Thursday, June 17, 2021

The ACA Survives, in One More Victory for Boring Old Liberalism

Plain vanilla American liberalism hasn't been particularly fashionable for a long time, and it certainly isn't now. Anyone who regularly consumes high-status media like NPR or the Wall Street Journal, or who spends any time at all in the Twitterverse, could well conclude that today's politics is mostly defined by a battle between a highly intellectualized, social identity-oriented, self-consciously "anti-establishment" left wing on one side and an array of conservative critics, both Trumpist and anti-Trumpist, on the other.

But when we shift our attention to what the government is actually doing, we see a policy-making apparatus that continues to be dominated by a familiar pragmatic liberal tradition representing the historical legacy of the New Deal and Great Society. The Affordable Care Act is one of this tradition's most important recent achievements, if it's appropriate to refer to a law passed more than a decade ago as "recent." And the Supreme Court's 7–2 decision, announced Thursday, upholding the ACA against what may well be the last in a series of major legal challenges only confirms the resilience of the center-left policy state in the face of dissatisfaction on both ideological sides.

The ACA is complicated. It's inelegant and kludgy. It was designed to patch up the most urgent perceived flaws in the existing health care system rather than to tear it down completely and construct a more efficient and coherent successor. It is easy for its strongest detractors to hate, but hard for even its strongest defenders to love.

And yet the ACA remains a representative model of policy-making because it had two critically valuable qualities: enough initial support to be enacted in the first place and a big enough constituency to protect it from subsequent retrenchment. For all of the well-argued critiques directed its way by dissenters on the left and right, neither side has demonstrated the ability to transform a purer ideological vision into achievable and sustainable policy. Decades of progressive attempts to replace the current health care system with a universal single-payer alternative have yet to bear fruit. Conservatives' philosophical opposition to government involvement in health care provision has historically been a politically potent force when working to block liberal reform proposals before they passed, as in 1994, or when mobilizing an electoral backlash immediately after enactment, as in 2010. But after Republicans gained full policy-making power in 2017, general anti-government sentiment turned out to be insufficiently strong to persuade enough politicians within the party to rescind the ACA's specific benefits once they had actually started flowing to the public.

This same pattern arises in a number of other issue domains besides health care: entitlement policy, education policy, environmental policy. The decades-long conservative project to redefine government's role in society has been largely unsuccessful, except for several rounds of tax cuts (never balanced by corresponding spending reductions) and a few smaller victories on the margins. Donald Trump abandoned previous Republican support for Social Security and Medicare reforms that had always been more effective at attracting damaging Democratic attacks than in producing actual legislative achievements. But Trump was hardly the first Republican leader to depart from shrink-the-government doctrine in search of votes

Conservative victories often amount to the successful obstruction of liberal initiatives, or even just a reduction in the rate of government growth, rather than actual rightward shifts in the direction of policy. As popular conservatism becomes more consumed with symbolic and cultural battles, such as the current conflict over the teaching of critical race theory in public schools, the movement's traditional primary objective of rolling back the modern welfare state is either moving down the agenda or increasingly delegated to the conservative judiciary rather than the elected branches of government. (As Thursday's ruling showed, judges may not always be much more eager to take on this assignment than executives or legislators have been.)

In the other ideological direction, an increasingly visible strain of progressive activism has certainly had a measurable effect on perceptions of the American political climate. But so far, its ability to directly impose policy has been mostly restricted to non-governmental institutions controlled by the highly-educated cultural left, such as media companies and liberal arts colleges. The new progressive style has yet to find a secure foothold in elective politics, even in Blue America—where are the socialist state governors? the leftist big-city mayors?—despite plenty of confident assertions that the Bernie Sanders campaigns and the AOC-aligned "Squad" foreshadow the near-term future of the Democratic Party. Conflicts in various left-dominated municipalities over police reform and defunding in the Black Lives Matter era, as well as other similar issues, suggest that there are still many unanswered questions about how this particular ideological framework can and will be converted into specific governing choices.

Traditional pragmatic liberalism is a perennial rhetorical target for people who think of themselves as committed to loftier ideals. On the right, social conservatives like Ross Douthat criticize it for lacking "a clear sense of moral purpose," suggesting that in our time it has become "somewhat exhausted." Purist activists on the left echo these themes, speaking of an age marked by the supposedly catastrophic failures of "neoliberalism" and representing the onset of "late capitalism"—implying that a non-capitalist future is surely soon to arrive.

But old-fashioned half-a-loaf liberalism has proven tough to replace. It's not just that revolutionary change is difficult to achieve in the American political system, though it is. There are also plenty of important constituencies invested in conventional liberal policy-making—classes of credentialed work-within-the-system subject matter experts, institutionalized interest groups that prize partial victories over none at all, and a large number of regular voters who hold moderately left-of-center views on domestic affairs and are wary of socialism and laissez-faire-ism alike. While critics on all sides yawn with impatience for the era of boring old liberalism to end, the boring old liberal ACA has just further entrenched itself, boring old liberals Joe Biden, Nancy Pelosi, and Chuck Schumer are working to enact more boring old technocratic incrementalist liberal policies, and boring old liberalism just keeps muddling through to prevail once again.