Last year I wrote a piece titled “We’re not ready for Single Payer Healthcare (because we disagree on basic morality).” The premise was that we could not advance towards universal healthcare because of the antipathy of conservatives to helping others. I provided some evidence:
- A 2011 Republican Presidential Primary debate, wherein parts of the audience exhorted Ron Paul to let a hypothetical person who did not buy health insurance to die in the street rather than treat them.
- Pennsylvania office candidates hearing repeatedly that providing social benefits (including healthcare) was effectively “letting people get over on them.”
- That people who don’t have insurance are losers and don’t deserve healthcare.
- Many Americans have brought just plain meanness to the discourse on social programs.
- Compared to other nations, Europe in particular, American conservatives practice a ruthless Social Darwinism.
I concluded by noting that three factors prevent us from having a meaningful discussion of moving to Universal healthcare:
- The Puritanical streak in American culture leading to the evidence listed above.
- The massive Medical Industrial Complex that has so much to lose with meaningful reforms.
- Our Cognitive Biases that prevent us from changing our minds on virtually every subject, as virtually every subject under the American Sun has a political side.
Since then, I began working with a group of self-funded, experienced health care activists under the rubric USA Healthcare – Universal, Simple, Affordable. Our goal is to change the conversation on healthcare from the reflexive rejection of the other side’s positions and arguments and to create a space for active processing (as opposed to automatic gainsaying) and useful conversations.
We think that just talking to our own team will not get us anywhere. We decided to try to understand what conservatives think about Universal Healthcare. And Simple and Affordable, too, but I am just going to talk about Universal for now.
Our budget is negligible, but we were able to use survey tools Prolific and Qualtrics and run three surveys – two practice runs and a third relatively polished one. We surveyed 282 (as I said, limited funds!) self-identified conservatives from red and purple states. Some key findings:
- Only about one third thought America had good or great healthcare
- 7 of 10 thought costs were awful or poor.
- 95% think healthcare in America needs to change a little or a lot. Only 5% approved of the status quo!
- Perceived barriers to care are more what we expect from a conservative cohort: a third feared lower quality (wait times, medication shortages), a fifth feared paying more but only an eighth feared government gaining too much power! 29% considered the power of corporations and the industry to be the biggest barrier. But here is why I am writing this piece – only 2% thought subsidizing others was a barrier!
- When we asked those who feared paying more, only 2% of this group were worried about subsidizing others.
- We asked about freedom, knowing how that word has been coopted so successfully in the American consciousness. But – prepare for a shocker for the health insurance industry – only 15% of conservatives thought the freedom to choose among health plans was the most important healthcare freedom! Half thought being able to make life choices without worrying about losing coverage was most important and 36% thought being able to choose doctors, and treatments was the most important freedom in healthcare!
- Is healthcare a right? 32% of our cohort thought so! 42% agreed it was a necessity and 17% think of it as a public service good. Less than 10% thought of it as a consumer good!
- Only 3% thought healthcare is deserved by only those who can afford it.
- However, when asked straight up if healthcare should be universal 28% disagreed. (I am not quite sure how to reconcile those, except to presume we are not professional pollsters and so may have fouled up our results based on our format, language, etc.) About a third of this subset cited freedom to not buy insurance as their reason and slightly fewer were concerned about too much government power.
- 72% of our conservative cohort agreed that it should be universal. They cited reduced worrying about getting healthcare, freedom in personal choices, justice and just promoting a healthier America.
- When asked about who has the most power to influence government, more than half recognized the private for profit companies as the primary source of power. 17% thought it lay with liberal politicians and their supporters and 12% viewed hospital systems as the most powerful. Only 7% viewed doctors and nurses as having major power.
These results left me gobsmacked and extremely hopeful. Three major points for me:
- Only a tiny minority in this group objected to subsidizing others and only a slightly larger group were worried about too much government power.
- The overwhelming majority viewed healthcare as something that should be universal and had the same concerns that we liberals are always going on about – freedom and justice and a healthier country.
- Most recognized that the commercial beneficiaries of our system (the Medical Industrial Complex, MIC, as we sometimes say) were also holding the power to prevent change!
As I now think back to my original, less hopeful post on this topic, I am left to wonder two things. Are our results way off, or, as we often do, do we pay too much attention to the loudmouths and the right-wing messaging machine? Consider the 2012 Presidential debate. Although you can clearly hear the “Let him die” shouts, they weren’t in the majority of this audience and this audience was a self-selected, hyper partisan crowd. So if it is a minority of them, maybe our results are more reflective of the average GOP voter?
And it may not just be the rank-and-file loudmouths, but also the paid loudmouths – lobbyists, influencers, and media. This Washington Post article describes the malign influence that leads Congressional staffers to believe their constituents are more conservative than they actually are. There may be no area in which this is more true than healthcare, at least based on our results. The bullshit fed to Congress about the unpopularity of universal healthcare may be part of the elaborate myth-making of the MIC. To wit, Wendell Potter’s observation that “Health insurers have been successful at two things: making money and getting the American public to believe they’re essential.”
Similarly, the relative few worried about too much government power, if it holds up to better testing, represents a sea change in my thinking, The corresponding number of conservatives who recognize that corporate power and influence are a far greater problem than government power is heartening.
This makes me hopeful because these ideas represent two of those deep-seated moral frames that I thought would be impossible to overcome but may turn out to be vocal but small minority of conservatives. This is kind of a big deal. Even with extraordinary effort, Frank Luntz and the GOP messaging machine can only drive the “resentment” and “fear the government” numbers up so far. We can work with this!
And even when that messaging tsunami comes, we have other significant findings to work with. Conservatives worry about losing coverage. They worry about their families if they want to switch jobs. They worry about freedom and justice in the ways that we do, at least in health care. They worry about the health of the country. They worry that the MIC has too much power.
And this matters because it’s all about the cognitive psychology of our approach. Fear, uncertainty, and doubt are powerful cognitive tools that have helped Frank Luntz and the conservative messaging machine win again and again and again. I have spent my spare time in the past couple years learning about Prospect Theory, Behavioral Economics and Cognitive Psychology and trying to figure out how to use it all in the universal healthcare space. If you want to learn more, please check out my video, Cognitive Science and Universal Healthcare.
I would love to have a discussion about this, as I am anxious to get feedback from the community on how to better use our findings.
As I mentioned at the beginning, we also did polling on the concepts of Simplicity and Affordability to round out our USA trilogy. I’ll be posting on those ideas soon as well. Spoiler – as you might expect, there is even more agreement across the political spectrum on what a train wreck our system is in those regards than it is with universality!
Cheers,
CMH