As our elected representatives become party representatives and the parties begin a slow decline in power -- membership, identification with voters, and effectiveness in terms of representing and negotiating on behalf of the American electorate, we as a nation are indeed considering alternatives.
The health insurance debate isn't about health insurance. Nor is it about health, nor is it a debate. It's a partisan game. The kind of game that independents don't like.
Below is a thoughtful article by Ezra Klein in The New Yorker which tries to address our conflicted political and cultural moment. It is interesting article at the crossroads between politics and
psyschology and culture. At the end of the day the article is talking
about (without ever using the words) the culture of politics in the US
and how it stifles a more developmental political process. I think that it
is potentially useful in the discussion about the Obama presidency, as the article begs the
question how does the current status quo change. Answer...you empower
independents bringing them as active players into the public dialogue.
On March 23, 2010, the day that
President Obama signed the Affordable Care Act into law, fourteen state
attorneys general filed suit against the law’s requirement that most
Americans purchase health insurance, on the ground that it was
unconstitutional. It was hard to find a law professor in the country who
took them seriously. “The argument about constitutionality is, if not
frivolous, close to it,” Sanford Levinson, a University of Texas
law-school professor, told the McClatchy newspapers. Erwin Chemerinsky,
the dean of the law school at the University of California at Irvine,
told the Times, “There is no case law, post 1937, that would
support an individual’s right not to buy health care if the government
wants to mandate it.” Orin Kerr, a George Washington University
professor who had clerked for Justice Anthony Kennedy, said, “There is a
less than one-per-cent chance that the courts will invalidate the
individual mandate.” Today, as the Supreme Court prepares to hand down
its decision on the law, Kerr puts the chance that it will overturn the
mandate—almost certainly on a party-line vote—at closer to
“fifty-fifty.” The Republicans have made the individual mandate the
element most likely to undo the President’s health-care law. The irony
is that the Democrats adopted it in the first place because they thought
that it would help them secure conservative support. It had, after all,
been at the heart of Republican health-care reforms for two decades.
The
mandate made its political début in a 1989 Heritage Foundation brief
titled “Assuring Affordable Health Care for All Americans,” as a
counterpoint to the single-payer system and the employer mandate, which
were favored in Democratic circles. In the brief, Stuart Butler, the
foundation’s health-care expert, argued, “Many states now require
passengers in automobiles to wear seat-belts for their own protection.
Many others require anybody driving a car to have liability insurance.
But neither the federal government nor any state requires all households
to protect themselves from the potentially catastrophic costs of a
serious accident or illness. Under the Heritage plan, there would be
such a requirement.” The mandate made its first legislative appearance
in 1993, in the Health Equity and Access Reform Today Act—the
Republicans’ alternative to President Clinton’s health-reform bill—which
was sponsored by John Chafee, of Rhode Island, and co-sponsored by
eighteen Republicans, including Bob Dole, who was then the Senate
Minority Leader.
After the Clinton bill, which called for an
employer mandate, failed, Democrats came to recognize the opportunity
that the Chafee bill had presented. In “The System,” David Broder and
Haynes Johnson’s history of the health-care wars of the nineties, Bill
Clinton concedes that it was the best chance he had of reaching a
bipartisan compromise. “It should have been right then, or the day after
they presented their bill, where I should have tried to have a direct
understanding with Dole,” he said.
Ten years later, Senator Ron
Wyden, an Oregon Democrat, began picking his way back through the
history—he read “The System” four times—and he, too, came to focus on
the Chafee bill. He began building a proposal around the individual
mandate, and tested it out on both Democrats and Republicans. “Between
2004 and 2008, I saw over eighty members of the Senate, and there were
very few who objected,” Wyden says. In December, 2006, he unveiled the
Healthy Americans Act. In May, 2007, Bob Bennett, a Utah Republican, who
had been a sponsor of the Chafee bill, joined him. Wyden-Bennett was
eventually co-sponsored by eleven Republicans and nine Democrats,
receiving more bipartisan support than any universal health-care
proposal in the history of the Senate. It even caught the eye of the
Republican Presidential aspirants. In a June, 2009, interview on “Meet
the Press,” Mitt Romney, who, as governor of Massachusetts, had signed a
universal health-care bill with an individual mandate, said that
Wyden-Bennett was a plan “that a number of Republicans think is a very
good health-care plan—one that we support.”
Wyden’s
bill was part of a broader trend of Democrats endorsing the individual
mandate in their own proposals. John Edwards and Hillary Clinton both
built a mandate into their campaign health-care proposals. In 2008,
Senator Ted Kennedy brought John McDonough, a liberal advocate of the
Massachusetts plan, to Washington to help with health-care reform. That
same year, Max Baucus, the chairman of the Senate Finance Committee,
included an individual mandate in the first draft of his health-care
bill. The main Democratic holdout was Senator Barack Obama. But by July,
2009, President Obama had changed his mind. “I was opposed to this idea
because my general attitude was the reason people don’t have health
insurance is not because they don’t want it. It’s because they can’t
afford it,” he told CBS News. “I am now in favor of some sort of
individual mandate.”
This process led, eventually, to the Patient
Protection and Affordable Care Act—better known as Obamacare—which also
included an individual mandate. But, as that bill came closer to
passing, Republicans began coalescing around the mandate, which polling
showed to be one of the legislation’s least popular elements. In
December, 2009, in a vote on the bill, every Senate Republican voted to
call the individual mandate “unconstitutional.”
This
shift—Democrats lining up behind the Republican-crafted mandate, and
Republicans declaring it not just inappropriate policy but contrary to
the wishes of the Founders—shocked Wyden. “I would characterize the
Washington, D.C., relationship with the individual mandate as truly
schizophrenic,” he said.
It was not an isolated case. In 2007,
both Newt Gingrich and John McCain wanted a cap-and-trade program in
order to reduce carbon emissions. Today, neither they nor any other
leading Republicans support cap-and-trade. In 2008, the Bush
Administration proposed, pushed, and signed the Economic Stimulus Act, a
deficit-financed tax cut designed to boost the flagging economy. Today,
few Republicans admit that a deficit-financed stimulus can work.
Indeed, with the exception of raising taxes on the rich, virtually every
major policy currently associated with the Obama Administration was,
within the past decade, a Republican idea in good standing.
Jonathan
Haidt, a professor of psychology at New York University’s business
school, argues in a new book, “The Righteous Mind,” that to understand
human beings, and their politics, you need to understand that we are
descended from ancestors who would not have survived if they hadn’t been
very good at belonging to groups. He writes that “our minds contain a
variety of mental mechanisms that make us adept at promoting our group’s
interests, in competition with other groups. We are not saints, but we
are sometimes good team players.”
One of those mechanisms is
figuring out how to believe what the group believes. Haidt sees the role
that reason plays as akin to the job of the White House press
secretary. He writes, “No matter how bad the policy, the secretary will
find some way to praise or defend it. Sometimes you’ll hear an awkward
pause as the secretary searches for the right words, but what you’ll
never hear is: ‘Hey, that’s a great point! Maybe we should rethink this
policy.’ Press secretaries can’t say that because they have no power to
make or revise policy. They’re told what the policy is, and their job is
to find evidence and arguments that will justify the policy to the
public.” For that reason, Haidt told me, “once group loyalties are
engaged, you can’t change people’s minds by utterly refuting their
arguments. Thinking is mostly just rationalization, mostly just a search
for supporting evidence.”
Psychologists have a term for this:
“motivated reasoning,” which Dan Kahan, a professor of law and
psychology at Yale, defines as “when a person is conforming their
assessments of information to some interest or goal that is independent
of accuracy”—an interest or goal such as remaining a well-regarded
member of his political party, or winning the next election, or even
just winning an argument. Geoffrey Cohen, a professor of psychology at
Stanford, has shown how motivated reasoning can drive even the opinions
of engaged partisans. In 2003, when he was an assistant professor at
Yale, Cohen asked a group of undergraduates, who had previously
described their political views as either very liberal or very
conservative, to participate in a test to study, they were told, their
“memory of everyday current events.”
The students were shown two
articles: one was a generic news story; the other described a proposed
welfare policy. The first article was a decoy; it was the students’
reactions to the second that interested Cohen. He was actually testing
whether party identifications influence voters when they evaluate new
policies. To find out, he produced multiple versions of the welfare
article. Some students read about a program that was extremely
generous—more generous, in fact, than any welfare policy that has ever
existed in the United States—while others were presented with a very
stingy proposal. But there was a twist: some versions of the article
about the generous proposal portrayed it as being endorsed by Republican
Party leaders; and some versions of the article about the meagre
program described it as having Democratic support. The results showed
that, “for both liberal and conservative participants, the effect of
reference group information overrode that of policy content. If their
party endorsed it, liberals supported even a harsh welfare program, and
conservatives supported even a lavish one.”
In a subsequent study
involving just self-described liberal students, Cohen gave half the
group news stories that had accompanying Democratic endorsements and the
other half news stories that did not. The students who didn’t get the
endorsements preferred a more generous program. When they did get the
endorsements, they went with their party, even if this meant embracing a
meaner option.
This kind of thinking is, according to
psychologists, unsurprising. Each of us can have firsthand knowledge of
just a small number of topics—our jobs, our studies, our personal
experiences. But as citizens—and as elected officials—we are routinely
asked to make judgments on issues as diverse and as complex as the
Iranian nuclear program, the environmental impact of an international
oil pipeline, and the likely outcomes of branding China a “currency
manipulator.”
According to the political-science literature, one
of the key roles that political parties play is helping us navigate
these decisions. In theory, we join parties because they share our
values and our goals—values and goals that may have been passed on to us
by the most important groups in our lives, such as our families and our
communities—and so we trust that their policy judgments will match the
ones we would come up with if we had unlimited time to study the issues.
But parties, though based on a set of principles, aren’t disinterested
teachers in search of truth. They’re organized groups looking to
increase their power. Or, as the psychologists would put it, their
reasoning may be motivated by something other than accuracy. And you can
see the results among voters who pay the closest attention to the
issues.
In a 2006 paper, “It Feels Like We’re Thinking,” the
political scientists Christopher Achen and Larry Bartels looked at a
National Election Study, a poll supported by the National Science
Foundation, from 1996. One of the questions asked whether “the size of
the yearly budget deficit increased, decreased, or stayed about the same
during Clinton’s time as President.” The correct answer is that it
decreased, dramatically. Achen and Bartels categorize the respondents
according to how politically informed they were. Among the
least-informed respondents, Democrats and Republicans picked the wrong
answer in roughly equal numbers. But among better-informed voters the
story was different. Republicans who were in the fiftieth percentile
gave the right answer more often than those in the ninety-fifth
percentile. Bartels found a similar effect in a previous survey, in
which well-informed Democrats were asked whether inflation had gone down
during Ronald Reagan’s Presidency. It had, but many of those Democrats
said that it hadn’t. The more information people had, it seemed, the
better they were at arranging it to fit what they wanted to believe. As
Bartels told me, “If I’m a Republican and an enthusiastic supporter of
lower tax rates, it is uncomfortable to recognize that President Obama
has reduced most Americans’ taxes—and I can find plenty of conservative
information sources that deny or ignore the fact that he has.”
Recently,
Bartels noticed a similar polarization in attitudes toward the
health-care law and the Supreme Court. Using YouGov polling data, he
found that less-informed voters who supported the law and less-informed
voters who opposed it were equally likely to say that “the Supreme Court
should be able to throw out any law it finds unconstitutional.” But,
among better-informed voters, those who opposed the law were thirty per
cent more likely than those who supported it to cede that power to the
Court. In other words, well-informed opponents realized that they needed
an activist Supreme Court that was willing to aggressively overturn
laws if they were to have any hope of invalidating the Affordable Care
Act.
Orin Kerr says that, in the two years since
he gave the individual mandate only a one-per-cent chance of being
overturned, three key things have happened. First, congressional
Republicans made the argument against the mandate a Republican position.
Then it became a standard conservative-media position. “That
legitimized the argument in a way we haven’t really seen before,” Kerr
said. “We haven’t seen the media pick up a legal argument and make the
argument mainstream by virtue of media coverage.” Finally, he says,
“there were two conservative district judges who agreed with the
argument, largely echoing the Republican position and the media
coverage. And, once you had all that, it really became a ballgame.”
Jack
Balkin, a Yale law professor, agrees. “Once Republican politicians say
this is unconstitutional, it gets repeated endlessly in the partisan
media that’s friendly to the Republican Party”—Fox News, conservative
talk radio, and the like—“and, because this is now the Republican
Party’s position, the mainstream media needs to repeatedly explain the
claims to their readers. That further moves the arguments from off the
wall to on the wall, because, if you’re reading articles in the Times
describing the case against the mandate, you assume this is a live
controversy.” Of course, Balkin says, “if the courts didn’t buy this, it
wouldn’t get anywhere.”
But the courts are not as distant from
the political process as some like to think. The first judge to rule
against the individual mandate was Judge Henry Hudson, of Virginia’s
Eastern District Court. Hudson was heavily invested in a Republican
consulting firm called Campaign Solutions, Inc. The company had worked
with the Presidential campaigns of John McCain and George W. Bush, the
Republican National Committee, the Swift Boat Veterans for Truth, and
Ken Cuccinelli—the Virginia state attorney general who is one of the
plaintiffs in the lawsuits against the Affordable Care Act.
The
fact that a judge—even a partisan judge in a district court—had ruled
that a central piece of a Democratic President’s signature legislative
accomplishment was unconstitutional led the news across the country.
Hudson’s ruling was followed by a similar, and even more sweeping,
ruling, by Judge Roger Vinson, of the Northern District of Florida.
Vinson declared the entire bill unconstitutional, setting off a new
round of stories. The twin rulings gave conservatives who wanted to
believe that the mandate was unconstitutional more reason to hold that
belief. Voters who hadn’t thought much about it now heard that judges
were ruling against the Administration. Vinson and Hudson were
outnumbered by other district judges who either upheld the law or threw
out lawsuits against it, but those rulings were mostly ignored.
At the Washington Monthly, Steve Benen kept track of the placement that the Times and the Washington Post (where
I work) gave to stories about court rulings on the health-care law.
When judges ruled against the law, they got long front-page stories.
When they ruled for it, they got shorter stories, inside the paper.
Indeed, none of the cases upholding the law got front-page coverage, but
every rejection of it did, and usually in both papers. From an
editorial perspective, that made sense: the Vinson and Hudson rulings
called into question the law’s future; the other rulings signalled no
change. But the effect was repeated news stories in which the Affordable
Care Act was declared unconstitutional, and few news stories
representing the legal profession’s consensus that it was not. The
result can be seen in a March poll by the Kaiser Family Foundation,
which found that fifty-one per cent of Americans think that the mandate
is unconstitutional.
What is notable about the
conservative response to the individual mandate is not only the speed
with which a legal argument that was considered fringe in 2010 had
become mainstream by 2012; it’s the implication that the Republicans
spent two decades pushing legislation that was in clear violation of the
nation’s founding document. Political parties do go through occasional,
painful cleansings, in which they emerge with different leaders who
hold different positions. This was true of Democrats in the
nineteen-nineties, when Bill Clinton passed free trade, deficit
reduction, and welfare reform, despite the furious objections of
liberals. But in this case the mandate’s supporters simply became its
opponents.
In February, 2012, Stuart Butler, the author of the
Heritage Foundation brief that first proposed the mandate, wrote an
op-ed for USA Today in which he recanted that support. “I’ve
altered my views on many things,” he wrote. “The individual mandate in
health care is one of them.” Senator Orrin Hatch, who had been a
co-sponsor of the Chafee bill, emerged as one of the mandate’s most
implacable opponents in 2010, writing in The Hill that to come to
“any other conclusion” than that the mandate is unconstitutional
“requires treating the Constitution as the servant, rather than the
master, of Congress.” Mitt Romney, who had both passed an individual
mandate as governor and supported Wyden-Bennett, now calls Obama’s law
an “unconstitutional power grab from the states,” and has promised, if
elected, to begin repealing the law “on Day One.”
Even Bob
Bennett, who was among the most eloquent advocates of the mandate,
voted, in 2009, to call it unconstitutional. “I’d group us”—Senate
Republicans—“into three categories,” he says. “There were people like
me, who bought onto the mandate because it made sense and would work,
and we were reluctant to let go of it. Then, there were people who
bought onto it slowly, for political advantage, and were immediately
willing to abandon it as soon as the political advantage went the other
way. And then there’s a third group that thought it made sense and then
thought it through and changed their minds.” Explaining his decision to
vote against the law, Bennett, who was facing a Tea Party challenger in a
primary, says, “I didn’t focus on the particulars of the amendment as
closely as I should have, and probably would have voted the other way if
I had understood that the individual mandate was at its core. I just
wanted to express my opposition to the Obama proposal at every
opportunity.” He was defeated in the primary, anyway.
But,
whatever the motives of individual politicians, the end result was the
same: a policy that once enjoyed broad support within the Republican
Party suddenly faced unified opposition—opposition that was echoed,
refined, and popularized by other institutions affiliated with the
Party. This is what Jason Grumet, the president of the Bipartisan Policy
Center, a group that tried to encourage Republicans and Democrats to
unite around policy solutions, calls the “think-tank industrial
complex”—the network of ideologically oriented research centers that
drive much of the policy debate in Washington. As Senator Olympia Snowe,
of Maine, who has announced that she is leaving the Senate because of
the noxious political climate, says, “You can find a think tank to
buttress any view or position, and then you can give it the aura of
legitimacy and credibility by referring to their report.” And, as we’re
increasingly able to choose our information sources based on their
tendency to back up whatever we already believe, we don’t even have to
hear the arguments from the other side, much less give them serious
consideration. Partisans who may not have strong opinions on the
underlying issues thus get a clear signal on what their party wants them
to think, along with reams of information on why they should think it.
All
this suggests that the old model of compromise is going to have a very
difficult time in today’s polarized political climate. Because it’s
typically not in the minority party’s interest to compromise with the
majority party on big bills—elections are a zero-sum game, where the
majority wins if the public thinks it has been doing a good
job—Washington’s motivated-reasoning machine is likely to kick into gear
on most major issues. “Reasoning can take you wherever you want to go,”
Haidt warns. “Can you see your way to an individual mandate, if it’s a
way to fight single payer? Sure. And so, when it was strategically
valuable Republicans could believe it was constitutional and good. Then
Obama proposes the idea. And then the question becomes not ‘Can you
believe in this?’ but ‘Must you believe it?’ ”
And that means that
you can’t assume that policy-based compromises that made sense at the
beginning will survive to the end, because by that time whichever group
has an interest in not compromising will likely have convinced itself
that the compromise position is an awful idea—even if, just a few years
ago, that group thought it was a great one. “The basic way you wanted to
put together a big deal five years ago is that the thoughtful minds in
one party would basically go off and write a bill that had seventy per
cent of their orthodoxy and thirty per cent of the other side’s
orthodoxy and try to use that to peel off five or six senators from the
other side,” Grumet says. “That process just doesn’t work anymore.” The
remarkable and confusing trajectory of the individual-mandate debate, in
other words, could simply be the new norm.
I asked Ron Wyden how,
if politicians can so easily be argued out of their policy preferences,
compromise was possible. “I don’t find it easy to answer that question,
because I’m an elected official and not a psychiatrist,” he said. “If
somebody says they sincerely changed their minds, then so be it.” But
Wyden is, as always, optimistic about the next bipartisan deal, and,
again, he thinks he knows just where to start. “To bring about
bipartisanship, it’s going to be necessary to win on something people
can see and understand. That’s why I think tax reform is a huge
opportunity for the economy and the cause of building coalitions.”
Perhaps he’s right. Or perhaps that’s just what he wants to believe.
