All of which brings me to the sad story of the Cadillac tax.

During the long debate over the Affordable Care Act a decade ago, the Obama administration was one of the only forces for fiscal conservatism — that is, trying to hold down health care spending. Congressional Republicans could have pushed for cost-saving measures, but instead they just opposed any effort to insure the uninsured. Many congressional Democrats, especially in the House, had no interest in policies to hold down spending.

Now that the Obama administration is gone, an important part of the health care law seems likely to die: the Cadillac tax. Had it gone into effect, the tax would have applied to expensive insurance plans — that is, those with relatively few restrictions — as a way of encouraging companies and workers to use more efficient plans. A few years ago, though, Congress delayed it, and on Wednesday the House voted to repeal it. The Senate seems likely to follow. Being in favor of unconstrained health spending is politically easy, even though it’s bad policy.

Labor unions are probably the best example of the perverse politics of medical spending. Unions have always opposed the Cadillac tax, out of fear that it will deny needed medical care to their members. As a result, the unions have ended up effectively pushing for expensive health care plans that quietly pinch their members’ paychecks.

The sharp rise of health spending in recent decades is one reason that wage increases have been so weak. As Paul N. Van de Water, a health care expert at the Center on Budget and Policy Priorities, told Abby Goodnough of The Times , the tax was “one of the A.C.A.’s most important cost-containment measures” and could have led to pay increases.

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“Rather than killing or delaying the Cadillac tax, Democrats should be trying to make it operational. The tax would raise revenue, lower costs, increase the efficiency of the tax code and give the Obamacare individual market its best chance at success,” Karl W. Smith wrote for Bloomberg Opinion. “Instead, Democrats have set up that market for more turmoil.”