The Health Care Conundrum
“I think the American people are hungry for something different and can be mobilized around big changes, not incremental changes, not small changes.” Thus announced Senator Barack Obama in January 2008. Now, a year and half later, president Barack Obama is trying to deliver on his promise of “sweeping change” on health care. As quickly as possible. Health care reform, for the president, will not come if we wait for some other time or some other person. Emboldened by his reverberant win in November and soaring approval ratings, Obama told supporters on a conference call, “If we don’t get it done this year, we are not going to get it done.” Apparently, it’s now or never.
Needless to say, the president’s need for speed is ruffling a few feathers in the GOP. Whoa Nellie!, said Senate Minority Leader Mitch McConnell: “It would be highly irresponsible in the extreme to take up a bill that affects 16 percent of the economy without bill language, without scores, and on a rapid time-frame,” McConnell barked. By now, the GOP’s calls for Obama to step on the brakes are familiar. Majority Leader Harry Reid mocked the trend: “We’re moving too fast on health care. We’re moving far too fast, in their minds, on energy. And certainly we’re moving far too fast on Sotomayor,” Reid said. “Is there anything we’re moving just right? Obviously they don’t like anything happening. They should get [GOP pollster Frank] Luntz to give them some new talking points.”
As our new president moves forward on health care reform, with a gusty popular wind in his sails and backed (for the most part) by the legislative horsepower of thumping majorities in both chambers of Congress, he has to face an interesting fact of life about Americans. A recent Gallup poll reports that conservatives remain the single-largest ideological group in America. Fully 40 percent of Americans describe their views as conservative. 35 percent say they are moderate. A mere 21 percent own up to being the “L-word.”
For “progressives” (i.e., liberals who’ve abandoned the name but not the thing), this must seem like some kind of bad dream. Conservatives still predominate in the electorate? Didn’t the center-right nation exit stage left on November 4, 2008?
Truth be told, self-identified conservatives have outnumbered admitted liberals in the U.S. for the better part of a century. This was so even back in 1964 — the electoral apogee of liberalism in the U.S. — when over half of the electorate identified Democrat. In the last year however, despite a rather liberal young senator’s meteoric rise to national leadership, the number of conservatives has grown by 3 percentage points.
So what does it mean? The answer depends on what conservative means, which in polls like this is probably rather subjective. It is safe to say, however, that one key element of conservatism involves a resistance to conscious change. The greater number of self-identified conservatives is partially attributable to what psychologists call “system justification” — defined as the “tendency to defend, bolster, and rationalize the societal status quo, even when social change would be preferable from the standpoint of self-interest.” (Jost, Banaji & Nosek, 2004). The status quo, that is to say, has a huge home court advantage. It’s sticky like molasses. The otherwise nimble spirit of change is invariably tempered, slowed and often halted entirely by the bulky stuff of routine, tradition, convention, the inertia of human life. Add to that a constitutional structure designed to throw sticks into the spokes of forward motion, and you have a daunting task for a leader seeking to bring sweeping reform, of any kind, to the country.
Which brings us back to health care. We’ve heard a lot about how the president is going to have to go head to head with the health care industry and lobby, the GOP and perhaps even a few more tea partiers. That Al Franken is now on board in the Senate is added lubricant. But this is not about the number of senators caucusing with the Democrats. It’s about public opinion. The challenge health reformers face is a powerful presumption that the status quo is will do, for now. That means Republicans have a built-in advantage. “For reform to be successful, Americans have to be willing to take a calculated leap into the unknown,” notes Dick Polman of the Philadelphia Inquirer. “Opponents of reform have the easy job; all they need to do is sow doubt.” With a $1 trillion price tag on health care reform, on top of an already unprecedented deficit, sowing a little doubt is duck soup.
The polling indicates that Americans, with characteristic inconstancy, want health care reform and do not want health care reform. That is, they believe the system is broken but are uneasy about paying for a fix. Underlying that unease are questions not only about the amount of the required expenditures but also about whether government will spend the money wisely. The American distrust of government did not magically disappear on November 4, 2008, nor on January 20, 2009. That distrust is as intractable as the status quo; in fact, it is the status quo.
Change is frightening, exhausting even. But without it, we go nowhere, we fix nothing, we stand still. Without conscious, deliberate change, enacted from above, this country would not be a country at all. “We must all obey the great law of change,” argued the great conservative political philosopher Edmund Burke. “It is the most powerful law of nature, and the means perhaps of its conservation.” For Burke, all the true conservative can reasonably ask is that change proceeds gradually, naturally and, if possible, imperceptibly. Forcing change through some grand, abstract plan was, for Burke, retrograde to nature. “Our part is to patch and polish the old order of things,” wrote Burke’s intellectual disciple, Russell Kirk, in the 1950s, “trying to discern the difference between a profound, slow, natural alteration and some infatuation of the hour.”
One is hard pressed to call health care reform an “infatuation of the hour.” It’s been on the table, and actively debated, for almost a half century. But Obama and the powerful Dems are well-advised to keep Burke in mind as they proceed. That does not mean the president should pander to the GOP, but he should seek, to the extent possible, to speak to the conservative in every American. “Habit is habit, and not to be thrown out of the window by any man, but coaxed downstairs a step at a time,” said Mark Twain. In order to coax the American public and Congress down these stairs, Obama must do much more than merely enumerate the technocratic pros of a “public plan.” He must inspire trust. In the final analysis, this is not about the ideological question of whether reform will amount to “socialism,” nor even about the pragmatic question of whether reform will bring about a certain set of results. It’s about whether the federal government, after abusing our trust for so many years, is entitled to get it back — and whether we are courageous enough to pledge it once again.
