Why did health care reform fail? Cognitive dissonance

Source: Ohio Daily

President Obama was determined to avoid the mistakes of Bill Clinton’s attempt at health care reform. He made sure Congress was heavily involved. He courted the major interest groups – the insurance industry, the pharmaceutical industry, hospitals. And yet it appears reform has failed once again.
Abigail Trafford, author and former Washington Post editor, has written an analysis of the failure that includes an historical perspective on the Clinton years.

It took too long and seemed too big

Although the Clinton and Obama strategies were polar opposites in many ways, one thing they had in common was how long it took to create legislation.

[B]oth strategies were undermined by fatal delays. Bill and Hillary Clinton waited almost a year to unveil their plan. With the Obama initiative, Congress has been the laggard. Administration lieutenants hoped to get something passed quickly; then they would sell the plan to the public. But the delay frittered away the public’s post-election enthusiasm for reform while allowing opponents to mount a counterattack.

The Clinton plan included everything but the kitchen sink. Many of the ideas were too complex to be communicated efficiently and effectively. This made political positioning, always difficult, even more delicate. It guaranteed there would be something to offend each and every one of the myriad interests groups that had a stake in health care.
The Obama plan was much more limited. The highly visible public squabbling in Congress, however, made it seem overly complicated and considerably more comprehensive than it was.

No one seemed in charge of the narrative of why health reform matters, so the public viewed a daily soap opera of squabbling lawmakers. One day, a particular reform was in; another day, out. Public option a must? Or a bust. Deals for whom — Nebraska? Unions? Big Pharma? What about home care? “Death panels”? Abortion restrictions — in, out. Cost control — out, with the special deals. The public became more confused about what was in the plan — and more disgusted with Washington.

Of two minds

Polls show that Americans want health reform. They want the government to take care of them when they need help. But they also want to maintain their image as rugged individualists who distain government intervention.
This creates cognitive dissonance – believing in two contradictory ideas at the same time. It’s a state of mind that generates anxiety, defensiveness, and anger. That’s exactly what we saw last summer – and continue to see — with the Tea Party. Obama – intelligent and articulate as he is – failed to explain how these two seemingly contradictory ideas could coexist.

Over the past year, there has been no grand communicator to help people reconcile these contradictory beliefs into a coherent philosophy of life that embraces personal freedom protected by a social safety net.

Continued in the next post.
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