Why are we so scared of health-care reform? Is it in our political DNA?
This article first appeared in the St. Louis Beacon, Aug. 21, 2009 - At the heart of the current ruckus over health-care reform is an all-American notion that historians say is deeply embedded in the arguments on either side of the debate:
We the People distrust big government, big business and big institutions.
"It is a powerfully American fear that is as old as the republic -- that a big institution, unknown to you, unaccountable to elected systems and somehow mysterious or invisible will somehow intercede in your private life,'' explains Peter Kastor, an associate professor of history and American culture studies at Washington University.
While one group argues that that government has no business making what should be very personal decisions about health care, another group argues that profit-driven insurance and pharmaceutical corporations are doing that very thing.
Kastor says that it is not surprising that these underlying themes of institutional distrust have once again exploded around the discussion of health-care reform, although the rancor displayed at recent town hall meetings has been a surprise to politicians and the media.
"If there was any subject that seemed to call out for quiet rationality, it's health care,'' Kastor said. "It's a subject that policy wonks love to talk about because it's a subject they think can only be solved through careful policy. It's about numbers and management and organization. And that's the way (President Barack) Obama started on this: Let's look at how people are insured for their health care and what the systems are. And it's about a very elaborate system and not a subject that people normally get passionate about.''
While most Americans agree that reform should bring about coverage for people who are not insured and pay for services that people need, the consensus seems to end there, he said
"What this is bringing home, in both financial terms and political terms, is that achieving that goal is extremely difficult in the United States, partly because of the vested interests but also because of the political culture," Kastor said.
Remember the Equal Rights Amendment?
Although historians are quick to warn that no two situations are totally analogous, Donald Critchlow, a professor of history at St. Louis University, does see some comparisons between today's highly charged debate over health care and the failed attempts to pass the Equal Rights Amendment in the 1970s.
The constitutional amendment, passed by Congress in 1972, guaranteed that equal rights could not be denied or abridged by federal or state law because of sex. After much debate, the amendment eventually failed because only 35 of the required 38 states ratified it by the July 1982 deadline.
"Everybody was basically in favor of ERA -- the politicians and the general public. It seemed like a good idea," Critchlow said. "What happened was that a small group of people began to protest it. And that protest spread. And so by the end of the fight, the majority of people in the battleground states had turned against ERA."
Critchlow said that although people tended to agree that the amendment's intentions were good, concerns grew over what was perceived as its vagueness -- what its implementation would mean. (Sound familiar?) Opponents found various reasons to unite together in opposition.
"You had some people who were concerned about the drafting of women. They didn't want their daughters drafted. There were some people who were concerned about abortion on demand. There were some people who were concerned about what was seen as an attack on traditional housewives," Critchlow said. "And what it allowed the opposition to do, led by Phyllis Schlafly, was to come up with this slogan to 'Stop ERA,' while the proponents were battling on all these fronts."
As is the case today, Americans in the 1970s were living through unsettled times: an oil shortage, government deficits and a sense of loss of power in the world.
"That all became symbolized in the ERA debate," said Critchlow who has written a book about Schlafly. "And, in a similar way, we're seeing that with health care. You're getting anti-abortion people, people concerned with euthanasia, people concerned with the cost, baby boomers concerned with the loss of health care when they're older. People concerned with the last gasp of the republic. The proponents are getting it from all these different fronts."
And, Critchlow points out, it is difficult to defend health-care reform when the legislation has yet to be written.
"So, you have some people in Congress say, 'Well, it doesn't mean this' and other people in the same party saying it does mean this. They're having to fight a battle on all fronts without any clear understanding themselves of exactly what the bill is."
Nation, heal thyself
With the nation in the midst of a painful economic recession, some argue that it is the wrong time to tackle health-care reform. But Kastor points out that, historically speaking, a crisis can be a convincing time to make dramatic change.
"Presidents have learned that you can bring about large-scale government restructuring in moments of crisis more easily than in moments of stability," Kastor said.
For example, Franklin D. Roosevelt pushed through large-scale reforms during the Great Depression, and after the Sept. 11 terrorist attacks George W. Bush restructured the government, creating the Department of Homeland Security.
"And it's a theme that is already a part of the Obama narrative -- coming into office at a moment of crisis and saying that now is the time we have to do these things. And he has said that health care is part of the reason for the financial crisis," Kastor said.
But at the same time, Americans are nervous about the price tag for reform in the face of the nation's growing deficit and worries about the future.
Critchlow agrees that the outcry over health care has become symbolic of other fears, including a distrust of Congress and spending, that are reflected in public opinion polls.
"I think there is a huge concern with this economic recession which is really unlike any of the others that we have experienced," Critchlow said. "There is a sense that America as a great power is coming to an end. And this is within the context of the government spending huge amounts of money -- and fears that we're going to go bankrupt."
Who sees a conspiracy?
Critchlow said that the Democratic leadership should be careful about dismissing opposition to health-care reform as a conservative conspiracy because many Americans are simply voicing what they believe are legitimate concerns about cost, fueled by the toll the recession took on their own finances and fear that change will threaten the health care they already have.
He said that Obama has attempted to avoid pitfalls that contributed to the failure of the Clinton administration to achieve health-care reform, but in some ways that has backfired. For example, Obama chose to work with the special-interest groups, such as the pharmaceutical and insurance companies, that had worked against Clinton. And then he turned to Congress to write the bill.
"It's turned out to be a mistake. People don't trust corporations. People don't see corporations as being on their side, and furthermore they see with the stimulus programs and the bailouts of corporations that the government is in collusion with them. That kind of reinforces their fears," he said. "It's just gotten very emotional, and there's a fear that Congress is going to try and ram some health-care proposal down the throats of Americans."
Critchlow said it is important to remember that the majority of Americans are center-right in their political philosophy, and not comfortable with the liberal viewpoints they associate with House Democratic leadership.
"There's this sense that health-care reform hasn't been bipartisan and the Democratic house leadership, in particular, has been highly partisan. Obama ran on bipartisanship and bringing a new era of politics, and it hasn't occurred."
He said there is also a fear that no matter what the proposal is, that the Democrats will push through a national health system.
"In this context of high anxiety and a larger historical context of distrust of government, which has intensified, it's not surprising that we're seeing this kind of populist outrage," Critchlow said. "It's disappointing for some and disconcerting, but I think this is the nature of democracy. I don't think we're seeing a fascist response to health insurance."
Can this reform be saved?
At this point, Critchlow said he doubts that major health-care reform will occur. He believes the Democrats will stop pushing for the establishment of a public option for insurance but will win some modest reforms in health insurance, such as portability of policies, eliminations of pre-existing conditions and caps on coverage.
"Once you reach the point of both sides seeing conspiracies on the part of their opponents, all rational debate ends," he said. "That's what we have right now. We have conspiratorial views on both sides. Not everyone is sharing them, but enough of it is going on. And trying to dissuade people that there is not a conspiracy going on is near impossible."
Kastor said the debate seems to be centered more on health insurance and how health providers are paid rather than on how they do their jobs. He finds it interesting that there has been minimal discussion about lawyers and malpractice suits during the current debate or about the financial practices of doctors and health-care providers.
"Most of the discussion is about people saying they want a system where they can see the doctor they want, have insurance pick up the tab and get free choice in who they see. But beyond that, we're not hearing very much."
Kastor believes it's too soon to predict what will happen with the legislation.
"When Congress gets back in session, this is something that will be discussed within committees. That's a completely different world," he said. "The town hall meetings will be over and you can make the claim that they'll craft something and if the Democrats agree to it, that's all that's necessary."