The most glaring self-inflicted wound from Donald Trump’s first term in office was his decision in 2017 to let Paul Ryan and other traditional Republicans push him into a futile war to repeal the Affordable Care Act. From Ryan’s perspective, the decision made perfect sense: He and his allies despised the welfare state in general and the ACA in particular, and saw Trump’s presidency as a final chance to destroy the hated law before its roots grew too deep.

From Trump’s perspective, the move was a fiasco. By dint of the threat to repeal it and take health insurance from millions of Americans, the ACA became more popular. The repeal effort exposed the hollowness of his grand promises to give everybody “terrific” insurance, and drove a midterm-election backlash that handed Democrats control of the House of Representatives.

Eight years on, Trump has plainly failed to learn his l

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