When the tweeter-in-chief castigated Senate Republicans as “total quitters”for failing to repeal the Affordable Care Act, he couldn’t have been more wrong. In fact, they showed zombie-like relentlessness in their determination to take health care away from millions of Americans, shambling forward despite devastating analyses by the Congressional Budget Office, denunciations of their plans by every major medical group, and overwhelming public disapproval.
Put it this way: Senator Lindsey Grahamwas entirely correct when he described the final effort at repeal as “terrible policy and horrible politics,” a “disaster” and a “fraud.” He voted for it anyway — and so did 48 of his colleagues.
So where did this zombie horde come from? Who ate Republicans’ brains?
As many people have pointed out, when it came to health care Republicans were basically caught in their own web of lies. They fought against the idea of universal coverage, then denounced the Affordable Care Act for failing to cover enough people; they made “skin in the game,” i.e., high out-of-pocket costs, the centerpiece of their health care ideology, then denounced the act for high deductibles. When they finally got their chance at repeal, the contrast between what they had promised and their actual proposals produced widespread and justified public revulsion.
But the stark dishonesty of the Republican jihad against Obamacare itself demands an explanation. For it went well beyond normal political spin: for seven years a whole party kept insisting that black was white and up was down.
And that kind of behavior doesn’t come out of nowhere. The Republican health care debacle was the culmination of a process of intellectual and moral deterioration that began four decades ago, at the very dawn of modern movement conservatism — that is, during the very era anti-Trump conservatives now point to as the golden age of conservative thought.
A key moment came in the 1970s, when Irving Kristol, the godfather of neoconservatism, embraced supply-side economics — the claim, refuted by all available evidence and experience, that tax cuts pay for themselves by boosting economic growth. Writing years later, he actually boasted about valuing political expediency over intellectual integrity: “I was not certain of its economic merits but quickly saw its political possibilities.” In another essay, he cheerfully conceded to having had a “cavalier attitude toward the budget deficit,” because it was all about creating a Republican majority — so “political effectiveness was the priority, not the accounting deficiencies of government.”
The problem is that once you accept the principle that it’s O.K. to lie if it helps you win elections, it gets ever harder to limit the extent of the lying — or even to remember what it’s like to seek the truth.
The right’s intellectual and moral collapse didn’t happen all at once. For a while, conservatives still tried to grapple with real problems. In 1989, for example, The Heritage Foundation offered a health care plan strongly resembling Obamacare. That same year, George H. W. Bush proposed a cap-and-trade system to control acid rain, a proposal that eventually became law.
But looking back, it’s easy to see the rot spreading. Compared with Donald Trump, the elder Bush looks like a paragon — but his administration lied relentlessly about rising inequality. His son’s administration lied consistently about its tax cuts, pretending that they were targeted on the middle class, and — in case you’ve forgotten — took us to war on false pretenses.
And almost the entire G.O.P. either endorsed or refused to condemn the “death panels” slander against Obamacare.
Given this history, the Republican health care disaster was entirely predictable. You can’t expect good or even coherent policy proposals from a party that has spent decades embracing politically useful lies and denigrating expertise.
And let’s be clear: we’re talking about Republicans here, not the “political system.”
Democrats aren’t above cutting a few intellectual corners in pursuit of electoral advantage. But the Obama administration was, when all is said and done, remarkably clearheaded and honest about its policies. In particular, it was always clear what the A.C.A. was supposed to do and how it was supposed to do it — and it has, for the most part, worked as advertised.
Now what? Maybe, just maybe, Republicans will work with Democrats to make the health system work better — after all, polls suggest that voters will, rightly, blame them for any future problems. But it wouldn’t be easy for them to face reality even if their president wasn’t a bloviating bully.
And it’s hard to imagine anything good happening on other policy fronts, either. Republicans have spent decades losing their ability to think straight, and they’re not going to get it back anytime soon.