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Why Majority Support Does Not Guarantee Health Reform (and Why This Isn't All Bad)

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Proponents of the public option are fighting back. After some pretty bad press during the August recess, the public option remains on the negotiating table. But its position is quite precarious, with many policymakers backing away from the public option -- citing opposition among the American public. Yet, public opinion polls indicate that a majority of the American public actually support the idea of government providing an additional health insurance plan from which they can choose, as well as expanding Medicare eligibility to those under 65. Some explain this contradiction by looking at the role of the insurance industry and their lobbyist -- explaining limited support among many members of Congress who receive campaign contributions from those with a financial stake in this industry.

But, a much more fundamental explanation can be found by examining our political institutions, which were designed to allow a minority to block governmental reforms that they oppose. Concerned about the potential for a majority to trample individual freedom and minority rights, our founding fathers created a system in which it is very hard to enact major reforms without very broad consensus. And in which it is nearly impossible, even with majority support among the public and unified party control, to push through changes that a substantial portion of Americans truly fear. These fragmented institutions introduce a status quo bias into the policymaking process that has served to block previous efforts to enact comprehensive health reform.

Opponents of reform understand this reality. This is evident in efforts to organize town hall meetings, issue warnings about "death panels," and let Americans know what could be lost if health reform is enacted. But, reform proponents seem to underestimate the power of a mobilized minority opposing reform. Pundits and politicos from the left tend to easily dismiss opponents' claims as over-blown, ill-informed, and manufactured by industry groups posing as grassroots organizations. And yes, it sure is easy to ridicule concerns when they come from someone holding a sign decrying, "Keep your government hands off my Medicare!" It is much harder to take seriously the valid fears underlying these claims. These are fears about our health, our life, our death, and our families' well-being. They are also fears about authority and impersonal institutions and the ability to actually get help when we need it most. These include personal fears -- of losing out to others and falling even further behind. And they include collective fears, which acknowledge the truth that policymakers on both sides fail to admit: that the ultimate effects, benefits, and cost of reform are still unknown. And in the face of uncertainty, we know that people turn back to the familiar -- introducing an additional layer of bias in the direction of the status quo.

A full defense of the public option requires moving beyond the basic arguments for reform. It requires reform proponents to take seriously the fears of opponents, even if they make up only a minority of the American public. This requires acknowledging the inherent uncertainty involved in any major policy change, expressing a true understanding of what is truly at stake, and taking the time to describe clearly how what is to be gained will be worth what is lost. The best way to combat public fears of serving as guinea pigs in a massive social experiment is not to tell people that their fears are unfounded and their information is wrong. Instead, supporters of the public option must demonstrate that they recognize, respect, and even share this wariness of a government that too easily dismisses its citizens' fears. From that starting point, they can make a more compelling argument detailing the parallel uncertainty, risks, and costs we face if we fail to enact reform and are left with the current system.

In light of the status quo bias built into our policymaking institutions, reform proponents are charged with much more than generating majority support for their proposal. In addition, they must do the hard (often frustrating) work of courting opponents who hold many weapons with which to fight back again policies they fear. Luckily, courting the minority serves much more than a tactical aim. A government that acknowledges and responds to its citizens' core concerns -- even when it has the ability to overrun them -- is the type of government that people are less likely to fear and more likely to trust with something as important as health care.

Elizabeth Rigby, PhD is an Assistant Professor of Political Science at the University of Houston. Her research examines the politics of health, education, and welfare policies affecting low-income families. She can be reached via her website: http://www.polsci.uh.edu/rigby.asp