I’m going to play devil’s advocate with myself here for a moment. Conor Friedersdorf has the best explanation I’ve seen of the public anxiety surrounding health care reform. While it’s clear that all those angry and misinformed town hall attendees are a small minority of the voting public, their anxieties – stoked by our current economic travails, rapid social and demographic changes, and government and politics that haven’t really worked for oh, a decade or longer – are real, and shared by millions more. For all the problems in the current health care system, and for all of Barack Obama’s talents, it would be crazy not to feel some trepidation at such a big undertaking. Many more people still have health insurance than don’t, and they don’t want to end up like those who don’t; so any change is perceived as a threat:
My grandmother, my mother, and countless other Americans may be misinformed about the particulars of health-care reform, and express certain misbegotten fears, but health care proponents would do well to understand the anxiety’s source: Theirs is ultimately a fear of rapid, sweeping policy shifts, especially those brought about by lengthy, amorphous legislative proposals that leave unclear exactly what might change the month after next.
How could that uncertainty fail to rile anyone with health care they like? Ours is a country where many citizens have premised career choices, financial decisions, and even where they reside on ensuring affordable access to quality insurance. Investment in any system, no matter how flawed, breeds a perfectly rational risk-aversion when changes are proposed. What perplexes me is how frequently elected officials underestimate that impulse.
This, he says, is an argument for taking an incremental approach to health care reform and other big structural problems. Handle it one piece at a time, in more digestible bites. Don’t overreach like Bill Clinton did on health care or George W. Bush did on immigration and Social Security.
This is a good argument – and, indeed, that’s pretty much how the modern welfare state came about, as Paul Begala points out in this piece – but I don’t completely buy it for the reason that so often, such anxiety proves politically transient.
A lot of people – liberals, skeptics of big government, deficit hawks – denounced Bush’s Medicare-prescription drug program (which Friedersdorf cites as an example of an incremental approach, but as increments go was pretty large) as unworkable. While it’s deeply flawed in various ways, bureaucratically it works better than anyone expected. Seniors aren’t storming into town halls demanding it be dismantled. The same thing is likely to happen with health care reform. Once something passes – and it may end up substantially closer to “incremental” than what Obama originally wanted – health care reform will disappear as a political wedge issue. There will be problems, of course, and controversies – the problems it addresses won’t go away overnight. But it’s unlikely that the Republicans will be running against Obamacare at this time next year.
Clearly, Obama underestimated public anxieties over health care reform – and a little extra humility won’t hurt him. But the political viability of reform efforts depends on a lot of things besides the public mood (which is by no means foursquare against health care reform): the party breakdowns in Congress, the actual need for the reform in question, the president’s own skills and ability to adapt. I’m betting Obama can leverage his advantages here.
