The failure of the American Health Care Act in the House is not principally the new president's fault. His pledge to "take care of everyone" with something better and cheaper, with smaller deductibles and lower premiums, fueled the poor reception for an Obamacare replacement bill that would leave 24 million more uninsured, raise deductibles, and hit older people especially hard. His pledge, however, simply mirrored the way Congressional Republicans have over-promised on this issue for years.
But Trump does bear responsibility for the way he handled this opening negotiation with a Congress controlled by his own party.
He and his relatively-thin, inexperienced administration team never offered their own plan, choosing instead to piggy-back on Speaker Paul Ryan's proposal. Having done that, Trump declined to fully embrace it.
Not only did it diverge wildly from his campaign rhetoric, but Trump never reckoned with that fact. Nor did he display any strong commitment to its provisions. Indeed, his public sales pitch for the bill cast it as a chore delaying his ability to start working on the tax-cut plan he values more.
That's no way to grind out votes on a contentious issue such as health care, a topic that wards off many conservative, limited-government Republicans. A frantic rush of phone calls and White House meetings wasn't enough to compensate, even for a president who calls himself a master negotiator.
Having personally raised the stakes on this issue, Trump suffers a significant blow from its failure. On the biggest stage, his actual clout has been shown to be far less formidable that he and his allies have claimed.
Along with fellow Republicans, he will gauge the blowback from rank-and-file conservatives who have expected a government controlled by their party to act. Even before this defeat, his approval ratings had fallen to 40 percent or below, with modest erosion among Republicans. An FBI investigation of potential collusion between Trump associates and Russian operatives hangs over his administration.
But Trump and his aides have signaled their eagerness to move on to other priorities. And his opening pratfall on health care does not assure he will stumble on those.
Tax cuts draw much broader consensus within the GOP. Big questions remain about whether a reform plan can encompass individual as well as corporate tax reform, and whether Republicans will accept higher deficits in the process.
Senate resistance to the House border adjustment tax makes the deep corporate rate cuts that the White House and Ryan want unlikely. But the effort will enjoy support from business lobbying groups that was lacking from the health-care effort.
Trump's effort for a large infrastructure program poses a more complicated test with echoes of the health-care debate. He has called for $1 trillion in new projects, though how much of that would come from Washington remains unspecified.
But many Republicans concerned about federal deficits would oppose any significant increase in infrastructure spending unless offset by budget cuts. And Trump has already proposed deeper cuts than Republican leaders support to finance military spending increases.
That means Trump may need some help from Democrats to achieve that priority. The same is true of health care, whenever the White House returns to the issue after Friday's defeat.
That would test a set of muscles Trump has not had to used during his first two months in the Oval Office. For those, as well as the muscles he pulled on health care, it is clear that the new president needs to get in better shape.