The Tribal Nature of Politics: Popular Accounts of the Health Care Reform Bill
by Keith Preston
The health care reform bill recently passed by the U. S. House of Representatives is clearly one of the most controversial public issues in the United States at present. Issues of this type tend to be debated according to preconceived ideological affinities, cultural norms and partisan loyalties rather than empirical analysis of relevant facts and data. Public debate concerning health care reform conforms to this pattern, as evidenced by the fact that of the 435 members of the House only one Republican voted in favor of the bill while only thirty-nine Democrats voted against the bill. It is rather implausible that such a divide along narrow partisan lines would have emerged were the issue to be debated according to the standards of rational discourse rather than mere tribal loyalties. Clearly, this division is rooted is pre-existing perceptions and presumptions on the part of the individuals, groups, and organizations who participate in the conflict.
A vast array of individuals, groups and organizations exist who have voiced strong opinions concerning health care reform. Because of the vastness of sources of opinion on this question, it is most likely best to evaluate the content of public debate on the basis of arguments and justifications for various perspectives offered by politicians and other influential political figures, as it is these figures that presumably speak for much larger bodies of opinion-holders, e.g. voters, contributors, activists, lobbyists, “interest groups,” “concerned citizens,” and so forth. The arguments in favor of healthcare reform are the mostly widely understood and recognized. Proponents of health care reform will point out the number of Americans who lack health insurance, the high costs associated with the provision of health care, the “double whammy” inflicted on persons who lose their employment and simultaneously lose their employer-provided health insurance, examples of individuals who have suffered severe damage to their health from lack of available or affordable care, and other related matters. Because such arguments are well-known, and not particularly controversial or disputed in and of themselves, it is perhaps most interesting to observe the opinions offered by opponents of health carereform, or at least the particular health care reform currently being advanced by the House of Representatives, and to examine the justifications for these opinions offered by their proponents.
The most predictable opponents of the health care reform bill are the conservative Republicans, and their various supporters in the media and in the private sector. The Republicans and their allies argue from the perspective of core tenants of the ideological framework officially espoused by conservatives. The values of this ideology ostensibly include a distaste for bureaucratic proliferation, suspicion of the efficacy of the state as an instrument of social reform, hesitance to raise taxes, and fiscal discipline when it comes to government budgetary considerations. Health care is not an issue like, for example, abortion or homosexuality where some people consider intentional termination of a pregnancy or same-sex relationships to be grave moral wrongs while others regard such practices as harmless, desirable, necessary, or as a matter of important personal liberties. Virtually no one denies that health care is a “good” in its own right. Therefore, conservatives and Republicans frame their opposition to the health care reform bill not on grounds of simply opposing health care per se, but on the grounds that the health care reform bill will actually diminish the quality or availability of health care in the United State, or produce unacceptable costs or consequences in other areas.
An illustration of the kinds of arguments and justifications offered by the conservative Republicans and related individuals, groups, and organizations is provided by an editorial in the Wall Street Journal written by Karl Rove, a former advisor to President George W. Bush. According to Rove, health care reform is “unnecessary” and will increase the cost of government-subsidized health care to the taxpayer. Greater efforts by government to provide health care will also undercut and “crate” private insurance systems, thereby having the effect of “forcing most Americans onto the government plan.” Health care reform proposals are also “too expensive” and will have the effect of placing government bureaucrats “in the middle of the relationship between patients and their doctors.” Further, the health care reform proposals offered by the Democrats are a “bait-and-switch tactic” designed to obscure a more radical goal of a “single-payer, government-run health care system.” Rove does not deny the need for health care reform of some kind and says: “Health care desperately needs far-reaching reforms that put patients and their doctors in charge, bring the benefits of competition and market forces to bear, and ensure access to affordable and portable health care for every American.” (Rove, 2009)
Implicit in Rove’s views and, presumably, the views of others who share hisperspective, whether policy-makers and opinion leaders or lay activists and members of the general public, is a worldview informed by a particular set of ideological and cultural values. Modern American conservatism is at least on a primordial level influenced by the wider classical liberal tradition represented by John Locke, Adam Smith and other similar thinkers. This tradition regards bourgeoisie property relations and market processes assacrosanct, and does so with a strong preference for efficiency, utility, and economic discipline. Rove’s comments also reflect a certain bias towards the interests and norms of the middle to upper classes. He is concerned that the interests and preferences of consumers in the private heath insurance and private health care markets, or the economic interests of private health care and health insurance providers, will be undermined by proposed health care reforms. He is also concerned about the cost to taxpayers (mostly middle to upper income persons), and fiscal costs to the U.S. economy and the federal budget. Rove also expresses concerns about the role of bureaucracy in the doctor-patient relationship in a public health care system. Little is said in Rove’s editorial about those persons (mostly lower class and lower middle class) who do not have access to health insurance and health care because of its cost prohibitive nature. Nor is there any mention of the bureaucratic nature of many private heath care and health insurance providers, and the impact of these on the doctor-patient relationship.
An article by Paul Waldman in the liberal magazine American Prospect heaps ridicule on the kinds of arguments made by conservatives and Republicans such as Rove. Waldman dismisses Republican arguments against health care reform with epithets like “dumb” and “despicable.” Opponents of health care reform are referred to as “liars, knaves, and fools” and are characterized as motivated by bad faith, hypocrisy, double standards, special pleading, and deliberate obscurantism. This kind of rhetoric is fairly in keeping with the frequent tendency of those with a left-wing outlook to regard their opponents as not merely in error but in sin. Those who are not ostensibly on the side of the poor, oppressed, downtrodden, disadvantaged, etc. are not merely people with different opinions, interests, value judgments, perceptions, or experiences, but are somehow evil, immoral, unethical, greedy, lacking in virtue, or possessing malevolent intentions. (Waldman, 2009)
Patrik Jonnson of the Christian Science Monitor (whose political stance is more or less middle-of-the-road) discusses the question of whether health care reform is “unconstitutional.” He cites arguments advanced by “right-wing” groups who claim that health care reform exceeds the prerogatives of Congressional authority specified by the Constitution. These groups rely on somewhat arcane legal doctrines concerning the so-called “commerce clause” found in the Constitution, as well as provisions for the taxing powers of government, and on the strand within the American political tradition that places a heavy emphasis on “states’ rights.” Such arguments are of an “appeal to authority” nature. Specifically, they appeal to the perceived cultural authority and supposed political and legal authority of the U.S. Constitution as originally drafted and established centuries ago. Such beliefs indicate a kind of political fundamentalism, perhaps akin to biblical literalism in the religious realm, and are probably taken about as seriously by educated elites and established legal scholars. However, these kinds ofbeliefs do appeal to the values of certain conservative subcultures. (Jonnson, 2009)
Timothy Noah of Salon.Com provides an interesting overview of opposition to the health care reform bill from the political Left. Some of this liberal opposition is purely pragmatic. For instance, Noah gives the examples of former Secretary of Labor Robert Reich and New York Times columnist Bob Herbert who argue that health care reform should play a secondary role to other policy matters of perceived importance such as ending the war in Afghanistan or reducing unemployment. However, there are others from the liberal or left-wing perspective, which are in opposition to health care reform for more substantive reasons. One of these is the Democratic Congressman Dennis Kucinich, arguably the closest thing there is in the U.S. Congress to an actual socialist. Kucinich and others with comparable views argue that the health care reform bill actually strengthens large, private insurance companies and that its provisions actually amount to a “corporate welfare” program for the insurance industry. While conservative critics such as Karl Rove argue that the health care reform bill will lead to “socialized medicine,” critics from the Left argue precisely the opposite, i.e. that the health care reform bill essentially eliminates the possibility of a genuine “national health care system” of a Canadian, British, or Western European model. (Noah, 2009)
Still another reason cited by Noah for left-liberal opposition to the health care reform bill is the inclusion of provisions barring coverage for abortion-related services. A perspective of this type is offered in a statement from the National Organization of Women:
The House of Representatives has dealt the worst blow to women’s fundamental right to self-determination in order to buy a few votes for reform of the profit-driven health insurance industry. We must protect the rights we fought for in Roe v. Wade. We cannot and will not support a health care bill that strips millions of women of their existing access to abortion.
Birth control and abortion are integral aspects of women’s health care needs. Health care reform should not be a vehicle to obliterate a woman’s fundamental right to choose.
The Stupak Amendment goes far beyond the abusive Hyde Amendment, which has denied federal funding of abortion since 1976. The Stupak Amendment, if incorporated into the final version of health insurance reform legislation, will:
- Prevent women receiving tax subsidies from using their own money to purchase private insurance that covers abortion;
- Prevent women participating in the public health insurance exchange, administered by private insurance companies, from using 100 percent of their own money to purchase private insurance that covers abortion;
- Prevent low-income women from accessing abortion entirely, in many cases. (O’Neill, 2009)
What is relevant about each of these perspectives concerning health care reform is the way in which each of the contending parties frames the issue within the context of the group norms, self-interests and language of their particular political tribe. This appears to be equally true of conservatives, libertarians, liberals, moderates, socialists, and feminists. The “justice,” efficacy, or benevolence of any proposed health care reform plan is evaluated within the context of the morality of the tribe. Reform is “good” if it serves and advances the tribe.
Jonnson, Patrik (2009). Is the House Health Care Reform Bill Unconstitutional? Christian Science Monitor, November 5, 2009.
Noah, Timothy (2009). Lefties Against Reform: A Taxonomy of Left-Liberal Opposition to the Health Care Bill. Salon.Com, November 10, 2009.
O’Neill, Terry (2009). NOW Opposes Health Care Bill That Strips Millions of Women of Abortion Access. National Organization of Women, November 8, 2009.
Rove, Karl (2009). How to Stop Socialized Health Care: Five Arguments Republicans Must Make. Wall Street Journal, June 11, 2009.
Waldman, Paul (2009). The Ten Dumbest Arguments Against Health-Care Reform. American Prospect, July 28, 2009.