On Hamilton, Madison, the Origin of the Two Parties, Ted Kennedy and the GOP Health Care Bill

Tom reflects on 1790, 2010 and 2017.

Alexander Hamilton was not very happy.  Hamilton had just delivered his opus, a report on the credit situation of the United States, and what to do about it, to the very first Congress.  The report was requested by Congress not long after George Washington had appointed Hamilton to be the first Treasury Secretary, and was widely anticipated.  Hamilton, in typical fashion, went far beyond the assignment, and delivered, essentially, a blueprint for how to achieve his vision of a strong, centralized U.S. government, replacing the ineffectual government under the Articles of Confederation.  Among his principal recommendations was the assumption by the new government of all state debts, which then amounted to a whopping $25 million.

Hamilton was unhappy because his intellectual partner, James Madison, had just launched a broadside attack on Hamilton’s report, a critique that dumbfounded Hamilton.  Just two years before, the pair had written 80 of the 85 Federalist Papers that were so instrumental in securing passage of the Constitution, thereby replacing the Articles and setting our nation on its unified course.  Madison was the strongest voice in Congress, and his blessing, which Hamilton took for granted, was crucial to passing Hamilton’s plan.  But Madison, it turned out, was wary of a strong, centralized government, and he knew the assumption of states’ debts would irrevocably establish the federal government’s preeminence over the states. 

And so began the battle still being waged in Washington, DC, today over the power of the federal government.  Hamilton and Madison would become arch-enemies, Hamilton (and President Washington) favoring – to put it mildly -- a strong, centralized government, while Madison (joined by the new Secretary of State, Thomas Jefferson), fearing the same, and favoring states’ rights instead.  The party names have changed since the time of the Federalists and Anti-Federalists, but the Dems and the GOP carry on the debate.

It is hard to find an issue that better exemplifies the two underlying party philosophies than the health care insurance debate.  The Dems believe in a strong role for the federal government, expressed through Obamacare, which sought to subsidize health insurance for the previously uninsured through an expansion of Medicaid, paid for by taxing the wealthy, and requiring a commitment of all Americans to enroll in health insurance program, the so-called mandate.  The GOP considers Obamacare to be yet another massive federal entitlement program, and for years argued for its repeal and a return to a market-driven system, with no “forced choices” such as the mandate.  Once in power, however, Trump realized that simply “repealing” the now-popular Obamacare would leave him and the GOP open to huge criticism, and thus announced a goal to “replace” it as well.

The divide reveals the effects of the two philosophies in ways rarely so starkly quantified    It is a pretty clear choice, and the CBO analysis makes the trade-off clearer still.  The new Senate bill will result in 22 million fewer Americans with health care coverage, and would save roughly $300 billion over ten years.  Under the GOP plan, the more limited government approach would give the wealthiest Americans a huge tax cut and deny coverage to poorer and older Americans, while eliminating the mandate of insurance coverage.

Which brings me to Ted Kennedy.  Perhaps no public official worked harder over his career than Kennedy to expand health care coverage (Kennedy’s and the Dem’s true goal was universal coverage via direct government insurance, essentially Medicare for all).  How thrilled Kennedy surely must have been in 2009 to see Obamacare moving through Congress; not universal care, perhaps, but strong enough to cut the number of uninsured in America from 50+ million to half that.  And success seemed assured, because the Democrats controlled the Presidency and both houses of Congress, indeed they had 60 certain votes in the Senate, enough to pass the bill without a single GOP vote.

Fate would, of course, intervene, and Kennedy would die in August, 2009, before he could cast one of those 60 votes.  And a Republican, Scott Brown, would, shockingly, win his seat.  Obama would get his bill though, and the GOP House would go on to vote to repeal it 60 more times.  Obamacare in practice did reduce the number of uninsured by tens of millions, but the Supreme Court, while upholding (surprisingly) the constitutionality of the bill, made the states’ Medicaid expansion requirement optional.  Obamacare’s various flaws inhibited its effectiveness, and in a number of states the number of insurers remained low.

Kennedy would not have been surprised by Obamacare’s defects. He would have seen the bill in a clear-eyed manner – landmark legislation that went far in achieving far greater coverage, but with defects, in need of legislative improvement.  “Never let the perfect be the enemy of the good” he would intone; his legislative philosophy always favored passing a good-but-not-perfect bill and then fixing it over time.  In Ted Kennedy’s Senate, this was the way it was.

But the GOP has, in seven years, refused to follow that dictum, choosing to repeal rather than engage in the needed fixes.  And thus, now, we have the ”repeal and replace” madness, with a Senate bill that is only slightly less “mean” (to use Donald Trump’s own words) than its House counterpart.  The fractured GOP hates the bill from both the far right and from the moderate center, and in reality, it is a garbage bill in all ways.

Hamilton could have predicted the folly of “repeal and replace”.  As he said, “Whoever considers the nature of our government with discernment will see that though obstacles and delays will frequently stand in the way of adoption of good measures, yet when once adopted, they are likely to be stable and permanent.  It will be far more difficult to undo than to do.”  Hamilton also decried smallminded legislators who followed their constituents rather than lead them.  He bemoaned, “The inquiry constantly is what will please, not what will benefit, the people.”

How did Madison’s Congress ultimately pass Hamilton’s program?  In the best political tradition, the way it has been practiced from 1790 until very recently, a deal was cut, the first major compromise in our legislative history.  Hamilton and Madison went to dinner at Jefferson’s house, in our young nation’s first capital in New York City.  And by the time dinner was over, Hamilton would have his bill, and Jefferson and Madison would have what they wanted, which was that the permanent site of the capital would border their beloved Virginia, right on the Potomac, in what would become – yes, Washington, DC.

The GOP of the 115^th Congress (or its immediate predecessors) does not appear to be capable of doing what Hamilton, Madison, Jefferson and Kennedy would have done – reaching a compromise with the Dems and fixing the ACA, which would actually both please and benefit the people.   The undoing is exposing the GOP’s dysfunction, putting them in a lose/lose debacle, where passing the bill could very well be worse than failing to pass the bill.