would come down. In fact, the B.C.R.A. would do the opposite, as it slashes subsidies for the poor and elderly, leads to higher premiums and deductibles, and reduces Medicaid coverage to finance a massive tax cut. But as The New York Times reports, the president may not understand how the bill works.