Thursday, November 19, 2009

Who opposes healthcare reform, and why?

Two interesting op-ed articles about healthcare in the New York Times today. One, by Nicholas Kristof, draws parallels between the current healthcare debate, the Medicare debate 40 years ago, and the Social Security debate 30 years before that. Kristof makes clear just how similar (and how devoid of reality) the arguments opposing each policy innovation have been.

For a more detailed analysis of the nature of such rhetoric I highly recommend Albert Hirschman's The Rhetoric of Reaction (The examples Kristof gives fall mostly in Hirschman's "Jeopardy" category: the new policy is argued to fatally undermine highly valued other achievements.)

The second article, by Gelman, Silver, and Lee, notes that a legislator's support for or opposition to "Obamacare" appears to be driven more by their constituents' support for or opposition to Obama than by whether or not these same constituents actually support healthcare reform. In other words (and unfortunately so): legislators care about politics more than policy.

The authors imply that this is strange, since legislators claim to be listening to their constituents. But it may make perfect sense, if legislators have reason to believe that their constituents also care more about politics than policy outcomes. (Indeed, they may well be correct in such a belief, as numerous political commentators have suggested, for example Thomas Frank in What's the Matter with Kansas?)

German, Silver, and Lee also provide a very telling chart of support for healthcare reform, by state, age, and income level. This chart makes clear just how important economic self-interest is to public opinion on healthcare reform. Those who are below retirement age and earn less than $40,000/year are more likely to support reform, on average (and the poorest are the most likely to do so), whereas those over 65 (who are eligible for Medicare) or who make more than $70,000/year (most of whom are probably insured through work, and who in any case are better able to afford basic preventive care) are less likely to support reform, with the richest and oldest are least likely to do so. It is striking how consistent this pattern is across states, although some regional differences do remain.

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