Why do US citizens resist healthcare reform?

The US Supreme Court is hearing arguments about whether or not President Barack Obama’s healthcare reform is constitutional. takes a closer look at a controversial law, and why Americans remain conflicted about it.


It is being called one of the “blockbuster” legal cases in recent American history: this week, the US Supreme Court is hearing arguments about whether or not President Barack Obama’s 2010 overhaul of the country’s healthcare system is valid under the Constitution.

The reform, officially called the Affordable Health Care Act, amounts to the most ambitious expansion of the US social safety net in more than four decades, with various rules obliging states, employers, and insurance companies to make healthcare accessible to 30 million uninsured Americans.

Studies show most Americans support specific elements of the law, like allowing children to be covered under their parents’ insurance until age 26. But a recent New York Times/CBS News poll has found that two-thirds of the US population wants some or all of the reform overturned. Even among Democrats, support for the law stands at only 56%.

The Obama administration has said it expects the law to become more popular when many key provisions kick in by 2014. But discomfort with the healthcare reform may stem from deeply entrenched, typically American attitudes, some analysts say.

Suspicion of government

In a now-iconic moment that has come to epitomise instinctive American aversion to government, one woman told a politician at a 2009 town-hall meeting: “Keep your government hands off my Medicare.” [Medicare is, in fact, a government-administered insurance programme.]

US healthcare in figures

Rankings of 34 countries*

1st in spending

1st in obesity

2nd in diabetes prevalence

3rd shortest waiting times for appointments

4th in stroke survival rate

7th in cancer incidence

9th in cancer survival

25th in preventing death from heart disease

27th in life expectancy

31st in percentage of population with health insurance

* According to Paris-based Organisation for Economic Cooperation and Development

According to Karlyn Bowman, a senior fellow at the right-leaning public policy think tank American Enterprise Institute, that kind of thinking – though taken to ironic extremes in that particular case – is not uncommon in the US, where traditionally, independence and a do-it-yourself spirit have prevailed.

“Europeans favour a much stronger, more assertive role for the federal government than Americans have, historically,” Bowman explained. “The opposition [to Obama’s healthcare law] is very consistent with historical attitudes in America: great scepticism about federal government power and reach.”

Last December, Obama himself publicly praised such scepticism as “healthy”, noting that it paved the way for the American Revolution and remains part of the American people’s “DNA”.

The most controversial piece of the reform, and the one sure to receive the most scrutiny from the Supreme Court, is the “individual mandate”: a requirement that Americans obtain health insurance or pay a penalty. The New York Times/CBS News poll revealed that 51 percent of Americans disapprove of the mandate, which indeed has been used as a rallying point for all opponents of what is sometimes derisively referred to as “Obamacare”.

“Americans initially objected to motorcycle helmet laws and seat belt laws, and now they object to a federal government mandate requiring them to have health insurance,” Bowman noted.

Those challenging the healthcare reform before the Supreme Court include 26 of the 50 states, a pro-business lobby called the National Federation of Independent Business, and various individuals; all contend that the government has no right to force them to spend money on something – in this case health insurance – they might not want.

Opponents of the reform have cited what has come to be known as the “broccoli argument”: the notion that an individual mandate could lead to other government-enforced requirements, like buying US-manufactured cars, joining a gym, or eating certain healthy vegetables. High-profile Republicans like former vice presidential candidate Sarah Palin and former presidential contender Michele Bachmann have gone as far as to call the healthcare reform and its individual mandate, respectively, “downright evil” and “a crime against democracy”.

Even Obama himself once opposed requiring all Americans to have health insurance; as a candidate for the Democratic presidential nomination in 2008, Obama slammed rival Hillary Clinton for including an individual mandate in her healthcare plan.

‘Emotional opposition’ to Obama?

Now that Obama’s signature legislative accomplishment is on the chopping block, however, his administration and its supporters are mounting an impassioned defence. They have pointed out that those without health insurance place an unfair financial burden on the entire system when they inevitably end up needing medical care. They have also warned of the damage that would be caused if the Supreme Court struck down the law, potentially reversing the recent extension of coverage to many young or seriously ill Americans.

Conservatives vying for the Republican presidential nomination, meanwhile, are watching the Supreme Court proceedings with equal interest. Maintaining that the reform imposes excessive costs on individuals, states, and businesses, they have vowed to push for repeal of the law if the Supreme Court upholds it.

According to some analysts, the unbending Republican stance toward the healthcare reform goes beyond any core American values or tendencies; it is, rather, indicative of a party that has shifted sharply to the right. “A very similar [healthcare] plan was signed into law in Massachusetts [in 2006] by then-Governor Mitt Romney,” noted Thomas Mann, a political scientist at the prominent public policy think tank the Brookings Institution. “Since those days, the Republicans…have become bent on lowering taxes, reducing the size of government, and opposing any further transfers to the poor and low-income households. Moreover, they are emotionally opposed to anything embraced by Barack Obama.”

If the court decides to strike down the individual mandate, it will have to rule on whether the rest of the law can stand. Another specific provision, the expansion of the Medicaid programme to cover 15 million uninsured lower-income Americans, is also expected to receive particular attention from the court.

No matter what the future of US healthcare holds, most pundits agree that at least some parts of Obama’s reform will remain. “People in both parties know there were problems with the old system: it was expensive and the quality was not what it should have been given how much money was spent,” Bowman assessed. “Those arguing for repeal will have to propose something in its place. At this point, going back to the status quo will be unacceptable in the public’s eyes.”

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