Health Care: Individuals and the Masses in History

So it’s done—done to a turn—for the time being, at least. The last-gasp attempt of Republicans to repeal and replace Obamacare.
    When historians try to rough out explanations for a sequence of events, they experience a constant tug of war between two modes of thinking: the shaping of history through larger social patterns actuated by the actions of thousands or even millions of people; and the consequential acts of individuals who change the course of history. Neither way of thinking is determinative, and good historical explanations depend on both. 
    But in this final turn of the health care debate, events have fallen out in a way that emphasizes the role an individual can play. Senator John McCain has acted in ways that often seemed contradictory over the past few days. Diagnosed with an aggressive brain cancer, he was lionized by the press, cable news and his colleagues as he returned triumphantly to the Senate to make a stirring speech imploring his colleagues to reinstate “regular order,” the traditional Senate procedures that would allow Democrats and Republicans alike to take part in creating a health care compromise. Then he voted in favor of the motion to open debate over the latest Republican bills. Many thought that vote undermined his own high sentiments, because the short amount of debate time and no committee hearings was exactly what Sen. Mitch McConnell wanted, as a means to push through some sort of stealth repeal.
    McCain further undercut his own rhetoric when he appeared willing to vote for a “skinny repeal” measure, so long as Rep. Paul Ryan could assure him unconditionally that Republican members of the House conference committee would not actually pass the bill the Senate was about to report out, a bill McCain condemned as slapdash, haphazard and harmful to the public health. If Ryan had acquiesced, McCain seemed ready to give his assent, despite the fact that the members of Congress who conferenced to work out a deal would be only Republicans, trying to cob together something even more slapdash and based also on the House bill, which even Trump had earlier condemned as too “mean” in its provisions. How would that have been a return to comity and compromise?
    As it happened, Ryan danced around the demands of McCain, Lindsey Graham and others, issuing reassuring words but guaranteeing nothing. Those honeyed generalities were enough for all the Senate Republicans to walk the plank and vote for their skinny measure, save for Susan Collins and Lisa Murkowsky. Those who went along included Portman, Heller, Capito and others who had for weeks nobly shed crocodile tears about wanting only the best for their constituents. 
    McCain refused to walk, joining Collins and Murkowski and providing the critical final vote that made the trip to conference a bridge too far. Talk about the effect of a single vote!...though it must be remembered that the strong stands of Collins and Murkowski were equally crucial. In such situations, individuals can by their deeds truly shape history in significant ways. I can’t help suspecting that McCain was able to take that step partly because the news of his cancer freed him from the partisan pressures that McConnell used to corral the rest of his Republican cohort. 
    All to the good. But neither should historians forget the crucial role that was played by the masses of individuals over the longer arc of health-care reform. As was eloquently noted by Josh Marshall, a guy with training as a historian who now runs Talking Points Memo, 

​With all this, though, all of the politicians were like small boats on a vast ocean. They made critical choices – some to their honor, Murkowski, others to their infamy, Heller; they executed strategies. But small boats on a vast ocean, no matter how expert their navigation, are ultimately subject to and at the mercy of waves and winds and tides. And here, to extend our metaphor, the ocean and the tides were activists and non-activists making phone calls, showing up at town halls, emailing, in some cases reaching beyond partisan affiliation to say in various ways that this was not right. The victory here is really millions, tens of millions of people who made noise on a sustained basis over months. Noise is comparatively easy; sustained noise over months is seldom possible. It is an immense and bracing victory for what was at the end of the day very much grass-roots, organic activism. Republicans were finally unable to overcome the common sense logic that the true measure of reform in the public interest was how a piece of legislation helped or harmed how many people.

    Even now, the fight is not over. And how America’s political parties and Constitutional system emerge from the stresses of the Trump whirlwind—to say nothing of how the health-care system may fare being run by its mortal enemies—these are topics for another day. For now, on at least this one occasion, a few key individuals and the masses conspired to do good.