Details, however, can be ironed out. The larger reason Congress has failed to come up with a bill that doesn’t take health insurance away from an estimated 22-24 million Americans is that many Republicans don’t think those people deserve health insurance in the first place. The sticking point here is one of cultural attitudes rather than insurance technicalities and it hinges on how you view the idea of responsibility.
Across the middle of the 20th century Americans shared a civic sense of responsibility that ran on a two-way street: the responsibilities that citizens had to the nation (as in John Kennedy's "ask not what your country can do for you, but what you can do for your country") and, in turn, the nation's responsibility to its citizens (embodied in Franklin Roosevelt's 1941 "Four Freedoms" speech).
By the 1970s, however, that civic sense of responsibility was eclipsed by one in which responsibility was seen as intensely individualistic. The nation owed you nothing, and you owed nothing in return. “There is no such thing as society,” Margaret Thatcher told an interviewer in 1987, only “individual men and women,” and her best political buddy Ronald Reagan wholeheartedly agreed.
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In this new cultural context, health insurance is no longer seen as a basic necessity that every American ought to have but as your individual responsibility. And thus if you don’t have coverage, that’s your own fault. That’s what House Oversight Committee Chair Jason Chaffetz (R-Utah) said back in March when he complained that “maybe rather than getting that new iPhone that they just love and they want to go spend hundreds of dollars on that, maybe they should invest in their own health care.”
Some Republicans think individual health outcomes are entirely a matter of personal responsibility, too. That’s what Rep. Mo Brooks (R-Ala.) meant when he told CNN that people without pre-existing medical conditions “have done things the right way,” implying that others had made bad personal choices and so don’t deserve health insurance.
Trump’s pre-holiday announcement was at least honest. Repealing ACA has always been the goal not because it has failed to provide access to health insurance to the previously uninsured but precisely because it has. In that sense, it violates the GOP’s sense of who deserves to be healthy and who doesn’t.
Steven Conn is the W. E. Smith Professor of History at Miami University.