It is said that history is written by the victors. Maybe so, but in the United States over the last century, history has largely been written by the liberals. This inevitably leads to bias, which inevitably operates on even the most impartial of minds. While most historians try to be fair and judicious, the fact that the overwhelming majority of them are on the left generates an inexorable tilt to the American historical narrative.
It is often subtle, but it is there — for instance in the different ways that presidents are remembered, depending on their politics. Richard Nixon is roundly and regularly assailed for the appearance of impropriety in the Checkers Scandal. Meanwhile, LBJ has basically been forgiven for potentially cheating on his taxes. And virtually nobody remembers that FDR probably called off the IRS to protect Johnson, his loyal protégé. The same FDR vigorously pursued a tax fraud case against Andrew Mellon, whose only ostensible misdeed was serving as treasury secretary for the preceding, Republican administrations.
This tilt is similarly evident in rankings of American presidents. Take this 2010 poll of historians by Siena College. If FDR, Truman, and Wilson had been conservative or Republican, a lot of their sins — on corruption, on race, on violating property and civil rights — would weigh much more heavily upon them. By the same token, William McKinley, Calvin Coolidge, Ronald Reagan, Dwight Eisenhower, and Gerald Ford are underestimated — likely because they refused to grow the national leviathan at the “appropriate” pace.
In other words, bias often gets down to which facts are emphasized and which are downplayed, or ignored altogether.
And bias is not exclusive to presidential history. As I point out in my new book, A Republic No More: Big Government and the Rise of American Political Corruption, the expansion of the state is largely celebrated by (mostly liberal) historians, yet its vices tend to be ignored.
Most mainstream historians celebrate myriad government expansions as good, right, and utterly necessary. The more power that is centralized in Washington, D.C., especially in the office of the president, the better. What I have found, however, is that those “wondrous” moments of state expansion are often followed … several years down the road, of course … by a phenomenon that gets left out of the mainstream story: political corruption.
It is the liberal cocoon that is wrapped around American history. And it is not spun through intentional deceit, nor are facts distorted. It is the inevitable bias of human beings to value certain facts over other facts. That is how we all work; liberals are no exception.
A recent example of this tendency is found in an essay in the New Yorker by Princeton historian Julian Zelizer, describing the passage of Medicare. In writing my book, I had occasion to study Medicare in some detail, and I can aver that each of Zelizer’s points is factually correct. It is his frame with which I disagree, because certain facts are excluded in service of that narrative.
Zelizer’s telling of Medicare’s enactment is fairly conventional. If you’ve read anything about the history of the program, you’ll know the story, which often reads like one of the fairy tales I read to my little boy. In the 1940s, good liberals were acutely concerned about providing health care through the federal government. Yet time and again they were thwarted by bad conservatives and selfish interest groups like the American Medical Association (AMA). Poor Harry Truman and John Kennedy wanted to make it happen, but they just couldn’t pull it off. Enter LBJ. With loads of grit and plenty of determination — leavened by just the right amount of Southern folksiness! — LBJ finally moved the wheel of history a little closer to its final destination. Huzzah!
Two important points are often left out of the story.
First, desperate to win over the AMA, LBJ, Wilbur Cohen (his point man on the project), and Wilbur Mills (chairman of the Ways and Means Committee), wrote a piece of legislation that was extremely favorable to that interest group, almost to the point of obsequiousness. The liberals clamoured for AMA buy-in, and they basically gave medical service providers the keys to the kingdom. As I write in my book:
The regulatory structure of the program was shockingly weak, considering how much money it would soon come to spend. For starters, the law made clear that provider participation was voluntary and open to any licensed practitioner, which would become problematic in the future as the government today lacks the capacity to discriminate between providers on the basis of quality. What’s more, the government employed intermediaries like BlueCross BlueShield to serve as claims processors. Thus, medical service providers did not even have to interact directly with the government. They dealt instead with third parties who, thanks to frequent interactions with the providers, were naturally disposed to their interests.
That is really just the tip of the iceberg, as I go on to detail. And it is a problem that more or less persists to the present day. If you want to know why waste, fraud, and abuse is such an intractable problem with the Medicare program, you often do not need to look farther than its design. The government does not provide medical services directly to citizens. Instead, it outsources it via private parties. These private groups, in turn, lobby the government aggressively to ensure that the mechanics of the program remain remarkably favorable to their interests.
Second, the actual construction of the bill was incredibly sloppy, almost inconceivably so. The liberals had been planning for something like Medicare Part A, i.e. hospital insurance. Congressional Republicans, led by John Byrne, threw them a curveball by offering “Bettercare,” which ultimately became Medicare Part B, or coverage for outpatient care. The AMA, meanwhile, proposed “Eldercare,” which ultimately became Medicaid. Mills — who did not want to waste time debating the relative merits of each — decided to combine them into a single program. A “three-layer cake” as it was called. And the good liberal historians shout: Huzzah for Wilbur Mills (who later resigned his chairmanship in disgrace after being caught cavorting with a stripper known as the “Argentine Firecracker,” but nevermind)!
The problem, though, is that the Bettercare and Eldercare parts of the cake were half-baked. Medicaid, as we all know, is not a well-functioning program — because it was never meant to be. It was a political ploy by the AMA to dissuade Congress from a hospital-insurance program. Bettercare was also poorly conceived, really just part of the GOP’s strategy to ground its opposition to Democrats in positive alternatives. Years later, Robert Ball — former commissioner of Social Security — would say this about Part B:
The provisions of the hospital insurance part—Part A—were really honed over several years during the early 1960s. . . . Part B, on the other hand, came out of an unexpected Ways and Means compromise. Mills took the physician part of John Byrne’s voluntary plan based on an Aetna health insurance policy and made it a voluntary part of the new federal program . . . it really wasn’t a good proposal . . . There were very few handholds for any kind of cost controls in Part B.
Why rush such a massive expansion of federal authority? The answer: politics. LBJ knew there was but a brief window to get a law enacted. Speed was of the essence. And, considering how consequential this program has become, it was passed with astonishing quickness: the three-layer cake approach came together in early March, 1965; Ways and Means passed the bill in late March; the full House acceded in early April; and LBJ signed it at the end of July.
Is it any wonder this program has been such a headache ever since?
All in all, the liberal narrative about Medicare is the same as the general understanding of expansive federal power. It is celebratory (these were good expansions!) and even hortatory (we must do more!).
My book strongly objects to these themes. Instead, I find two persistent tendencies that should give us pause — both of which are evident with Medicare. First, expansions of the federal state tend to be ad hoc, ill-conceived, and full of unfortunate side effects. Second, they become breeding grounds for clientelism: private interests draw a benefit from public policy; they dedicate a portion of that largesse to the political process to ensure their revenue streams persist; the government, particularly Congress, cannot resist such pressure; and ultimately the private interests dominate what was supposed to be public policy.
These patterns are related. When politicians want to expand government power, they are concerned primarily with political questions — specifically, how to get the bill passed, and then how to inoculate it from future threats. They are thus focused on speed — speed in legislative passage and the speedy delivery of benefits to targeted groups — rather than proper institutional design. They are usually content to allow later generations work out the bugs. The problem, of course, is that oftentimes the bugs never get worked out. This is why big government tends systematically to favor well-placed and well-heeled interest groups.
James Madison called this factionalism. Liberals today label it corporate welfare. Conservatives are wont to call it cronyism.
My word for it is corruption.
Jay Cost is a staff writer at the Weekly Standard. His new book, A Republic No More: Big Government and the Rise of American Political Corruption, is now available.
