Will public opinion kill health care reform in the US? Naturally, I don't know the answer to that question. What is interesting is how a reform process that appeared close to conclusion can wobble mightily upon the apparent signaling of public displeasure. If reinforces once again the centrality of politics - and of public opinion- to processes of reform. What matters now, as the leaders of US government grapple with how to conclude or abandon the reform effort, is to reflect on some of the lessons coming out of the process at this point that might be applicable to reform processes generally. The following seem fairly clear:
- A fiendishly complex reform is not easy to communicate. Ideally you need to be building majority opinion behind what you are trying to accomplish, what a better future will look like, but the more complex the reform is the easier it is for opponents of reform to find aspects of it bound to terrify or annoy different sections of the public. A reform process that only policy wonks fully understand is not likely to build majority support.
- Values matter. If, as in the US, you have a center-right electorate a complex reform signaling government intervention in a major part of the economy can attract opposition simply for that reason, no matter the good you ,are trying to do. It is striking how many Americans simply oppose activist government, no matter the extenuating circumstances.
- As a corollary to that, it seems clear that not everybody thinks it is important to help the millions of Americans without health insurance. Some simply say, "Well it would be nice to help the uninsured but don't ask me to pay for it.!" Majority interest appears to be in cost-control and the security of the health insurance of those who already have insurance.
- Finally, an issue like the public debt of the United States can, for some voters, trump any public spending proposal. The fine points of fiscal policy regarding what is and what is not a sustainable quantity of public debt for a large economy does not appear to matter to these people. Their message: 'Just balance the budget, stop spending!' Again values matter, and they are powerful shapers of attitudes and opinions.
I always thought that the health care reform story in the US would be one for the ages. That is even truer now. It is going to be fascinating to see how the story ends.
Photo Credit: Flickr user seiuhealthcare775nw