Sunday, March 21, 2010

Political Stereotyping: Why Health Insurance Reform Was So Difficult

Just about everyone agrees that America's health insurance system is broken and needs to be fixed. Why, then, has change been so difficult to achieve? There are many reasons. One very important but rarely mentioned one is political stereotyping.

Political stereotyping, as we use the phrase, means attacking a politician for fitting the stereotype of his or her party and background. For example, President Obama has been typecast by the tea parties and the right as a big spending, big government politician. Being a Democrat who espouses mostly moderate and liberal ideas, he is vulnerable to such stereotyping.

It's very difficult for any politician to achieve change when the change is susceptible to political stereotyping. President George W. Bush's "ownership society" proposal to change the Social Security system by cutting back on guaranteed benefits and introducing government-funded investment accounts was easily be typecast as Republican parsimony toward moderate and low income Americans. It was DOA.

But Medicare Part D, an expensive prescription drug benefit that looked suspiciously Democratic, was enacted during the Bush 43 administration. This program, although weirdly structured with a "doughnut hole" in benefits, contravened the political stereotype of George W. Bush and was adopted with considerable Democratic support. (Postscript: the Obama health insurance reform will close the doughnut hole, good news for the many retirees having high prescription medication expenses.)

Presidents are often successful when contravening their political stereotypes. President Obama encountered relatively light opposition to escalating the war in Afghanistan. President Clinton famously failed to reform health insurance, but was singularly successful in closing the federal deficit and producing a surplus (putatively a Republican aspiration if there ever was one). Clinton deregulated the financial sector, another seemingly contra-stereotypical policy that would unfortunately contribute to the 2007-08 financial crisis. He also reformed welfare to reduce opportunities for recipients to stay on the dole for long periods of time.

Farther back in time, Richard Nixon attained rapprochement with China, a step that a Democratic President would have been vilified for taking. President Eisenhower's expensive program to build the interstate highway system was an easier sell coming from a Republican President.

Programs that fit political stereotypes are usually adopted when the party in the White House has a large majority in Congress and the urgency of a crisis to invoke. Franklin Delano Roosevelt's New Deal wouldn't have been possible except for the Great Depression and the large Democratic majority in Congress. Lyndon Johnson's civil rights program followed from his landslide victory in 1964 and the increasing stridency over civil rights. The last great political battle over health insurance--the Medicare program adopted in 1965--also followed from the Democratic landslide of 1964.

Barack Obama's health insurance reform, approved by the thinnest of margins, was achieved only because of the sweeping Democratic victory in 2008 and the virtual breakdown of the status quo in health insurance. Nevertheless, with the Democrats having demonstrated the ability to deliver on a major program, they have overcome the disadvantages of fitting the stereotype. The yin and yang of Washington have shifted again.

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