March 22, 2010
Health Care and Organizational Identity
Posted by Gordon Smith

The final tally on the Patient Protection and Affordable Care Act:

  • 219 Democrats voted in favor.
  • 178 Republicans and 34 Democrats voted against

Of the 34 Democrats who sided with Republicans, most (not all) were in Republican leaning districts. 

The Tea Party was out in force in Madison, yesterday, but to no avail. In the immediate wake of the vote, a number of my friends' Facebook status updates touched on health care. While some of them yearned for change in November, many others had the following flavor:

O beautiful for patriot dream--That sees beyond the years; Thine alabaster cities gleam--Undimmed by human tears! America! America! God shed his grace on thee; Till nobler men keep once again Thy whiter jubilee! I am extraordinarily proud to be an American on this Historic Day.

What is it about the health care debate that produces such division and such emotion? Before answering that question, I offer some thoughts on what the health care debate is not about:

  • This is not a populist story about the people triumphing over big corporations. After all, some of the scariest corporate bogeymen -- hospitals, health insurance companies, and drugs companies -- will be among the primary beneficiaries of the bill.
  • This is not just an extension of the abortion debate, though that accounts for a great deal of emotion on the margins of the debate.
  • This is not primarily about President Obama. Health care has been a divisive issue for as long as I can remember, which (thankfully) is much longer than Obama has been President.
  • This is not primarily about government spending. The Congressional Budget Office estimates that the new bill will reduce the federal budget deficit by $138 billion from 2010 to 2019. Count me among the skeptics. (Here, too.) In the end, however, the cost of this bill is not the main issue here.
  • Perhaps most surprising, this is not primarily about health care. Many of the tens of millions of uninsured Americans who will now get health insurance are people in good health, and even for those who are sick, the question of access remains. As noted by one perceptive commentator, "There will be no new access to health care if we do not have physicians to provide it." Some people are arguing that the bill will help control health care spending, but you can count me among the skeptics about that, too. I don't know whether this bill will improve health care in the United States. I hope that it does, but I do not believe the debate over health care was motivated primarily by the merits.
With all of the references to "partisan politics" in the press, you might be tempted to think that the Democrats and Republicans were just itching for a fight about anything, and health care was handy. But the wellspring of partisanship is a fundamental conflict of identities. Democrats view themselves as protectors of the weak and oppressed and describe passage of the bill as moral imperative. Meanwhile, Republicans believe that the quickest way to expanding the numbers of the weak and oppressed is to create a new government entitlement program, so they focus on the loss of freedom and responsibility that is said to accompany any expansion of the federal government. Both sides exaggerate, of course -- Ralph Nader is right in calling the bill a "major political symbol wrapped around a shredded substance" -- but organizations do that when their identities are at stake.

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