Why did we shoot ourselves in the foot on health care?

Source: The University of Minnesota

Unlike the US, where a turkey dinner is traditionally associated with Thanksgiving, the United Kingdom dines on turkey at Christmas. So when the British or Australians accuse you of acting like “a turkey voting for Christmas,” they mean you’re going against your own best interests.
The BBC has a new radio series that addresses the question: Why turkeys vote for Christmas. David Runciman writes the first installment, in which he asks: Why is it Americans who would benefit the most from health care reform are the most opposed? One third of Texas residents have no health insurance, for example, but 87% oppose reform.
There are many opinions on why Obama’s reform didn’t pass, and pundits will be arguing this issue for months, if not more. Texans, for example, are likely to oppose government involvement in any aspect of their lives, and that opposition can easily outweigh the value they place on health insurance.

Here’s Runciman’s take on why people vote against their interests:

If people vote against their own interests, it is not because they do not understand what is in their interest or have not yet had it properly explained to them.
They do it because they resent having their interests decided for them by politicians who think they know best.
There is nothing voters hate more than having things explained to them as though they were idiots.

Bush vs. Gore: Stories trump statistics

To make his case, Runciman draws on the ideas of Drew Westen, author of The Political Brain. Weston cites a presidential debate between Al Gore and George Bush in which Gore explained why voters would be worse off under Bush’s plans for Medicare: “Under the [Texas] governor’s plan, if you kept the same fee for service that you have now under Medicare, your premiums would go up by between 18% and 47%.”
Bush’s response: “Look, this is a man who has great numbers. He talks about numbers. I’m beginning to think not only did he invent the internet, but he invented the calculator. It’s fuzzy math. It’s trying to scare people in the voting booth.”
Runciman writes:

Mr Gore was talking sense and Mr Bush nonsense – but Mr Bush won the debate. With statistics, the voters just hear a patronising policy wonk, and switch off.
For Mr Westen, stories always trump statistics, which means the politician with the best stories is going to win: “One of the fallacies that politicians often have on the Left is that things are obvious, when they are not obvious.
“Obama’s administration made a tremendous mistake by not immediately branding the economic collapse that we had just had as the Republicans’ Depression, caused by the Bush administration’s ideology of unregulated greed. The result is that now people blame him.”

More recently, Obama has been making an effort to B.I.O.B. (“Blame It On Bush”), as Senator McCain was eager to point out.

The French Revolution in reverse

Runciman also cites the ideas of Thomas Frank, author of the 2004 best-seller What’s the Matter with Kansas?.

[Frank] believes that the voters’ preference for emotional engagement over reasonable argument has allowed the Republican Party to blind them to their own real interests.
The Republicans have learnt how to stoke up resentment against the patronising liberal elite, all those do-gooders who assume they know what poor people ought to be thinking.
Right-wing politics has become a vehicle for channelling this popular anger against intellectual snobs. The result is that many of America’s poorest citizens have a deep emotional attachment to a party that serves the interests of its richest.

Disadvantaged Americans think they are voting for one thing and end up getting the opposite. According to Frank:

“You vote to strike a blow against elitism and you receive a social order in which wealth is more concentrated than ever before in our life times, workers have been stripped of power, and CEOs are rewarded in a manner that is beyond imagining.
“It’s like a French Revolution in reverse in which the workers come pouring down the street screaming more power to the aristocracy.”

The triumph of truthiness

The preference for emotional engagement over reasonable argument is an example of The Colbert Report’s concept of truthiness: Truth is what we know intuitively, from our gut. It doesn’t matter if our beliefs are contradicted by evidence, facts, or logic.
Runciman: “The authentic politicians are the ones who sound like they are speaking from the gut, not the cerebral cortex. Of course, they might be faking it, but it is no joke to say that in contemporary politics, if you can fake sincerity, you have got it made.”
Runciman concludes:

This is a culture war but it is not simply being driven by differences over abortion, or religion, or patriotism. And it is not simply Red states vs. Blue states any more. It is a war on the entire political culture, on the arrogance of politicians, on their slipperiness and lack of principle, on their endless deal making and compromises.
And when the politicians say to the people protesting: ‘But we’re doing this for you’, that just makes it worse. In fact, that seems to be what makes them angriest of all.

Is this truly what we have become, a nation destined to shoot ourselves repeatedly in our collective feet? Unfortunately, it would seem so.
Frank’s “French Revolution in reverse” alludes to a fairly comprehensive explanation for this mess we’re in, including a majority of the changes we’ve seen in medicine and health care since the 1970s. Another name for what’s happened is neoliberalism: “The policies and processes whereby a relative handful of private interests are permitted to control as much as possible of social life in order to maximize their personal profit.” It’s a complex story, and one I hope to return to many times in explaining the recent history of medicine.
David Runciman, as you may have guessed from his use of the word “learnt,” is not American, but British. He teaches political theory at Cambridge University and is the author of Political Hypocrisy and The Politics of Good Intentions.
Related posts:
This mess we’re in – Part 1
Why is it so hard to reform health care? Rugged individualism
Why is it so hard to reform health care? The historical background