Donald Trump’s substance-free approach to governing may be comfortable for him but it’s caused his presidency big problems. To take the most prominent example, the health care bill: if Trump had paid attention to the details of legislation he’d have been down on his knees in gratitude toward those who defeated it in the House a couple of weeks ago. Had that bill had any chance of becoming law (which it didn’t, since the Senate wouldn’t have agreed to it), it was likely to spell election disaster for Trump and the Republican Party. The Congressional Budget Office predicted that the last version of the bill it saw—following which the bill was made even more restrictive—would have caused 14 million people on Obamacare to lose their coverage next year and 24 million to do so by 2026. While the wealthiest citizens would have received a large tax break, millions of poor people would lose their Medicaid coverage, and in a last-minute concession to the hard right, Trump also agreed to drop a requirement that insurance companies cover such basic services as emergency care, hospitalization, treatment for drug addiction, pregnancy, prescription drugs, preventive efforts, pediatric care, and others.

But Trump was clearly unaware of and unperturbed by what was in the bill; he wanted to win. He told his aides that he simply wanted to sign a bill, that it would make him look presidential.

Trump’s first great legislative defeat threatens to define his presidency. He came across as blundering and incompetent. He is the first modern president to lose his first major piece of legislation. This came on top of other unfortunate firsts: Trump is the first president whose approval ratings began to go down after he won the election and then after the inauguration, and that have kept doing so since. Recent polls show his approval ratings to be from 35 percent to 42 percent, not enough to form a governing majority.

Trump’s nonchalance about substance threatens trouble for other parts of his agenda. When Trump ran for president he said he could get a health care system that would deliver more services at a lower cost and, wonder to behold, would cover everyone. (If such a formulation were possible Obama would have proposed it.) And though Trump stated during the transition that he was drawing up his own health care measure, that it would be ready at any moment, no such bill ever appeared. Absent his own proposal, Trump was the captive of House Speaker Paul Ryan. And Ryan’s proposed bill showed his disposition as a deeply conservative ideologue, contrary to the idea that he’s a thoughtful politician—not to mention one who cares about inner cities and the poor—myths of Ryan’s own making that had been bought by much of the press until now.

Unconcerned with what the bill said, Trump gave way in particular to the Freedom Caucus, some three dozen highly conservative House Republicans who, like their Tea Party antecedents, were unwilling to compromise on their strong beliefs. (This was the group that brought down Ryan’s predecessor, John Boehner, and it’s not enamored of Ryan.) To members of the Freedom Caucus the fact that there were any remnants of Obamacare in the bill—such as coverage for pre-existing conditions and allowing kids up to age twenty-six to be covered under their parents’ policies—made it unacceptable. But when Trump gave way to the Freedom Caucus, he lost the support of the roughly fifty moderates who remain in the House and tend to represent urban areas and wanted, among other things, Medicaid to remain intact.

Trump apparently didn’t grasp that in political negotiations, unless one is very skilled, the more you give away the more insatiable the forces you give away to become. It’s not like business trading, where both sides have an incentive to reach a deal. Since conservative Republicans hadn’t ever wanted the government to get in the business of providing health care, they had nothing to lose from continuing to extract more and more from the president and still voting against the bill. Trump didn’t understand this.

The result was a proposal for which Ryan couldn’t obtain a majority of the votes. No Democrat was going to vote for anything that smacked of a repeal of Obamacare, so Ryan had to produce a majority from the deeply riven Republicans. (Not long ago, the congressional Republicans were united and the Democrats deeply divided.) Ryan was much criticized for not being able to round up the votes, but the votes weren’t there to be rounded up. When the president acceded to Ryan’s suggestion that they pull the bill and not have a vote on it, Trump couldn’t help himself from reacting to this only valid alternative, a crushing failure, with a plenitude of blame and threats.

Trump is a blame-thrower with bad aim, which shreds even further what credibility he has. His first instinct was to lay it on the Democrats, which even his own advisers said was ridiculous. He then made matters worse for himself by accusing the Freedom Caucus of betraying him and threatening its members with primary challenges for the 2018 elections. All but a tiny few of these members won more votes in 2016 than Trump did, were from safely conservative districts, and would be hard to dislodge. A threat to an elected member of Congress is the last thing that will make him or her amenable. Trump’s tweet attacking both the Democrats and the Freedom Caucus for his loss suggested he couldn’t do the simple math of finding a majority in the House. And this was likely to doom any revival of the health care legislation—if in fact the White House’s effort this week was serious and not just an attempt to suggest that Trump hadn’t really given up, as it was said he shouldn’t have done when the bill first went down to defeat.

Some observers concluded that the president would have an easier time on other pieces of legislation, but the behavior of various congressional factions and of the president bring this into question. The next large issue Congress is likely to act on is the sweeping tax cuts Trump has promised but, once again, the president has yet to propose such a bill. His infrastructure bill is caught among warring factions within the administration.

The far right in Congress know that Trump can be played, and Democrats have little incentive to give him successes. (Democrats have differing calculations on the matter of whether to support or oppose Neil Gorsuch for the Supreme Court but enough want to filibuster his nomination to force Senate Majority Leader Mitch McConnell to threaten to “go nuclear”—make Supreme Court nominations subject to only a majority vote, a change that it seems nobody wants.) It’s widely assumed in Washington that the president can make common cause with Democrats on an infrastructure proposal, but if he chooses to pay for it with tax credits, as he’s indicated, he won’t find many interested ones. Now Trump is confronted with the revelation that the Syrian government has once again used chemical weapons against its citizens—killing dozens, including children—and Trump has blamed Obama, which doesn’t address the problem of course.

Second guessing is a major activity in Washington, so it became fashionable to say that Trump had made a big mistake by letting the health care issue come up first, that he shouldn’t have let Ryan talk him into that. But Trump had little choice. Republicans had been riling up the base on Obamacare ever since it was passed in 2010, and to keep them stirred up (and raise money) House Republicans held over sixty roll-call votes calling for the repeal of Obamacare. (“Replace” got tacked on after a while, under pressure from others, including members of the press.) Trump pledged numerous times that if elected Obamacare would be his first priority. It simply wasn’t politically feasible for him to try to pull a switcheroo once in office.

Another reason for the collapse of the effort to “repeal and replace” was that in the cocoon of his fixed right-wing views, Ryan overlooked certain realities, and Trump simply didn’t understand them: it was one thing to talk about killing Obamacare before it had been established and another after some 20 million people had come to depend on it. While the right was indulging primordial urges, Obamacare became a popular entitlement, and federally provided health care a presumed right. Thus its determined congressional opponents were taken aback by this year’s rowdy town halls all across the country in which Obamacare beneficiaries laid into them for proposing to take it away.

There’s been a great deal of speculation about shifting alliances among Trump’s White House staff—it’s virtually a daily exercise—but in the end Donald Trump defines his administration. Trump has a mediocre staff, whom he doesn’t treat well. They’re hesitant to give him news he won’t like for fear of being screamed at, a frequent event. Experienced potential aides haven’t been keen to work in a Trump White House and though it’s not widely known by the outside world many of those who are there are unhappy. As one close observer put it to me, “They came to work for the president but found themselves working for Donald Trump.” The moody man at the top is strongly affected by what’s in the news. But so far only one significant aide has seen fit to quit, Chief of Staff Reince Priebus’s deputy Katie Walsh; while some reporters described her departure as part of a White House “shakeup,” it’s more likely that Walsh left because she couldn’t stand the unpleasantness of working for Trump. According to reports, with things not going well for him, the atmosphere in Trump’s White House has grown progressively worse. The removal of White House adviser Steve Bannon from the National Security Council is being much examined for its implications, but if Bannon continues to get in Trump’s head it may not mean much at all.

Yet despite the weakness and disorder of the president’s staff, and though previous White House staffs have tried it (if not as thoroughly but without success), Trump and his top aides seem particularly determined to hold power throughout the government. This is why even more than halfway into the first hundred days most of the Cabinet officers are home alone. It’s not accidental that few of them have a deputy, not to mention the legally established complement of assistant secretaries and deputy assistant secretaries—some 550 appointments the president makes and the Senate confirms. As of now, Defense Secretary James Mattis is the only newly confirmed official in the entire Pentagon leviathan, but the wars he has to fight and the crises he has to try to avert won’t wait until he gets his own staff. Secretary of State Rex Tillerson is also without a deputy, the one he wanted having been vetoed by Trump because he’d criticized him during the primaries. Such a consideration would rule out a great many potential presidential appointees. Tillerson is another tycoon who is more than a little lost in government. The generals whom Trump has appointed (three of them) are more accustomed to a political atmosphere and to dealing with elected politicians. This is no guarantee of success but they do tend to be less bewildered in their new positions of power. At least two other cabinet officials are under a legal cloud—Tom Price, secretary of Health and Human Services, for allegedly using his inside knowledge to fatten his financial portfolio while he was working on health legislation in the House; and EPA administrator Scott Pruitt, who allegedly lied during his confirmation hearings.

Yet the thinness of the ranks of officials to propose and implement the laws is actually also how Trump and his top aides want it. “A lot of those jobs, I don’t want to appoint someone because they’re unnecessary to have,” Trump said in late February. “In government, we have too many people.” Trump, Bannon, and son-in-law Jared Kushner have been particularly keen to keep control of the government in the White House. Kushner now has more assignments than any single figure known of in a modern White House and shows no inclination to devolve power. These people may well be taking on the impossible, and this would be true even if they’d had any government experience. Kushner’s latest assignment—on top of achieving peace between the Palestinians and the Israelis and calming US relations with Mexico, Canada, and China—is nothing less than to reorganize and reshape the entire federal government.

Other jobs that Kushner’s been handed are “reimagining” the Department of Veterans Affairs; improving the criminal justice system; combating opioid abuse; providing broadband service to all Americans; and developing “transformative projects” for an infrastructure program. And on Monday he suddenly turned up in Iraq, though Chinese President Xi Jinping’s visit to Trump in Florida, which Kushner had been coordinating, is to begin Thursday. Even if one tries not to be jaded, it’s hard to avoid having limited expectations of what Kushner can achieve.

Kushner is in over his head. But Trump, as inexperienced in government as his son-in-law is, does not seem to realize that, and so he keeps loading new responsibilities on him, apparently as the only person inside the White House he’s been able to trust. Ivanka is of course a trusted and cherished daughter, who has just officially become a presidential adviser. This odd arrangement would raise more hackles if it weren’t that people see Ivanka and Jared as calming influences on the president. Since they haven’t completely cut themselves off from some of their former sources of income the possibilities for conflict of interest—for which, unlike the president, they’re not legally exempt—are rife.

Kushner comes across as a highly self-confident man who loves accruing power. He’s made it plain to ambassadors and business leaders that he’s the one they should talk to—and they’re happy to flatter him and play his power game. He talks on background to some members of the press. But does he fit in government? Like his father-in-law, Kushner believes that government can and should work more like business. He said recently, “The government should be run like a great American company.” But in government one cannot lop off a division because it hasn’t met expectations, and because of civil service rules aimed at protecting government workers from partisan purges it’s not even easy to fire them. (Trump supports Republican legislative proposals to change that.) And a collection of government workers can make it difficult for the White House to change priorities.

Trump may be finding that out already in the case of the antediluvian budget he sent to Congress, where it was immediately declared dead by powerful figures, including Senate Majority Leader Mitch McConnell. McConnell doesn’t say extraneous things. Trump is paying the price for staffing his government with conservative ideologues. Trump chose as his budget director Mike Mulvaney, a former member of the Freedom Caucus. Thus, the budget is beginning to suffer from the same problem that the health care bill did: it’s so far over to the right—calling for a staggering increase in spending on defense while slashing or killing what remain of domestic programs—as to miss its mark in Congress. It hurts Trump voters in several ways, including the fact that they, too, like Sesame Street. (Of course it includes an allotment for Trump’s perhaps still chimerical Wall.)

Maybe it’s Tillerson’s business background that has caused him thus far to accept 30 percent of his State Department funds being lopped off, including a third of the funds for foreign aid—for assistance in agriculture, fighting diseases, education, and disaster-relief, and more—cuts that appall not just the foreign-policy world but Defense Secretary Mattis as well. Mattis understands, apparently better than Tillerson, the usefulness of foreign aid for furthering American interests. (Mattis is reported to have taken Tillerson under his wing and is tutoring him in Washington’s ways and the responsibilities of the State Department, which Tillerson hasn’t seemed to understand.)

That Trump announced a rollback of environmental regulations adopted by Barack Obama is probably the least surprising thing he’s done as president. Climate change has been eliminated not only as a consideration in formulating policy but even as a term that can appear in official government documents and websites. But while Trump’s proposals pleased the merchants of the extraction industries and many other private businesses, and outraged environmentalists, they may turn out to be far less effective than it first appeared.

Sheldon Whitehouse, senator from Rhode Island, who has given a speech on the environment every Monday that the Senate’s in session—he has given more than a hundred thus far—told me, “We have to be on our guard against Trump’s instincts to please polluting industries, but because of his limited grasp of things, he won’t achieve what he thinks. He doesn’t grasp the economics of what natural gas is doing to coal mining jobs in Appalachia. He doesn’t grasp how courts require administrative agencies to adhere to fact and law.” And, according to Whitehouse, in eschewing the environmental movement’s achievements and goals, Trump is bringing onto himself a political problem: “He also doesn’t appear to grasp that America is not on his side as he sells out the environment to big donors.”

It was widely understood, even by the happy coal mine operators present at Trump’s announcement of his deregulations, that so much has happened in the development of cleaner fuels that coal mining jobs aren’t coming back in any significant number. But Trump has led unemployed coal miners in Appalachia—which contains two crucial electoral states, Pennsylvania and Ohio, both of which Trump carried—to believe that they will.

This is a pattern that might cause Trump a great deal of trouble over time. Coal miners aren’t the only disenchanted working class voters to whom Trump addressed his campaign. He led a great many unemployed and underemployed people in depressed industrial areas to believe that he could get their jobs back.

But despite the relative success of Trump’s early flim-flam about saving some jobs at a few plants—never to the extent that he claimed—companies are again showing no compunction about relocating to Mexico. He misdiagnosed the cause of job losses as being the result of trade deals that he says cheated the US, when in fact the much larger problem is that the jobs are obsolete; even if, as he kept promising, he could get other countries to yield the US more in those deals, he’s not going to produce any significant number of new jobs that way. And then his budget cut funds for training for other kinds of jobs. That’s the thing: though he campaigned with the rhetoric of a champion of the displaced and angry middle class, his policies would make their situation worse. It’s doubtful how much the tax bill—called a reform bill but essentially about cutting taxes for business and the wealthy—helps the middle class. A fundamental problem for Trump’s legislative agenda is that its nature will be strongly determined by Ryan but Trump doesn’t have a mandate for the socially harsh Ryanism. The fact that members of Congress don’t fear Trump weakens his hand considerably.

The most telling and disturbing aspect of Trump’s major lie (one can divide them into tiers now) that Obama had him wiretapped during the campaign or transition is that on the afternoon of the day he made the charge Trump is known to have recognized that he’d gone too far. He was claiming on the basis of no evidence that the previous president had committed a felony. But rather than back away, perhaps saying that he’d been given bad information, he pressed on, even after FBI Director James Comey testified on Capitol Hill that he’d seen no evidence to support the charge—to the point where Devin Nunes, chairman of the House Intelligence Committee, made a fool of himself and jeopardized the House inquiry by letting the White House use him to suggest that indeed Trump aides had been subjected to surveillance (though they’d been picked up only talking to foreigners who were under surveillance). Nunes has had to recuse himself from his committee’s inquiry into the Russia matter, and he’s under investigation for allegedly having disclosed classified information.

Trump’s compliant and fearful aides, rather than try to dissuade him from pressing his story, set off in pursuit of any evidence that might suggest that in fact Trump or his campaign had been surveilled. So far-reaching were the consequences of Trump’s flight of fancy that it also damaged relations with Britain. After Trump said that the British intelligence agency GCHQ had conducted a wiretap on Trump on Obama’s behalf, the normally reticent spy group called this “nonsense,” and a spokesman for Prime Minister Theresa May, Trump’s new best friend not long before, said the idea was “ludicrous.” These weren’t rote reactions; high-level Brits were deeply angered. And now the havoc has swept in former national security adviser Susan Rice, who apparently did nothing untoward, though the president saw fit to tell reporters that she’d committed some unspecified crime. Trump’s refusal to admit error not only created a lot of damage but also raised the very unsettling thought that he could do this in some more serious international collision, when the consequences might be far more deadly.

When the subject comes up, as it does incessantly in Washington, of whether in fact Trump will end up serving as president for four years, a major argument against his somehow having to leave office (for reasons other than health) is that he has a strong base. Richard Nixon also did, until he didn’t. Gradually, Nixon’s onetime backers became disenchanted for one reason or another; he still had support at the end, but it wasn’t strong enough to save him. How long will Trump’s base stick with him even in the face of seeing their hopes betrayed? This isn’t a fanciful question: a recent poll by Geoffrey Garin for Priorities USA, showed a ten-point drop in support among Trump voters in the third week in March (the week the health care bill failed).

A lot of Republicans who had deep misgivings about Trump went along with him before and after the election because they assumed that he could produce legislation dear to their hearts. But what if it turns out that he can’t? Politicians are highly pragmatic people; they will support a president as long as he isn’t too costly to them. But if he becomes too expensive to their own reelection, all bets are off. The discontent with Donald Trump on Capitol Hill runs very deep and also very wide. I’ve been told that upwards of two-thirds of the Senate Republicans, in particular, discuss—in the gym and in clusters on the Senate floor—their desire to see him gone. These senators talk rather openly—even with their Democratic colleagues—about their fear of Trump’s recklessly getting the country into serious danger, about the embarrassment he causes it in the world (his petulantly refusing to shake hands with Angela Merkel was just one example of his mishandling of foreign leaders), about his overall incompetence.

Whether or not anything is ever proved, most members of Congress, including Republicans, think something was amiss in the Trump campaign’s relationship with Russia, or Russians, including plutocrats who owe much to Vladimir Putin. No one thinks that FBI Director Comey would have opened, much less announced, a counter-intelligence investigation of the Trump campaign’s possible collusion with the Russian government in its attempt to sway the election if he didn’t have serious evidence. On the Senate floor the other day, a cluster of Republicans jocularly made a betting pool on the way in which they think Trump will be forced to leave office.