Why the debate over healthcare reform may be just beginning
Responding to a recent paper examining public opinion on healthcare reform, John Sides writes:
This article comports with an intuition I’ve had about the Affordable Care Act. I’ve heard commentators opine on whether people’s attitudes toward the ACA will grow more favorable with time, once they see that it helps them in various ways. This presupposes that people’s attitudes about health care reform are predicated on self-interest. I’ve been dubious, and Lynch and Gollusk provide some confirmation. Health care opinions are really based on things that don’t change very much: partisanship, ideology, values.
If support for the ACA or “Obamacare” or whatever does increase—note that I said “if”; I’m not making a prediction here—it will be because organized opposition to the ACA has died down, and the information that this opposition provided to the public has become less available. And without exposure to arguments about problems of Obamacare, public opinion will become less polarized and some independents and maybe a few Republicans will become more supportive. This comports with an argument I’ve made previously: public opinion about health care reform derives from cues provided by political elites. Thus, the sharp division between Democratic and Republican leaders produced polarized attitudes among Democrats and Republicans in the public. Leaving aside the possibility of a Supreme Court ruling on the individual mandate, the question is whether, five years from now, Republicans and others are still criticizing the ACA as strongly as they do today.
I’m of the mind that the “rational” basis for much of our politics is arrived at ex-post facto and that the most influential parts of our decision to self-identify as left-wing, right-wing or moderate are subjective and social. By social, I mean to say that they’re determined by the values we’ve come to hold most dear, and that our ordering of these values is a process largely comprised of experience and emotion. And, yes, it’s very tribal.
For example, I’m swayed by arguments that favor Keynesian policies for a struggling economy in which aggregate demand is low. But I didn’t come to that conclusion through some scientific estimation of the various schools of economic thought. I came to that point because people in my tribe — people who seem to privilege the values of fairness and equality as I do — have signaled that, in specific contexts and for our chosen ends, Keynes’s ideas work best.
Result: of course running a deficit when demand is low is the right thing for the government to do. Duh!
Maybe you’re somehow built from different stuff than I, and all of your political beliefs exist relatively divorced from your subjective, emotional identity. But unless you’ve got some lizard blood in there, I doubt it. We have our feelings, and find the facts later. And that’s where elites are useful, because they (or their interns) take the time and do the work to gather up all the intellectual window-dressing to bolster these deeply-felt beliefs. I don’t want to take this too far — you can see that despite the intense signaling from GOP elites on Paul Ryan’s plans for Medicare, a slight majority of Republicans aren’t actually on-board — but I think it’s a very useful general principle to keep in mind when you try to figure out American politics.
If Sides is right, then it means the truly vituperative trench-war between the left and right in this country over the ACA won’t be over until it’s either embraced by the GOP or abandoned by the Democrats. The bill itself could be a great success or an absolute failure. It could be cheap puppies and pap smears for all, or we could be asked to stand before a Death Panel so many times that it becomes a real bore (like going to the DMV, but with a lot more Panel and a bit more Death). But as long as one side or the other has elites willing to use it to gin up the base and fill up campaign coffers, the reality of the legislation will likely have an only marginal influence upon how we talk about it.
And that brings me to the Supreme Court.
Challenges to the bill are moving their way through a few courts right now, and it’s possible that the SCOTUS will decide to hear at least one of them. If this happens, I think it will be the most closely-watched case since Bush v. Gore. And besides the polarizing nature of the legislation itself, the fact that Justice Kagan, who was Solicitor General during the bill’s crafting, would likely hear calls to recuse herself — and would likely rather not, considering the stakes — could result in it being the most controversial ruling since Roe v. Wade.
Just imagine it: Another 5-4 decision with Justice Kennedy tipping the balance. All the teeth-gnashing and garment-rending of Citizens United just times, I don’t know, around 100? Just thinking about it is starting to give me a headache.