If the Democrats can’t transform this monstrosity of a bill into fuel to power them to victories in the 2018 midterms and beyond, then they should just pack it up and go home.
Could they screw it up? You bet they could. This is the party, after all, that just a few months ago lost the presidency  to the most unsuitable, unfit, unappealing major-party candidate in American history, and has spent most of the time since then blaming Russia for its own ineptitude.
So yes, the Democrats could blow it. But they shouldn’t. Especially when the path to victory is so clear.
The primary thing they need to do is follow the example of Bernie Sanders. Have you heard about his town hall in rural West Virginia  on Monday night? A 70-something socialist with a thick Brooklyn accent won over a crowd of Trump supporters with his earnest, straight talk about health insurance and the struggles faced by voters in coal country. I don’t often agree with Glenn Greenwald, but he was surely right to plug the event with this tweet:
Precisely. Sanders has a message that resonates with large numbers of Democrats — and like Trump, it’s a message with potential appeal among members of the other party as well. This is a moment of realignment, both in the U.S. and Europe. Neoliberal, managerial, centrist globalism is being challenged by populists of the anti-liberal right and left. Right now, the right-wing variant holds power in Washington. If Trump had the guts to combine his populist-nationalist appeals with support for a single-payer health-care system, he just might succeed in realigning both major American parties by scrambling their policy commitments. But despite his occasional words of support for covering “everybody ,” Trump shows no sign of actually doing this.
That leaves the field wide open for the Democrats to act boldly. And Sanders is showing how to do it: Call the AHCA the social calamity  that it is. Talk about how trade deals have enriched some but impoverished many others. Propose bold policies that could make things better, and do so with confidence, daring the Republicans to denounce them. And make the case for all of it in terms of citizenship.
I agree that the bill is a monstrosity — but I’m less convinced that it’s guaranteed to do serious damage to Trump :
[One] possibility is that Trump thinks the game works differently for him than it did for Obama. Obama’s large majority in the Senate in 2008 was built on the back of two successive wave elections, each of which explicitly involved reaching beyond the Democratic core. He had a lot of room to fall. Trump himself certainly altered the shape of the electoral map — but by accelerating polarization , not decreasing it. And his legislative majority in both houses of Congress is thin and dominated by the right.
Because of this, Trump may well think it makes sense to govern as if Democrats just don’t matter. If Democrats overwhelmingly oppose anything he does, that may just convince the voters who elected him that he’s on the right track. Those people losing insurance? Maybe they’re mostly poorer, or non-white, or are happy to avoid paying for insurance that they don’t want. Maybe he’s gambling that for the bulk of his voters, making sure they aren’t paying for insurance for the “undeserving” is precisely the point. Particularly given the shape of the 2018 electoral map, Trump and the GOP may rationally conclude that the more polarized the political environment, the better for them — and the AHCA will certainly be polarizing if it passes. Meanwhile, by 2020 the state of the economy and job growth is what will really matter to voters, or at least an electoral college majority thereof.
Paul Ryan is another story:
The AHCA was announced to furious condemnation by many Tea Party-type Republicans for not completelyeviscerating the ACA, but instead being “ObamaCare light.” Since then, it’s shored up its support on the right in the House, but come under fire  from less-doctrinaire Republicans in the Senate without having won back Cruz and Paul. What are the odds that a bill with that kind of opposition can even pass? Maybe not high. It’s possible that this is fine with the Trump administration, and that in fact they would prefer for the bill to fail.
It would normally be strange for a Republican president to want his own party’s majority to suffer a major black eye like that. But this is Ryan’s bill, and Trump has no love for Ryan. Moreover, inasmuch as Bannon is in competition with Ryan-ally and Chief of Staff Reince Priebus for influence over the White House’s agenda, it’s very much in his interest specifically for Ryan to fail . The collapse of the AHCA would be a massive failure — and would likely invite a leadership challenge.
And if it failed quickly, it would be easy for Trump to blame Ryan for getting it wrong, tinker with ObamaCare around the edges (particularly in ways that could be done without even passing legislation), and then when the exchanges don’t collapse claim he fixed them. After all, the same CBO report that said the AHCA would cost 24 million people their insurance said that the much-heralded death spiral isn’t coming all that soon. Trump could yell at a bunch of insurance executives, watch premiums stabilize, and claim victory.
The most exotic possibility is that Trump not only wants the bill to fail and Ryan to take the blame, but that he wouldn’t be too upset to see the Freedom Caucus defanged, opening the door to more creative possibilities. There are certainly people in Trump’s inner circle  who see the big problem with ObamaCare as being its support of private insurers, and who would prefer a relatively stingy single-payer plan to either ObamaCare or ObamaCare light. Trump doesn’t have a legislative majority for a reform like that — but maybe after some strategic losses in 2018 he would?
Personally, I think those kinds of hopes are misplaced, and that Trump ultimately just doesn’t care that much about the subject of health care. But it is important to recognize that Trump’s position is far less exposed than Ryan’s is.
This, from my perspective, is the dominant political fact about the Trump presidency. He won by attacking his own party’s leadership. He can’t win again without retaining the support of the Republican base — which means he has to be supportive of any effort to repeal ObamaCare, because the base has demanded that for years. But he will take every opportunity to convince that same base that they should be more loyal to him than to a GOP leadership for which they have already demonstrated mistrust. Which means failures by that leadership can be turned to his advantage. Whereas apart from individual leaders who have their own personal following (as, in their different ways, Cruz and Paul and McCain do), the traditional GOP leadership has a much harder time doing the opposite and triangulating against Trump.
So Ryan’s taking a huge gamble with the AHCA, and he’s taking that gamble because it actually matters to him as a policy priority. Trump is taking a much more modest one.
That’s the way I see it, anyway.