How did everything fall apart so quickly?
After the first 100 days, President Obama and the Democratic
majority in Congress were on top of the world. The President's job
ratings were in the 60s. In the Pew Research Center poll, Democrats
had a 19-point edge in favorability over Republicans (59 percent
favorable for Democrats, 40 percent for Republicans).
By August, the President's job approval had dropped to 51 percent
in the Pew poll and the NBC News poll. The Democrats' lead over the
Republicans in favorability had dropped to 9 points -- entirely
because of a sharp drop in positive opinion of the Democratic Party.
It's not the economy, stupid. While the nation's economic gloom
has certainly not lifted, people don't think things have gotten
markedly worse. In the August Washington Post-ABC News poll, more
people said President Obama's economic program was making the
economy better (43 percent) rather than worse (23 percent). And
more Americans expect the recession to be over in the next year (28
percent in February, 49 percent in August).
The problem is health care, of course. By every available
measure, confidence in President Obama's health care policy has
diminished. In the Post-ABC poll, Americans approved the
President's handling of health care by nearly two to one in April
(57 to 29 percent). Now they narrowly disapprove, 50 to 46. In the
NBC poll, the number who think President Obama's health care plan is
"a bad idea'' went from 26 percent in April to 42 percent in
August. Only 36 percent now say it's "a good idea.''
President Bill Clinton's experience stands as a warning to
Democrats. During Clinton's first two years in office, the economy
actually got better. The unemployment rate dropped from 7.4 percent
when Clinton got elected in 1992 to 5.6 percent in November 1994.
And so what? The Democrats still got blown away in the 1994
midterm. Not because of the economy, but because of voter anger
over taxes and gun control and gays in the military and midnight
basketball and, above all, health care.
The big surprise is that the backlash over health care reform
came as such a surprise. The force of voter anger seemed to astound
both parties. President Obama's formidable political movement
failed to mobilize until the threat was in their face. Some
Republicans seemed ready to work with the Administration until they
saw the ferocity of the protesters. Those who believe the protests
were staged by the GOP are giving the Republican Party too much
credit. They're not that well organized.
It's not that the public rejects health care reform. It's still
a popular idea. The Kaiser Health Care poll continues to show solid
support for requiring all Americans to have health insurance, with
subsidies for those who can't afford it (68 percent). And the
public favors requiring employers to offer health insurance to their
workers (68 percent). People even support the idea of a public
option -- "a government-administered public health insurance option
similar to Medicare to compete with private health insurance
plans'' (59 percent).
When asked specifically about changes to the health care system
being proposed by President Obama and Congress, the public is
split. But what matters is not just numbers. It's intensity. And
the opposition is more intense: 40 percent say they're "strongly''
opposed while 27 percent are "strongly'' supportive." In the Pew
poll, 38 percent of Republicans say they'd be angry if health care
reform passes. Only 13 percent of Democrats say they'd be angry if
health care reform fails.
Why did this happen?
Recriminations have already started. The Obama Administration
overcompensated for President Clinton's failure 15 years ago.
President Obama did not turn the issue over to a secretive task
force headed by an unelected First Lady and a team of policy wonks
(remember Ira Magaziner?). Instead, Obama let the Democrats in
Congress come up with a plan. Or more precisely, several plans, all
making their way through congressional committees. That approach
gave the President more options and greater flexibility. But he has
no actual proposal for Democrats to rally around. No one is sure if
President Obama even intends to fight for a public option.
Recriminations are, of course, a favorite Washington pastime, but
the real reasons for the backlash are deeply rooted in American
culture. In two places, to be precise -- ideology and psychology.
Distrust of government is a core value of American populism. The
people are "us.'' Government is "them.'' Distrust of government
is embedded in the Constitution, which was written by men who
disliked central government (King George III) and intended it to be
as weak as possible. Hence, the elaborate system of checks and
balances and separation of powers and the many ways in which
decisive action can be blocked. In fact, the Constitution replaced
an earlier document, the Articles of Confederation, in which
government was so weak it was unworkable.
Distrust of government is a principle of faith among
conservatives these days, but the sentiment is not limited to the
right. For the first century of American politics, Democrats were
the anti-government party. Then, as now, Democrats were the party
of the poor and the oppressed, but government was then seen as a
bastion of privilege. Reaganism can't hold a candle to Thomas
Jefferson's and Andrew Jackson's attacks on centralized power. What
changed was the discovery -- first by Progressives, then by New Deal
Democrats -- that government could be used to attack privilege and
promote economic and social justice.
The scholar Seymour Martin Lipset used the analogy of loaded dice
to describe how values work. Once certain values are loaded by
defining historical experiences, they will come up again and again
and shape later events. That is happening now with health care
reform. The anti-government backlash started building up even
before Barack Obama became President, when President Bush endorsed
the Wall Street bailouts. The backlash intensified with the
automobile industry bailout, the economic stimulus plan, the energy
bill and mounting deficits. Health care reform gave conservatives
the opportunity to light the fuse.
The wonder is that American government actually does work, even
though it was designed not to. It works when there is a crisis --
when an overwhelming sense of public urgency overwhelms blockages
and lubricates the system. That is supposed to be the case now with
health care. But it is not. Sure, there's sense of crisis in the
country, but it is over jobs more than health care. When Americans
are asked to name the major problems facing the nation, the economy
towers over everything else. Health care ranks third, after the
economy and government spending.
That's where psychology comes into play. President Obama has put
out a mighty effort to create a sense of crisis, warning voters
about the cost of inaction. "If you're worried about rationed
care, higher costs, denied coverage or bureaucrats getting between
you and your doctor, then you should know that's what's happening
right now,'' the President said in his weekly address on August 15.
In the NBC poll, only 24 percent of Americans said they thought the
quality of their health care would get better if the Obama plan
passes. Forty percent thought it would get worse.
Americans overwhelmingly say they're satisfied with their health
care (83 percent in a CNN poll) and their health insurance (74
percent). A whopping 71 percent are satisfied with both. What's
striking is that nearly half of that "satisfied majority'' still
favor health care reform (44 percent in the CNN poll). They believe
all Americans should be covered. Their view is, if people don't
have health insurance, the government should see to it that they can
get it, even if it means taxing the rich. But they see no reason
why that means their own health care has to change.
The psychology of health care is not driven by economic
rationality. People rarely choose a doctor or a hospital or a
treatment based on price. (Medications, yes.) In the current
health care system, costs are largely hidden from consumers. Try
telling employees that their employer-paid health care benefits
should be taxed as income. It's income they never see. Economists
argue that rising health insurance costs for employers have been
supressing wages for years. But most workers are unaware of the
real and growing costs of those benefits. Somebody else pays most
People's sense of security about their health care may be false
and irrational. But it is real. Just like the warning Members of
Congress hear over and over again from seniors at town hall
meetings: "You tell the government to keep its hands off my
Does this mean President Obama's health care agenda is doomed?
No. A lot of people continue to support reform, and the Democrats
have solid majorities in Congress. They don't want to pull the plug
on health care reform as the Democratic Congress did in 1994. For
one thing, they don't want to bring down their own President. The
failure of health care reform in 1994 forced President Clinton to
shrink his agenda from big ambitions to protecting the safety net.
For another thing, congressional Democrats know who paid the
political price of failure in 1994. They did.
Some version of health care reform will very likely pass,
possibly including a public option. But it will pass on a partisan
vote. What's wrong with that? Democrats won spectacular victories
in 2006, when they took control of Congress, and in 2008, when they
took the White House. If that's not a mandate to govern, what is?
But for a major policy initiative to be politically secure, it
needs a bipartisan base. Like the Civil Rights Act of 1964, which
actually got a higher proportion of support from Republicans than
from Democrats (in those days, there were still a lot of
conservative southern Democrats). Any policy that passes on a
partisan vote is subject to constant sniping and threats of reversal
when the other party gains power.
President Obama will probably win on health care reform. But
voter backlash has steeled the Republican Party to mount a full-
scale opposition. Victory on health care will be a triumph of the
partisan culture that President Obama pledged to defeat.
Disclaimer: The views expressed above are solely those of the
author, they do not represent the views of Third Way