Health Care Reform, Progressivism and ‘Making History’

The claim that health care reform “made history” highlights how fully the political debate hinges on ideas of progress.

Having finally succeeded in passing the massive health care reform bill that has dominated American politics for much of the last year, Democrats and liberals are now congratulating themselves on having “made history.” Their accomplishment is without question historically noteworthy. Like Social Security and Medicare, it marks a significant milestone in the development of the American welfare state. The enactment of the health care bill, however, stands out even from those legislative feats. After all, Social Security and Medicare, though certainly controversial in their time, were also somewhat popular when enacted—popular enough that they could be passed with bipartisan support. In contrast, the Democrats passed their health care bill with no Republican votes, and, in fact, over bipartisan opposition in the House of Representatives and against the clear and consistent opposition of public opinion.

The latter considerations—by calling to mind the widespread and deeply held disapproval of this undeniably significant accomplishment—remind us that “making history” is not always an unequivocally good thing. Fame is not the same thing as infamy, and perhaps as many names are carved indelibly in history for their perfidy and error as for any claim to greatness. Benedict Arnold is remembered along with George Washington, Neville Chamberlain along with Winston Churchill.

American liberals are, of course, well aware of this. Thus their contention that they have made history is not merely a claim to lasting notoriety but to something altogether more grand. They are claiming, in fact, not just a place in history, but the vindication of History—History with a capital H, understood not merely as a record of events, some good and some bad, but as a standard of judgment. As the term “liberal” gained a negative connotation over the last two or three decades, liberals more and more came to refer to themselves as “progressives.” This was a clever shift in rhetoric: progressives are presented as favoring “progress,” something that almost no one would oppose. To claim such a name, however, is more than mere political marketing. The title of “progressive” is genuinely apt to the extent that contemporary American liberals are believers in “progress”—specifically, progress as an inevitable result of the workings of the historical process. American liberals believe that history is not merely a record of events, but that it is a force moving in a certain, discernible direction—moving, in fact, toward an ever greater realization of the good in practice. For them, History is a gradual but unrelenting amelioration and perfection of the human condition. This, then, is the sense in which American liberals are claiming to have made history, a sense that was most clear, perhaps, in Harry Reid’s call, late last year, for the Republicans to join Democrats “on the right side of history.”

One could well question whether such a view of history is plausible. By “progress” most American liberals seem to have in mind not just a general improvement in the human condition, but also, more specifically, an increasing equalization of conditions. Their concern for equality has certainly been evident in the health care debate, in which liberals consistently emphasized the inequalities in the health care available to the rich and the poor. Viewed in this light, their claim that history can be understood as a progressive development of equality has a certain plausibility. One can easily see the history of the last century and a half as a record of the inexorable advance of welfare statism in the western industrialized democracies. On the other hand, there is ample room to doubt the historical inevitability or permanence of such “progress.” Recently, it has become possible for serious voices, examining contemporary trends, to question whether the welfare states of the west are economically sustainable in their present forms, let alone capable of pursuing an ever-increasing generosity. Taking a longer view, similar ambiguities remain. While it is certainly possible to view the history of the last five hundred or one thousand years as a progress in human equality and general wellbeing, one must nevertheless contend that nobody can, even on the basis of such a lengthy record, forecast the next five hundred to one thousand years.

Leaving aside the question of the validity of the liberal view of history, one can say at least this much about its consequences: the rise of the belief in History as Progress is a significant and ongoing source of much of the rancor in our political life. The commitment to Progress is one of the reasons our politics takes the form of a bitterly contested culture war. This happens because, as in the case of the recent health care debate, both sides sense that in every major policy question much more is at stake than the mere policy options at hand. Both sides believe—and correctly—that they are divided not just by a disagreement about the best means to commonly approved ends, but instead that they are involved in a clash involving their fundamental beliefs about the true nature of political life.

For liberals, the prospect of policy defeat—an apparent cessation of the Progress of History—or, worse, the prospect of the victory of conservative reforms—an unthinkable “turning back of the clock”—calls into question their most deeply held beliefs about the nature of human life itself. On the other side, conservatives sense that each proposed expansion of the welfare state involves not just an extension of the power of the state beyond its previous limits, but that the whole idea of limited government is itself at stake. After all, the liberal belief in progress cannot admit of principled, permanent limits to government power. Liberals believe that government is the necessary actor in at least midwifing progress. Since the progress for which they hope has no defined limit, they cannot admit, in advance, that any sphere of human life should be inaccessible to state supervision. Moreover, since the progress for which they hope is specifically understood as a progress in equality, they cannot exclude government from any area of human life in which inequality might manifest itself.

The recently passed health care bill was so hotly contested not because of mere partisanship—because of a ruling party’s desire to wield power after having won it and an opposition party’s desire to frustrate such efforts—but because both sides correctly divined that, in some sense, everything was at stake. Since liberals will not soon abandon their belief in progress, or conservatives their belief in limited government, the late liberal victory will likely prove to be not an end to our ongoing cultural war, but only the most recent flash point in it.

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