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Obamacare repeal: A political path never taken

David Shribman is executive editor of the Pittsburgh Post-Gazette

U.S. President Donald Trump is not simply working to repeal the health-care plan of Barack Obama. He is working to refute the conviction of Tommy Douglas.

It is almost certain that Mr. Trump never heard of Mr. Douglas, who fought for Saskatchewan's pioneering health-care scheme a half-century ago, just as it is certain that Mr. Douglas, who headed the province's Co-operative Commonwealth Federation and then the New Democratic Party, never contemplated an American president remotely like Mr. Trump.

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But Mr. Douglas argued that once government-mandated health care was imposed, the public would be so pleased with it that there would be no going back. He was basically right – in Canada. He is about to be proven wrong – in the United States.

Politicians from both U.S. parties are fighting right now about the virtues of Obamacare, the shape of the new Republican health-care program and the projections produced this week by the bipartisan Congressional Budget Office, which say that the plan Mr. Trump supports would eventually leave about 24 million Americans without insurance – a total that is almost exactly the combined populations of Quebec, Ontario, Manitoba and Saskatchewan.

Despite the controversies, despite the qualms among some conservatives and despite the outright opposition of every Democrat in the capital, almost nobody in Washington believes that Obamacare will survive the challenges Mr. Trump and many of his Republican allies are mounting. The Real Clear Politics polling average over the past three months shows that the public approves of Obamacare by a narrow 48.5-per-cent to 44-per-cent margin, but GOP opponents have control of both chambers of Congress and the White House and they are determined to redeem their campaign pledges to repeal Obamacare.

In doing so they are on the verge of doing what has never happened in U.S. politics before – retreating from a broad social-welfare plan passed in earlier times.

Both Social Security, the income supplement for the aged supported by Franklin Roosevelt and passed in 1935, and Medicare, the health-care plan for the elderly proposed by Lyndon Johnson and passed three decades later, had stubborn opposition, primarily from Republicans doubtful about the extension of Washington's influence in the economy. Indeed, a year after Social Security was passed, governor Alf Landon of Kansas, the 1936 Republican presidential nominee vowed, "To get a workable old-age pension plan we must repeal [Social Security]."

But by the time Dwight Eisenhower – the first Republican elected president since the passage of Social Security – was in his seventh month of office, he was saying that the "Social Security program furnishes, on a national scale, the opportunity for our citizens … to build the foundation for their security," adding in a message to Congress, "We are resolved to extend that opportunity to millions of our citizens who heretofore have been unable to avail themselves of it."

Republicans have toyed with mounting attacks against Social Security and, to a lesser extent, Medicare, over the decades, sometimes – especially in the early part of the 21st century – talking about privatizing the system. But the support for Social Security is so wide, and so firmly entrenched in all of the 435 congressional districts of the United States, that nothing became of it. Even under Ronald Reagan, efforts to address Social Security resulted in a bipartisan commission designed to ensure its survival, not to threaten its survival.

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That is why Republicans fought Obamacare so fiercely in the first place, believing that they would never be able to undo what the Democrats were able to accomplish. The measure passed without a single Republican vote.

The lesson of Social Security and Medicare was not lost on the Democrats, either. They believed that, once enacted, Obamacare would be immune to attacks – just as Mr. Douglas believed when he argued that once the CCF health plan was enacted into law, it would become part of the political landscape of Saskatchewan, despite a doctors' strike that won global attention. Indeed, by 1970 the concept had spread to the other nine provinces.

So in talking about scaling back, or eliminating, a broad social-services program, the Republicans are on a path that has never really been trod before. "The big ones have never been walked back," said Paul O'Neill, who had been part of Richard Nixon's domestic policy team and then was treasury secretary under George W. Bush. "This is a major departure. Ordinarily the only conversations about these programs have been about expansion."

One more piece of evidence that these are not ordinary times.

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About the Author
Executive editor, Pittsburgh Post-Gazette

David Shribman, executive editor of the Pittsburgh Post-Gazette, won a Pulitzer Prize for coverage of U.S. politics. More

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