I blame Obama

Elisabeth Geertruida Wassenbergh (1729-81), The Doctor's Visit.

Shorter David Brooks ("The Republican Health Care Crackup"), March 9 2017:

The Republican health care bill could signal the crackup of the old order of American politics, the end of everything since 1974. I blame Obama, who pigheadedly insisted on having his own health care bill instead of doing what I wanted him to do. If he'd just left well enough alone, the Republicans wouldn't have to do one now.

See, according to the former New York Times columnist (I'm going to keep calling him that even if it turns out he's not really leaving), the time for thinking about universal health care was in 1974, when Nixon proposed it (in the hope of persuading Democrats not to impeach him), or as Brooks puts it, censoring the Nixon name for some purpose of his own,

That era began around 1974, when Ted Kennedy introduced a bill to supplement America’s employer-based insurance system with a government program. The Democratic dream of universal coverage continued through Hillary Clinton’s time as first lady and reached a partial culmination with the passage of Obamacare.

As you know, the dream of universal health coverage as an official Democratic dream began in 1933, when President Roosevelt asked Isidore Falk and Edgar Sydenstricter to incorporate it into the Social Security Act, and the medical profession freaked out. Truman demanded national health insurance (a more European than British approach, which I favor over "single-payer") in his Fair Deal program of 1949, but in Wikipedia language the proposal

faced much opposition from the many conservative politicians who wanted a reduced role of the federal government

Kennedy introduced his first universal health insurance bill in 1970, an AFL-CIO product, alongside Martha Griffiths's UAW Medicare for All bill and Republican Jacob Javits's "cost-sharing" proposal, in which patients would have to pay a portion of the medical bills. Nixon's first proposal was in February 1971, an employer mandate and block-granting Medicaid to the state capitals, in response to a reconciled Kennedy-Griffiths plan. Nixon's February 1974 plan, a more Obama-like employer mandate combined with a more Ryan-like destruction of Medicaid, was met by a Kennedy-Ribicoff proposal in April for just about universal health insurance, not to "supplement America's employer-based system" but to replace it—only with cost-sharing provisions that the unions and AARP couldn't accept. You could pretty much say this era ended with Nixon's resignation in 1974, or 1975, when President Ford announced that he would veto any health insurance reform, or 1977, when President Carter told Kennedy he needed a deal that cut in the insurance industry for a bigger share of the profits—all this according to Wikipedia, you know.

What began around 1974, then, was the era of reduced hopes for health care, when politicians began to face the sad fact that in America insurance companies and ignorant doctors' lobbies have more power than the people's representatives, Carter wasn't making this up because he enjoyed the idea, and began to look for ways of using a multiplicity of techniques to approach universal coverage without making the corporate gods too angry.

Including of course Senator Kennedy, who was pretty much the guiding spirit of the Massachusetts law for which Willard Mitt Romney now takes credit (though he did his best to veto the heart of the bill, requiring employers to buy insurance for their workers), and the corresponding federal legislation known as the Patient Protection and Affordable Care Act signed by President Obama in 2010 which (like the Social Security legislation pushed through 77 years earlier) did indeed represent a kind of culmination, but not an ending.

Combating government health care was a central Republican preoccupation through all that time, and the passage of Obamacare provoked the Tea Party reaction and final arrival of Goldwaterite populist conservatism.

It was a central Republican preoccupation from 1933 (when the national health insurance system would have been the second in world history, instead of more or less the last), not 1974.

The Tea Party movement, to whatever extent it was a real thing, began in February 2009 in response to Obama plans to "give financial aid to bankrupt homeowners", that's Wikipedia too, and had nothing to do with health care—I think it was about the belief that "Warshington DC" was pushing black people to live in "decent"-i.e.-white suburban neighborhoods by offering them easy loans, which wasn't true, but that's not the present point. Nobody in that original group had any thoughts about health insurance other than that they loved their socialist Medicare (though the myth says some denied that Medicare could be a government program, because they knew the government was evil) and the scooters they took to the rallies.

I have nothing but contempt for Barry Goldwater and his libertarian religion, and his willingness to exploit racism for political purposes four years before the Southern Strategy was officially put into operation, but the dumb populism of the people who went to the rallies and the Goldwaterism of the people who funded them shouldn't be conflated into a single phenomenon.

Anyhow, Brooks thinks the health care issue sort of just wandered away, or became unserious.

By 2010, however, both the Obama administration and the Tea Party opposition were out of step with the times. They both still thought the big political issues in American life were universal health care and the size of government.

No, that's getting it wrong on the Obama administration too, which did not think the size of government was a big political issue in American life. I don't believe Obama thought universal health care was "the big issue" either—it was just his issue, the thing he was willing to lose the 2012 election over. Which he didn't.

Also, whatever the polls said, it wasn't getting any less important, as the uninsurance rate kept creeping up and the cost of health care shot up year by year in ways no other country was experiencing.

In fact, another set of problems had magnified and come to overshadow the old set. This new set included:

First, the crisis of opportunity. People with fewer skills were seeing their wages stagnate, the labor markets evaporate. Second, the crisis of solidarity. The social fabric, especially for those without a college degree, was disintegrating — marriage rates plummeting, opiate abuse rates rising. Third, the crisis of authority. Distrust in major institutions crossed some sort of threshold. People had so lost trust in government, the media, the leadership class in general, that they were willing to abandon truth and decorum and embrace authoritarian thuggery to blow it all up.

Oh for fuck's sake, you know, this gets so fatiguing. If you take it seriously—the endless Brooks belief that government needs to mount a direct assault on declining marriage rates and trust in the authorities but doesn't need to do anything about poverty and economic insecurity—you can argue that the Obama administration did it all, not least through Obamacare.

The Obama administration was able to do something about wage stagnation, though it didn't start showing up in a big way until 2015:

The median American income grew faster in 2015 than at any point on record, according to a report released Tuesday by the Census Bureau.

White House officials were ecstatic with the news, with Jason Furman, the Chairman of President Obama's Council of Economic Advisors, saying on Twitter Tuesday morning that "I usually try to be restrained, but this is unambiguously the best Income Poverty and Health Insurance Report ever."

Besides the good news on income, the report also showed that the number of Americans in poverty fell by 3.5 million last year. The number of uninsured Americans also fell. More importantly, and striking, given the 99% vs. 1% rhetoric, the report clearly showed that incomes rose for every income segment in the country.

The rightwing prophecy that the Affordable Care Act would tempt employers to reduce their workers to part-time status so they'd be exempt from the insurance mandate didn't pan out; in fact the ACA has worked as an employment program in its own right, creating 2 million and more relatively high-paying jobs in the health industry.

The Affordable Care Act literally shrunk the divorce rate (before the ACA, people under 65 with serious medical issues were getting divorces to qualify for Medicaid, and the effect of Medicaid expansion on that is big enough to show up in the statistics; Brooks has likely seen only the dire rightwing predictions from 2010-13 that Obamacare was going to break up everybody's marriage, not the data showing that didn't happen). The Affordable Care Act also has given access to substance abuse treatment to 2.8 million people who didn't have it before.

As far as trust in public institutions goes, if you look at public attitudes toward the Affordable Care Act, as they've been developing since the election—people's faith that Trump would never take their health care away and their anger as they began to realize he might—you begin to realize that Obama's work on this actually won some reluctantly given trust, some feeling that government wasn't just out to get you, even a lot of trust.

If President Obama had made these crises the center of his administration, instead of the A.C.A., Democrats wouldn’t have lost Congress and the White House. If the Tea Party had understood the first two of these crises, there would have been no opening for Donald Trump.

In that sense you're damn right Obama is the cause of the Republicans' misery over their unpassable piece-of-shit health care bill. Then again the solution isn't exactly complex: what they need to do is stop fighting it—if you'd fix what you can, regulating deductibles, increasing subsidies and Medicaid access, restoring those risk corridors, taking the bill further "left", that might earn you some public trust of your own, but at least just drop this idea that you need to get rid of the thing.