American health care

Friend or foe?

Aug 14th 2009 | NORTH ARLINGTON, NEW JERSEY
From The Economist print edition

It is not wise for Democrats to bash America's health insurers

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“I AM not a Nazi, I’m not being paid to be here, and I’m not un-American!” The elderly man who uttered those angry words on the afternoon of Monday August 10th was clearly boiling over. He and several hundred others had gathered in a poorly ventilated hall in North Arlington, New Jersey, to berate Steven Rothman, their Democratic congressman, for advocating health reform. The patriotic constituent echoed the sentiments of the angry crowd by declaring that the Democrats’ health plan was something his children and grandchildren simply “can’t afford”.

With Congress in recess this month, many members are holding such town hall meetings—and meeting a similar reaction. Across the country politicians are being confronted with the outrageous allegation that Democratic reforms will create a rationing bureaucracy of “death panels” to decide who lives and who dies.

It is true that e-mails and other documents have surfaced confirming that conservative groups and talk-radio hosts have been fanning the flames of discontent. And prominent Republicans ranging from Newt Gingrich to Sarah Palin have indeed pounced on the issue with glee. The former governor of Alaska even posted a note on her Facebook page claiming that Democratic reforms would somehow do in her handicapped child.What explains all this? The initial Democratic instinct was to see a dark plot masterminded by conservatives. Mr Rothman recalls encountering such open hostility at public meetings only twice before—during Bill Clinton’s impeachment saga and over the Iraq war—but the difference this time, he insists, is that the complainers are well-organised. A White House official claims that the protests were the result of a “concerted viral whisper campaign”. Nancy Pelosi, the speaker of the House, went so far as to suggest this week that the tactics used by those disrupting public meetings were “un-American.”

Look beyond such opportunism, however, and it becomes clear that there is much genuine anger and concern among ordinary people about health reform. For one thing, the punters at these meetings often have poignant and unscripted personal tales that explain their distrust of proposed reforms. Also, numerous polls now confirm that scepticism among Americans at large—and independents in particular—is growing about health reform.

The Democrats are using two other strategies to try to quell dissent. The high-minded tactic is the White House’s redoubling of efforts to address the concerns of Americans directly. To that end, the administration has set up a new website designed to debunk half-truths and myths and is pouring money into a huge advertising campaign. Mr Obama has also headed out on the road again, with three town hall meetings on health reform planned for this week alone.

The more underhanded gambit is the decision to bash the insurance industry at every turn. Ms Pelosi now calls its bosses “villains”, while Mr Obama wags a disapproving finger. This will score some political points, as many Americans have a deep (and often well-founded) distrust of health insurers. But the tactic could ultimately hobble or even doom reform. That is because the health insurance lobby may prove to be Mr Obama’s most important friend this year.

Though it has a shameful history, the insurance industry has done a U-turn of late. It now accepts the need for a radical overhaul of insurance markets through measures such as guaranteed issue of coverage and the creation of health insurance “exchanges”. But its leaders are increasingly unhappy about the shrill attacks. Can Mr Obama continue to bash the insurers one day and rely on them the next?