David Brooks

The Republican Health Care Crackup

CreditCreditStephen Crowley/The New York Times

The Republican health care bill could represent the moment when the old order of American politics completely cracks up, the end of a certain era in American politics.

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.

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.

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.

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.

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.

Trump came along and exploited these crises. But if his administration’s health care approach teaches us anything, it is that he has no positive agenda for addressing them. He can tap into working class anxiety negatively, by harnessing hostility toward immigrants, foreigners and the poor. But he can’t come up with a positive agenda to make working class life more secure.

So we have a group of Freedom Caucus Republicans who still think the major problems in the country today can be cured with tax and spending cuts. We have a Trump administration that has populist impulses but no actual populist safety net policies. And we’ve got a Republican leadership in Congress mired in Reagan-era thinking and trying to pay lip service to every obsolete prejudice in the various wings of the party.

You end up with this hodgepodge legislation that pleases nobody and takes the big crises afflicting our country and makes them all worse.

The Republican health plan would make America’s economic chasm worse. It would cut health subsidies that go to the poor while eliminating the net investment income tax, which benefits only the top 1 percent.

The Republican plan would further destabilize the social fabric for those at the bottom. Throwing perhaps 10 million people off the insurance rolls will increase fear, isolation, social tension, chronic illness, suicide and bankruptcy.

The Republican plan will fuel cynicism. It’s being pushed through in an elitist, anti-democratic, middle of the night rush. It seems purposely designed to fail. The penalties for those who don’t purchase insurance are so low they seem sure to guarantee Republican-caused death spirals in the weaker markets.

This thing probably won’t pass, but even if it passes it will probably lead to immense pain and disruption. That will discredit market-based social reform, cost the Republicans their congressional majorities and end what’s left of the Reagan-era party.

It will also point the way to a new era.





A version of this article appears in print on , Section A, Page 31 of the New York edition with the headline: The G.O.P. Health Care Crackup. Order Reprints | Today’s Paper | Subscribe