The overarching theme of The Ten Year War is that, for at least a few more years, any major legislation will follow a political process similar to that of the Affordable Care Act. One must grasp “the true nature of the opposition..secure at least some buy-in” from the opposition (p.398). But, policy making today is changed by the ongoing political polarization across America as well as the need for social media-friendly soundbites that neglect any nuance of meaningful widespread public understanding. The ultimate issue any ambitious policy maker will face is taking a good idea and figuring out what can actually survive the political process. The healthcare system we see today is a product of such compromises.
In describing the history of healthcare legislation in America, the author reminds me of Stayin Alive, a book I read about union political power in the 1960s and 70s. The author describes the effort by politically potent unions to “pressure Democrats to hold off, figuring the extra leverage would lead to a better overall [healthcare] package. It didn’t,” (p24). Furthermore, trust in government declined in the midst of major civil rights legislation, which led a “large swath of white voters [to be] angry over federal interventions on behalf of African Americans,” (p25). It didn’t help that Reagan fostered a distrust by American voters in the government he ran, which led Americans to be fairly suspicious of any major social legislation for decades to come.
Demonstrating a significant indicator of the political shift over the last 25 years even with the same people, the author cites internal Republican conflict: “McConnell was primarily focused on gaining and keeping power for his party. DeMint was trying to change the party itself,” (p189). As McConnell caught on that voters liked the shift rightward, Republicans who were passionate about health policy and engaged in negotiations could not vote to approve the ACA if they wanted election support. This (largely successful) effort to shift the Republican party further right has now been taken up by an increasingly powerful Freedom Caucus with the likes of Marjorie Taylor Green and Lauren Boebert. Conversely, an ideological comparison (though less harmful) is that of the Progressive Caucus. I want to be careful to note here that Progressive Caucus is generally not inciting violence and is an ideological counterpart, not equally bad or good.
The book documents the long term shift Republicans have focused on. People today wonder how Florida, for example, has become so right-wing fascist. The answer is that the effort began almost 50 years ago. One example can be found in right-leaning courts across the country. Another example can be found in the Federalist Society, which began in the 1970s as a law student organization and grew into an association for conservatives who believed there was a “liberal hegemony over both academia and the courts” (p255). Overall, I found this book to be a fascinating inside look into one of the most significant pieces of legislation since FDR. This book has far-reaching insightful political analysis related to both health policy and partisanship in America.
Many thanks, Jeremy, for this recommendation.
Miscellaneous quotes:
“‘The work goes on, the cause endured, the hope still lives, and the dream shall never die,’” from Ted Kennedy (p104)
“There is common strength in common vulnerability,” (p396).