In pushing health care reform, President Barack Obama is confronted by contemporary critics and haunted by history. Obama has to learn from the last Democratic president’s failure. Bill Clinton also championed health care reform. Moreover, Obama cannot forget that Americans are ambivalent about big government, not only since the Ronald Reagan era but since the American Revolution.

Americans are torn. Most retain enough of their nation’s historic fear of executive power to dislike big gov- ernment in the abstract. But after 75 years of Franklin Roosevelt’s New Deal and Harry Truman’s Fair Deal, of John F. Kennedy’s New Frontier and Lyndon Johnson’s Great Society, Americans are addicted to many of the government programs that together make their government big, their tax bills high, their bureaucracy dense " as well as their society a kinder, gentler place to live. Usually, Democrats miscalculate by overlooking this traditional fear of big gov- ernment; Republicans err by overstepping and eliminating essential programs that Americans now take for granted.

Although the American Revolution was far less radical than the French and Russian revolutions, Americans did rebel against executive power. The revolutionaries’ experi- ence with the King of England " and his governors in the colonies " soured a generation on strong, centralized government. The younger men of the revolution such as Alexander Hamilton, who assisted George Washington in trying to win the war, better understood the need for an effective government. They pushed for the new constitution in 1787, replacing the Articles of Confederation that bore the mark of the revolutionary struggle by keeping the national government weaker than the states, and the executive impo- tent compared to the Congress.

Still, the Constitution established a federal government that was not supposed to overwhelm either ”œWe the People” or ”œthese United States,” as the country was called at the time. Moreover, there was a strong ethos of self-sufficiency. People were supposed to take care of themselves, especially considering America’s riches.

This question of how vigorous the new federal govern- ment should be split George Washington’s cabinet. Secretary of State Thomas Jefferson, having opposed execu- tive power so eloquently in the Declaration of Independence, fresh from admiring the French Revolution up close, led the charge with his friend James Madison against a strong government " and executive. When Secretary of the Treasury Alexander Hamilton proposed a national nank in 1791, Jefferson opposed this power grab by subtly mis- quoting the Constitution. Analyzing what he called the Constitution’s ”œfoundation,” Jefferson wrote to Washington that the 10th Amendment of the Constitution declared that ”œall powers not delegated to the United States, by the Constitution, nor prohibited by it to the States, are reserved to the States or to the people.” Jefferson feared that taking ”œa single step” beyond Congress’s clearly drawn boundaries meant seizing ”œa boundless field of power,” with no limits. In fact, the Constitution reads ”œthe” powers, not ”œall” powers. The original text still pre- serves the prerogatives of the state and the people, but less globally.

Pushing back, Hamilton hastily drafted his opinion defending the Bank of the United States as constitu- tional. Hamilton endorsed a ”œliberal” reading of what is known as the ”œelas- tic clause,” article I, section 8, author- izing the new Congress ”œto make all laws necessary and proper for carrying into execution” the powers granted to the federal government. Appreciating the clause’s ”œpeculiar comprehensive- ness” regarding the government’s many implied powers, Hamilton said that Jefferson’s strict reading made the clause unduly ”œrestrictive,” an ”œidea never before entertained.” Hamilton said it would be as if the Constitution only authorized laws that were ”œabsolutely” or ”œindispensably” ”œnec- essary and proper.”

This Hamilton-Jefferson divide defined the debate for more than a century. Jeffersonian liberals wanted small, non-intrusive government, thinking of farmers as ideal citizens, and trusting self-sufficiency over any kind of government patronage. Hamiltonian conservatives wanted a larger and more vigorous government to help America develop, trusting pri- vate-public partnerships to serve the economy and the citizenry.

While saving the union in the 1860s, President Abraham Lincoln articulated a vision of the nation, united, effective and supreme, forever changing the power balance between the federal government and the states. After the Civil War, these United States became the United States. Moreover, the often forgotten part of Abraham Lincoln’s Republican Party agenda advocated a more activist approach to helping farmers and labourers, using national power to improve individuals’ quality of life.

With the growth of government " and corporations " during the Civil War, with the rise of a national curren- cy (the greenback), a national debt and national income taxes, American busi- ness leaders noticed that government involvement could restrict their growth as much as feed it. In what the political scientist Clinton Rossiter called ”œthe Great Intellectual Train Robbery of American History,” conser- vative business leaders hijacked Jeffersonian small-government liberal- ism to suit their own purposes. The ”œlaissez-faire” doctrine they embraced suggested that government should step back and let corporations thrive. Connected to this hands-off policy was a notion that the poor could fend for themselves " or be taken care of local- ly, by relatives, churches, volunteers.

As the nation grew, so did the gov- ernment, and so did the sense of col- lective responsibility. Both the rural-based Populist movement of the 1870s, 1880s and 1890s and the more urban-based Progressive movement that began in the 1890s and lasted through the 1920s mobilized the gov- ernment to protect the people against corporate fat cats and the vicissitudes of life. Still, the Great Depression of the 1930s initially highlighted the lim- its of Progressivism " and the contin- uing American allergy to dramatic government intervention. Thomas Jefferson’s ideas survived, propped up by private-property-protect- ing business interests that rejected government redis- tribution or regulation as anti-American.

The despair spreading through society, combined with the hopes generated by radicals in Europe and Soviet Russia, challenged American stability and values. While only a few actually waved the banner of revolu- tion, many feared that the American economic system was broken, and the sclerotic American political system made it unfixable.

In these dark days, Franklin D. Roosevelt’s infectious optimism brightened America’s mood, while adjusting the country’s ideology. Roosevelt’s ”œFirst Hundred Days” in office set a template of presidential action and established numerous precedents for direct government intervention in American life. Mixing Jefferson’s democratic populism with Hamilton’s top-down centralization, Roosevelt created big-government lib- eralism. ”œI am not for a return to the definition of liberty under which for many years a free people were gradual- ly regimented into the service” of cap- italism, Roosevelt said. Liberalism ”œis plain English for a changed concept of the duty and responsibility of govern- ment toward economic life.”

Using appeals to the collective, jus- tifying his emergency actions with military analogies, Roosevelt offered a three-pronged program. First, he mobilized the power of government to offer immediate relief, shifting the responsibility from churches, commu- nity groups and relatives to the local, state and federal governments. Then, he tried to jump-start a recovery, put- ting the government in the business of micromanaging the economy " and violating the long-standing American aversion to federal budget deficits. Finally, he sought broader reforms to institutionalize the changes and avoid a repeat.

Suddenly, the executive branch was choreographing currency shifts, bring- ing electricity to the South, eliminating corporate abuses, subsidizing individual homeowners. The government provided the old with pensions, the disabled with support and the poor with suste- nance while hiring millions through a new ”œalphabet soup” of agencies, the CCC (Civilian Conservation Corps), the PWA (Public Works Administration), the AAA (Agricultural Adjustment Adminis- tration) and the NRA (National Recov- ery Administration). The ”œfirst duty of government is to protect the economic welfare of all the people in all sections and in all groups,” Roosevelt said in a 1938 fireside chat. This casual statement reflected a revolutionary departure from Alexander Hamilton’s vision, even more so from Thomas Jefferson’s.

The Social Security Act of 1935 was arguably the single most dramatic New Deal reform. The Act helped the elder- ly poor immediately and began a fed- eral pension plan gradually. It eventually offered unemployment insurance, federal aid to dependent mothers and children, and assistance to the blind and handicapped. Half a century of Progressive agitation culmi- nated in this legislation. Roosevelt made this great leap seem like a logical next step. His genius for making revo- lutionary changes appear inevitable built popular support for these auda- cious steps. The Democratic Party became America’s party, the party of activist government protecting the middle class and the poor.

Roosevelt wanted to provide ”œcra- dle to grave” security, but con- structing a workable plan took years. Advisers and activists debated whether there should be cash grants or welfare programs, whether support should be national or state-based, whether social welfare guaranteed dignity or destroyed individual responsibility. Such comprehensive social insurance deviated from American constitutional practice and offended many conserva- tives, both rich and poor. The National Association of Manufacturers blasted this attempt at ”œultimate socialistic control of life and industry.”

To soften the blow, Roosevelt injected an all-American centrist twist into this legislative master stroke. Workers would pay into the Social Security system for decades before get- ting their payouts. This innovation reinforced the sanctity of private prop- erty, individual dignity and govern- ment centrality. ”œWe put those payroll contributions there so as to give the contributors a legal, moral and politi- cal right to collect their pensions and their unemployment benefits,” Roosevelt explained. The individual contributions also guaranteed the pro- gram’s future. ”œWith those taxes in there,” Roosevelt declared, ”œno damn politician can ever scrap my social security program.”

After vigorous debate, most mem- bers of Congress could not oppose helping the American com- munity’s weakest, sickest and oldest members. The House passed the bill 371 to 33. The Senate bill passed two months later, in June 1935, 76 to 6. Roosevelt’s Social Security Act truly was a bipartisan bill enjoying overwhelm- ing support.

Roosevelt’s ”œNew Deal” did not end the Great Depression. But it reas- sured Americans. It repositioned the government and the president in the centre of American political, economic, and cultural life. The advent of The Second World War jump-started the economy " and launched a half-cen- tury of unprecedented economic pros- perity. America became the world’s first mass middle-class society. The war also brought about a level of government intervention, regulation and, of course, taxation that would have been denounced as ”œBolshevik” by millions at the start of Roosevelt’s reign. But step by step, improvisation by improvisa- tion, speech by speech and crisis by cri- sis, Roosevelt had brought Americans to a new approach " and understanding. Europeans and Canadians remained surprised by America’s limited welfare state; thoughtful Americans with some sense of history were surprised at how far this initially reluctant giant had moved toward government activism.

Still, for all his talk of ”œcradle to grave” coverage, FDR could not get any bill for universal health care out of committee. Harry Truman’s Fair Deal expanded Roosevelt’s program, but Truman was no more successful in get- ting a health care bill to the floor of the Congress. In the 1950s, by main- taining signature New Deal programs such as Social Security, the first Republican president since the New Deal, Dwight Eisenhower, ratified Roosevelt’s vision and guaranteed that America would maintain a generous welfare state. Eisenhower also averted a bruising partisan battle.

The federal government’s meteoric growth and the equally quick emer- gence of a national focus meant that the civil rights movement of the 1950s and 1960s could function " and suc- ceed " as a national movement fight- ing an injustice rooted most intensely in one region, the South. The civil rights movement’s success in an age of big government and national televi- sion furthered the development of a national conversation about once- local problems " and the search for national solutions. John Kennedy’s tragically brief presidency raised expectations further.

Increasingly, the debate during Kennedy’s years was no longer ”œshould the federal government be involved,” but ”œhow should the federal government solve particular problems.” What was so revolutionary about this shift was that it no longer seemed remarkable. Government had become so big, so cen- tralized and so central in Americans’ lives, many forgot how novel a phenom- enon the welfare state was in American history. It would take conservatives who began mobilizing in the 1960s around Barry Goldwater and Ronald Reagan nearly 20 years to remind Americans that questioning big government was not marginal or anti-American, but rooted in some of the most fundamental American political traditions and assumptions. Increasingly, it seemed that Americans liked their government small in the abstract, but big when it came to helping them.

Lyndon Johnson became president in 1963 after John Kennedy’s assassination, trusting in a govern- mental solution for nearly every prob- lem. ”œThe roots of hate are poverty and disease and illiteracy, and they are broad in the land,” Johnson pro- claimed in an early speech, planning to legislate these scourges into obliv- ion. Johnson linked the challenges of Communism, civil rights and poverty. He wanted to win the Cold War by per- fecting America, vindicating democracy worldwide.

In May 1964, Johnson redefined America’s historic mission at the University of Michigan’s commence- ment ceremonies. After settling the land, Americans had developed an industrialized infrastructure. During this next stage Americans would go beyond mere riches and power, ”œto enrich and elevate our national life, and to advance the quality of our American civilization.” Johnson envi- sioned a ”œGreat Society,” providing ”œabundance and liberty for all. It demands an end to poverty and racial injustice…The ”˜Great Society’ is a place where every child can find knowledge to enrich his mind and to enlarge his talents…It is a place where the city of man serves not only the needs of the body and the demands of commerce but the desire for beauty and the hunger for community.”

Propelled by his electoral landslide in November 1964, Lyndon Johnson surpassed the New Deal. In 1964 and 1965, Johnson muscled through an ambitious array of laws that trans- formed the way the government helped the poor, the sick, the old, the young. Eventually, staffers counted 207 laws as ”œlandmark” legislative achievements. Under Johnson, the fed- eral budget first topped $100 billion. Aid to the poor nearly doubled, health programs tripled, and education pro- grams quadrupled. LBJ outdid FDR by enacting the 1965 Medicare amend- ment to FDR’s Social Security Act. Harry and Bess Truman received the first two Medicare cards. Medicare was for all older Americans (and some disabled citizens), theoretically paid for by their own contributions when they worked; another program, Medicaid, was a means-tested program for the poorest Americans, and involved state partici- pation as well.

Alas, Johnson could not legislate away America’s problems. Even as Congress passed a landmark civil rights law, the Voting Rights Act, riots erupted in Watts, the Los Angeles ghetto. The Vietnam War became Johnson’s alba- tross " and America’s burden, wasting billions of dollars, sacrificing 58,000 American lives and bleeding away America’s credibility and confidence. Johnson’s Great Society hopes sank in the Vietnam morass. Johnson retired prematurely, refusing to run for re-elec- tion in 1968.

The Great Society’s failure spurred the Reagan Revolution " a backlash against big government. Ronald Reagan spoke eloquently about up-by-the-bootstraps, do-it- yourself American individualism, saying the Great Society failed because big government never worked. When Bill Clinton was elect- ed in 1992, he understood his mis- sion as trying to restore Americans’ faith in government, by showing that government could be effective with- out getting too big.

Ultimately, Clinton failed to enact health care reform because he missed the centre; he forgot how deeply skepti- cal Americans remained about big gov- ernment. Few remember how likely prospects for change appeared in 1993. ”œAmerica’s ready for health care reform and so are we,” South Carolina’s Republican governor, Carroll Campbell, declared, as Republicans scrambled to offer their own alternatives.

Clinton " and his polarizing wife, Hillary Rodham Clinton " squan- dered that early mix of bipartisan good will and political fear so necessary for an ambitious reform effort in a divided Congress. In what was widely per- ceived as a payoff for her wifely loyal- ty amid all the adultery rumours in the 1992 campaign, the First Lady chaired this ambitious health-reform effort.

Rather than developing a general plan with Congress, Mrs. Clinton presented a fait accompli, a byzantine 1,354-page program more suited to the big-gov- ernment ambitions of Franklin Roosevelt and Lyndon Johnson than to the small-government era Ronald Reagan had pioneered.

Rather than adjusting the elaborate plan to mollify Republicans, the President and his wife went rigid and attacked their critics. Hillary Clinton refused to compromise. She urged her husband to wave a pen in his 1994 State of the Union address, promising to veto ”œlegislation that does not guar- antee every American private health insurance that can never be taken away.” On the stump, the First Lady bashed doctors, pharmaceutical com- panies, insurance executives and con- servatives. Mrs. Clinton mocked those who ”œdrive down highways paid for by government funds” and ”œlove the Defense Department” but object ”œwhen it comes to…trying to be a compassionate and caring nation.” The Clintons’ personal scandals, congressional counter-attacks and media nitpicking gradually under- mined the effort. Emboldened, Republicans began following the ideo- logues rather than the moderates. ”œThere has been almost total surrender amidst the largest power grab in U.S. history,” former education secretary William Bennett first complained in October 1993. On Meet the Press, the Republican congressional leader Newt Gingrich denounced the plan as ”œthe most destructively big-government plan ever proposed.”

As the Clintons lost control of the health care debate, two powerful streams in modern American ideology merged. Cartoons of the ”œEvil Queen” offering up a Pandora’s box of ”œsocial- ized medicine” linked ancient and modern obsessions about government power and powerful women. Partisan Republicans and cynical reporters described an out-of-control, crusad- ing radical feminist and her hen- pecked, secretly liberal husband imposing another arrogant, expensive Great Society failure on the American people. ”œNational Health Care: The compassion of the IRS! the efficiency of the post office! all at Pentagon Prices!” one bumper sticker seen in 1994 proclaimed. This crude carica- ture encapsulated many of the anti- government themes developed in the 1980s and demonstrated the Clinton opponents’ success in transforming the public debate.

Most dramatically, the health insurance industry created a fic- tional couple to balance out the presi- dential couple. In a $14-million advertising campaign, compounded by all the free media coverage it gener- ated, the American people met Harry and Louise, two middle-class Americans struggling with their bills, celebrating Thanksgiving, going to the office " all the while debating health care reform. In one commercial, the announcer warned: ”œThings are going to change, and not all for the better. The government may force us to pick from a few health care plans designed by government bureaucrats.” ”œThey choose,” Harry then says, and his wife chimes in, ”œWe lose.” In another, Louise tells Harry: ”œThere’s gotta be a better way.” Furious " and reflecting just how effectively the Harry and Louise message had penetrated, Mrs. Clinton snapped in November that the insurance companies ”œhave the gall to run TV ads that there is a bet- ter way, the very industry that has brought us to the brink of bankruptcy because of the way that they have financed health care.” Speaking of Harry and Louise, Ben Goddard, the president of the agency that invented them, exulted: ”œThese are people” average Americans ”œfeel comfortable with; they might invite them to a Christmas party.” Liberals and Democrats tried to mobilize, but no reply was as effective as the Harry and Louise onslaught.

The Clintons’ operatic marital dynamics kept the President wed to Hillary Clinton’s rigid strategy even as their initiative fizzled. The Clintons further alienated Congress by bypassing the usual procedures and slipping this major reform into a budget bill. President Clinton did not throw himself into the fight as intensely or as nimbly as he had with the budget or the North American Free Trade Agreement. The bill with- ered on the congressional committee vine; neither the Senate nor the House even voted on it. Bill Clinton’s failure to deliver even a compromised health care bill sym- bolized a broader failure to fight effectively for policies and principles with the same tenacity and agility he would display in 1998 when fighting for survival during the Monica Lewinsky scandal.

Barack Obama’s people have stud- ied the Clinton case carefully " many, including White House chief of staff Rahm Emanuel, witnessed the failure from within the Clinton administration. Obama’s decision to let Congress draft the health bill, for example, reflects an attempt to avoid the dynamics that hurt the Clintons whereby the White House sent legis- lation down Pennsylvania Avenue to Capitol Hill for approval. But the real test is yet to come. Can Obama con- vince Americans that universal health care coverage should be as American as Social Security (if not apple pie)? Or will the Republicans play to Americans’ traditional suspi- cion that big government will do more harm than good?