Stuck In a Moment You Can't Get Out Of

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 of them.

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 Medicare!''

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.

Published with kind permission of Third Way.