08.11.09

Why Obamacare Scares America

Listen to your grandmother. The Democrats’ new health-care plan may benefit working class folks, but the president’s sales pitch is giving them a heart attack.

On arriving in Orange County, California, I expected hostility to President Obama’s health-care agenda, especially in my Republican family. But it surprised me to hear my Catholic grandmother say that if health-care reform passes bureaucrats will show up at her door advising euthanasia—and especially to hear my mother, now undergoing chemotherapy, insist that were Obamacare already law it is more likely than not that she’d now be dead.

Why can’t Obama take the approach on health care that works better—and that scares my grandmother less?

How to explain these dubious fears? They’re partly due to a deliberate, shameful GOP misinformation campaign. As Steve Pearlstein wrote in The Washington Post, “The recent attacks by Republican leaders and their ideological fellow-travelers … have been so misleading, so disingenuous, that they could only spring from a cynical effort to gain partisan political advantage.”

Well put! But isn’t every major partisan debate rife with deliberately misleading rhetoric? Most notable aren’t the brazen falsehoods so much as their uncommon effectiveness—it is impossible to sew such exaggerated paranoia absent fertile ground.

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.

Is Social Security facing long-term insolvency problems? Is our immigration system broken? President George W. Bush responded to those widespread beliefs by advocating sweeping, “comprehensive” reforms that failed largely because they freaked out too many Americans. Even worse, the policy problems he failed to address still exist, but are unlikely to be readdressed for some time—among the many downsides to comprehensive reform is that its failure renders every facet of an issue politically radioactive.

Especially curious is President Obama’s decision to pursue comprehensive health care reform when it failed so spectacularly under the Clinton Administration. In contrast, “small bore” reform efforts initiated years later extended insurance to millions of children and afforded senior citizens a hugely expensive prescription drug benefit. Why are those who seek further reform so invested in a sweeping approach certain to provoke intense blowback? They’ve enjoyed their best successes using more incremental methods!

Though an Obamacare skeptic, I am hopeful that some health-care reforms will be made, as is my family. This American Life, a favorite radio program in my household, recently aired a segment on rescission, the insurance industry practice whereby insured Americans, having paid premiums over many years, find their claims rejected when they get breast cancer or diabetes or some other costly illness—the insurance companies scour their archived applications hoping to find an innocent mistake, often unrelated to their condition, that serves as a pretext for cancelling their policy. Why don’t the Democrats draft, pass, and enact legislation that ends rescission? It would be wildly popular, even among Orange County conservatives. And it would rectify an injustice.

David Frum has recently argued that the right should also favor “national health insurance exchanges to permit the self-employed to buy insurance with untaxed dollars, just as employees do through their employers,” and that legislation should create “government bodies to compare the effectiveness of different healthcare practices.” I’ve got my own wish list of health care reforms I’d like to see pass, including malpractice reform that I doubt any Democratic Congress will touch, but the point is that whatever one’s policy preferences, there are plenty of discrete ideas favored by enough Americans to pass without a fight.

Beyond focusing the debate, disaggregating reforms might even enable more broad changes over time: every piece of discrete legislation can pass with its own coalition, whereas a complex bill requires that a single majority agree on many different things.

Other benefits of simpler legislation are legion.

Conservatives and liberals can argue productively about a particular health care reform proposal—whereas if you start debating Health Care Reform, the grand concept, ideological arguments are inevitable.

Some partisan hacks are going to use dishonorable debate tactics regardless of legislative approach. It is nevertheless comparatively easy to frighten and mislead people about a multi-thousand page bill so confusing and amorphous that even congressmen are unable to predict its ultimate shape—whereas if you tell my grandmother that a new bill deals exclusively with, say, universal community rating, her support or opposition won’t hinge on aversion to boogeyman euthanasia counselors.

Of course, some on the right will mistrust any legislation that President Obama backs, but even conservatives like me, who assume he is acting on the best possible motives, are right to be concerned by particularly complex bills. They are prone to capture by special interests, ripe for the sneaky inclusion of unpopular provisions, and more likely to result in unpredictable and unintended consequences. Talk of socialist plots is paranoia. The mundane reality to fear is that complicated measures benefit well-connected elites, who are best able to manipulate the legislative process.

In American politics, presidents and legislators from both parties have nevertheless proven themselves disinclined to make piecemeal reforms. This is partly because journalists and historians assign prestige to folks who pass landmark legislation, and mostly ignore elected officials who accomplish as much or more via many discrete measures over time. More ominously, politicians appreciate that crisis conditions whet the public appetite to do something—and that massive, complex legislation is the best means to exploit the moment. Small reforms are thus disfavored insofar as they’d help alleviate the crisis, which is needed as cover for measures that wouldn’t otherwise pass muster.

What if Republicans win the health-care fight? The broken status quo will persist. “We’ll have sent a powerful message to the entire political system,” Mr. Frum argues, “to avoid at all hazards any tinkering.”

Politicians will undoubtedly draw that conclusion. But I’d suggest a different one: Since people are conditioned to prefer the devil they know, Congressional effort is best spent taking small, discrete steps to reform any system, even if incremental changes aren’t the stuff of presidential legacies or televised ceremonies where parchment is signed with a fancy pen.

Why not take the approach that works better—and that scares my grandmother less?

Conor Friedersdorf writes for The American Scene and The Atlantic Online's ideas blog.