The debate over the Affordable Care Act, aka Obamacare, is one of the most intense and complex debates in American history. With polls showing that just over half of Americans oppose the law and just under half support it, the debate seems destined to continue. Many observers in the UK, Western Europe and other parts of the world where government-funded, single-payer healthcare systems have been in place for decades are genuinely confused by this debate. In particular they wonder why half of the American population is resistant to greater access to healthcare for those who don’t now have that access or who find themselves struggling with the current system. It seems incomprehensible that this would be the case.
When analyzing the opposition to Obamacare one must take into account the complex dynamics of American history, cultural philosophies and the current political polarization in the American system. Those who oppose Obamacare would argue that the debate is framed incorrectly. To them it is not a debate about whether people should have access to excellent healthcare. They would argue that everyone most certainly should have that access. To them the debate is about how American citizens gain access to healthcare. They argue the debate is about insurance coverage, not healthcare, and about who will provide insurance coverage for Americans: private employers or the government.
Conservative distrust of federal government
Here, American history and cultural patterns have to be taken into account. There has always been a large segment of the US population that distrusts the federal government and will reject any new effort by that government to expand its power. For the roughly 40% of Americans who self identify as conservative, resisting an increase in the size of the federal government is a cultural absolute. They are not arguing that government should not exist at all; they are just much more comfortable with local and state governments than the government removed in distant Washington. For two centuries, this cultural strain has run through U.S. history. With a continent to explore, early Americans could “light out” as Mark Twain put it and if a certain area became too congested or the local leaders too intrusive, one could just move to a place where there were fewer people and even less government, where success depended on hard work and self reliance. In other parts of the world with limited land, where populations grew and developed in smaller areas, there developed a stronger sense of community and cohesiveness; a sense of “we are all in this together” if you will. In the US, this mindset developed in the larger cities, but the traditional conservative attitude of resistance to government remained strong in suburban and rural areas. In the 20th century this resulted in most Europeans accepting a larger role for government in their lives but in the US, a significant number of people remaining opposed to larger government and what they consider government intrusion into their lives.
Opposition to new government action
Playing a large role in the opposition to Obamacare is the historical tendency for government programs in the US to cost more than originally suggested and be less effective than advertised. In countries where government action is more accepted the response to these issues would be to address what is wrong and make it better. The premise of course, being that the government action was appropriate and needed. In the US, the response is often more of an “I told you so” from those who opposed the government action all along. Coming from a mindset that the federal government often makes things worse, any deviation from the initial government proposal is seen as a vindication of the conservative views. Of course, the cultural and political divides in the US ensure that government action will never be fully effective. With 40% of the population opposing any new government action and 40% advocating more government action it is the 20% of the population that doesn’t really care that swings each election. This means that the party that favors government action will gain power and increase the role of government and then four or eight years later the party that opposes government power will come in and try to weaken or remove what has been put into place.
Finally, pure partisan politics cannot be taken out of the equation. There is a significant segment of the population that opposes anything the other party does. This is true of members of both major political parties in the US. In this case, there are some conservatives who oppose Obamacare simply because President Obama and Democrats proposed, passed, and signed it into law. For these Republicans, the fear is that given time to take root in the American system, most Americans will get used to Obamacare and come to support it, thus giving Democrats some advantage in future elections. Since Democrats are the party of government action, any action by the government that comes to be seen positively should strengthen that party.
Understanding the opposition to Obamacare
It may remain hard for those outside the US to understand why anyone, let alone a large group of people, would oppose more access to healthcare, and in the end, many may never understand it. A greater understanding of American history, cultural and politics, however, will at least help explain why there is opposition and how those who oppose Obamacare, come to their point of view.
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