All I need now is a really tall ladder....
March 20, 2010 12:22 AM   Subscribe

Help me to understand the mentality of those Americans who are opposed to Obama's national health-care plan.

In an attempt to suppress my urge to climb up my high horse and feel morally superior over the seemingly selfish Americans who only deserve healthcare if they can afford it (ok, and to stop yelling at the radio and the tv), I would like to be able to understand the reasoning people have for opposing it.

There are plenty of resources out there, like this article, which quite eloquently explain their personal reasons, but I am looking for a more generalised mentality that people may hold.

I realise that I may be/am:

1. completely wrong about the general reaction of Americans to the plan.
2. misinformed about the nature of the reforms themselves.
3. assuming that most people don't have a thorough understanding of the plan itself and are therefore opposing it on emotional and poorly informed opinion.
4. belong myself to the above category and support the plan based on a poorly informed opinion.

As an Australian living under a national health-care plan, I cannot fathom why someone would be opposed to the idea of everyone having the same basic human right to healthcare. Every system has its pros and cons, but I have read countless articles and anecdotes linked through Metafilter to be able to see that the current system isn't working and shouldn't stay (but that is for another time, another place).

Clear it up, set me straight - I want to understand the mindset of those who disagree with it, so I can either stop stereotyping them, or continue safe in the knowledge I was right all along.
posted by Pippi Longstocking to Society & Culture (67 answers total) 56 users marked this as a favorite
There are plenty of resources out there, like this article, which quite eloquently explain their personal reasons, but I am looking for a more generalised mentality that people may hold.
There was a lot of pushback on that article (not surprisingly), in particular she was wrong about what the NIH actually does.

As for why the average person on the street opposes it, I think it's basically a case of people not wanting to pay for anyone else.
posted by delmoi at 12:29 AM on March 20, 2010

Essentially, the opposition believes themselves to all be very hard workers, and that hard work enables them to purchase medical care, which they do not think is a right, rather, it is a service to be purchased with money(or insurance) they've earned. The idea that less hard-working people, not to mention immigrants, getting the benefits of their hard work via taxes is deplorable to them.
posted by Threeway Handshake at 12:50 AM on March 20, 2010 [2 favorites]

I've spent too much time argue this issue with some of my conservative acquaintances. Besides a general distrust of anything government, they spend most of their time talking about Medicare/Medicaid fraud and the lack of effective cost savings measures in the proposed reforms (namely tort reform). When they're being more blunt, they say that Medicare/Medicaid is a fraud-riddled system that illicitly benefits various constituencies that vote for Democrats. If pushed, they will concede that it would be a decent idea for the government to provide healthcare as part of a safety net for the poor and elderly. But they will not support any such measure until Medicare/Medicaid is rid of fraud and tort reform passes.
posted by mullacc at 12:56 AM on March 20, 2010 [2 favorites]

As an Australian living under a national health-care plan, I cannot fathom why someone would be opposed to the idea of everyone having the same basic human right to healthcare.

Older conservatives are actually pretty at ease with the idea of socialized healthcare for everyone, in that senior citizens (among others) receive Medicare and Medicaid benefits administered by the government and paid for by fellow taxpayers. A lot of the conservative opposition to Obama's plan is rooted in racist fears of a black president, fears stoked by the mainstream media in the United States.

In turn, radio, print and television media have a strong right-wing bent and an editorial agenda to spread fear for power and profit. Providing more choices and independence to people — by providing socialized services as a legitimate alternative to private options — reduces fear (like the very real fear of getting injured and going bankrupt) and therefore threatens the control that moneyed interests have, which threatens the right-wing elite and its media outlets.

It's a vicious feedback loop of fear, ignorance and bigotry that taps into the country's ugly past and its mean Calvinist streak.
posted by Blazecock Pileon at 1:58 AM on March 20, 2010 [4 favorites]

Best answer: Some Americans, or their loved ones, have been badly treated, or extensively injured, in the modern medical system, and want no more of it for themselves. They may have seen loved ones die enormously expensive, heavily medicated deaths, that cost hundreds of thousands of dollars in the last weeks, supported by expensive, useless treatments that in the end accomplished little or nothing. They resent, hugely, being forced to pay for insurance that supports that system by national mandate, under penalty of fines if they do not buy mandated insurance.

They view the current health care reform proposal as an unmitigated disaster for the U.S. economy, and a conglomeration of special interest deals made under pressure of lobbyists who have spent hundreds of millions of dollars to influence career Washington politicians for narrow gain. They see existing working, but underutilized, health insurance solutions like Healthcare Savings Accounts and cafeteria benefit plans being gutted, in favor of vastly expanded forms of government directed Medicaid, to be paid for by higher taxes and lower benefit levels on the elderly, including a $500 billion reduction in benefits under Medicare over the next 10 years. They resent being told that they "can keep their existing insurance, if they like it, untouched" and many other falsehoods, by a President who has now staked his political future on this program, and is making confusing statements and promises, to pass it, with no means of backing those statements and promises included in the legislation.

They see a political process so broken, that to pass this legislative travesty by the narrowest of cold political margins, and in the face of enormous public opposition, the House of Representatives will pass a Senate bill that House Democratic leadership said publicly they would not approve, when the Senate passed its version, on the assumption that, to make the program at all "viable," they (the House of Representatives) will then turn around and pass a "reconciliation" bill, to modify the Senate version of the bill they will just have passed, in hopes the Senate will then, too, go along with that "reconciliation." They (the members of the American public opposing this legislative disaster) think this legislation is the very worst of bad political leadership, and the kind of sausage that gets made when pigs take over the sausage factory.
posted by paulsc at 2:04 AM on March 20, 2010 [25 favorites]

I am by no means well-informed on the subject, but I have heard several doctors indicate that they will find it exceedingly difficult to work under the new plan. Namely, all doctors become the doc you are seeing for your back pain used to be a foot doctor or an ob/gyn before the change. Secondly, they will all have to take major pay cuts, which they don't want to do. They spent all that time in school to be doctors because that's a very high paying job...very few of them are in it for the glory of saving lives....most are in it for the cash. When the new plan takes over, they will not see anywhere near the levels of pay they currently see, and their workload will increase exponentially since they will have to treat every Tom, Dick, and Harry that walks through the door. Not to mention that the ones that actually do have a passion for the craft will get so overwhelmed by the sudden decline in the number of Docs in the states, that the waiting lists will back up for months.

I agree that something needs to be done about healthcare, but Obama's plan isn't going to work, and will likely have more corruption and crappier care than the current system.
posted by AltReality at 2:10 AM on March 20, 2010

Never underestimate Americans' fundamental distrust of government. While you see health care as a right to be protected and provided by the state, many Americans see the freedom to make health care dcisions free from government intervention as a right - even if it means that they ultimately get no health care at all.
posted by googly at 2:10 AM on March 20, 2010 [4 favorites]

Namely, all doctors become the doc you are seeing for your back pain used to be a foot doctor or an ob/gyn before the change.

What could possibly cause this?
posted by jacalata at 2:39 AM on March 20, 2010 [9 favorites]

Best answer: This blog post entitled "Health care reform bill is immoral and won't work" is a round-up of several popular arguments against the plan. Specifically, Health Care Is Not a Privilege … Nor Is It a Right seems like a popular sentiment. Others believe that some kind of health care reform is necessary, but that this plan threatens to degrade the quality of American health care while inflating its overall cost. And many believe under the proposed plan they will be funding abortion which they feel is fundamentally amoral.

Conversely, the reasons for Dennis Kucinich's opposition offer some perspective from the other side of the aisle. (He has since pledged to vote for the bill.)

Anecdotally, I find a lot of fellow Americans base their opinions on domestic policy by boiling issues down to a dichotomy of whether "I" or a nebulous entity called "the government" is more fit to make what seem to be simple, personal decisions.
posted by churl at 2:51 AM on March 20, 2010

Namely, all doctors become the doc you are seeing for your back pain used to be a foot doctor or an ob/gyn before the change.

Where did you hear this? Its not true.

and their workload will increase exponentially since they will have to treat every Tom, Dick, and Harry that walks through the door.

They have to do that now. Doctors do not have the right to pick and choose their patients. If their practice is full, its full. If its not, its not. Nothing about medical caseload will change.
posted by anastasiav at 3:03 AM on March 20, 2010 [6 favorites]

paulsc sums up several key threads of the anti-Obamacare position very eloquently above.

As for some of the rest of the ideas volunteered above, I suppose it's possible that Americans oppose the healthcare bill because they're at heart just evil ol' racists and meanies, but that certainly hasn't been my personal experience in discussing this issue with educated conservatives.
posted by yersinia at 4:01 AM on March 20, 2010 [2 favorites]

Kucinich was against it as well - don't discount those on the left who have structural problems with it. And to paulsc's point above, I'd imagine there are people who took Obama at his word about not doing 'business as usual', 'kicking the lobbyists out of Washington,' etc. who might be frustrated with the way this has been handled.
posted by mattholomew at 4:34 AM on March 20, 2010

I've thought quite a bit about this, even though (or perhaps "especially because") I support the plan and will not be personally impacted by it in any way.

Much as I wish it weren't so, the US seems to be locked in tension between two factions: those who would like to see it become a more progressive and egalitarian society and those who believe it should retreat to a more feudal state. At present, much of the pressure toward the latter system is fueled by the worship of Ayn Rand's writings, but I think that's more a symptom than a cause.

What I've labeled "feudal" means that the playing field is not and should not be level. If the vast bulk of Americans work at marginal jobs without any meaningful benefits or additional supports, that is as it should be because they lack the skills or connections or inheritances to do differently.

Those who are in this camp oppose the notion of equal access to healthcare, as well as affirmative action, progressive taxes, attempts to regulate businesses, unions, and so forth because they all seek to level the playing field. When the playing field gets leveled, feudalism breaks down.

And, as noted by other commenters, one should never discount the desire to defeat healthcare reform as a way of ensuring that our first black president fails.
posted by DrGail at 4:50 AM on March 20, 2010 [5 favorites]

There is major opposition to it on the left. This is from the popular liberal blog Firedoglake, in December 21, 2009:
Top 10 Reasons to Kill Senate Health Care Bill

1. Forces you to pay up to 8% of your income to private insurance corporations — whether you want to or not.
2. If you refuse to buy the insurance, you’ll have to pay penalties of up to 2% of your annual income to the IRS.
3. Many will be forced to buy poor-quality insurance they can’t afford to use, with $11,900 in annual out-of-pocket expenses over and above their annual premiums.
4. Massive restriction on a woman’s right to choose, designed to trigger a challenge to Roe v. Wade in the Supreme Court.
5. Paid for by taxes on the middle class insurance plan you have right now through your employer, causing them to cut back benefits and increase co-pays.
6. Many of the taxes to pay for the bill start now, but most Americans won’t see any benefits — like an end to discrimination against those with preexisting conditions — until 2014 when the program begins.
7. Allows insurance companies to charge people who are older 300% more than others.
8. Grants monopolies to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market.
9. No re-importation of prescription drugs, which would save consumers $100 billion over 10 years.
10. The cost of medical care will continue to rise, and insurance premiums for a family of four will rise an average of $1,000 a year — meaning in 10 years, your family’s insurance premium will be $10,000 more annually than it is right now.
More thoughts:

You're describing the bill in glowlingly idealized terms, as "everyone having the same basic human right to healthcare." My understanding is that it's not nearly as strong as that. It's been heavily watered down, but it still has an individual mandate for people to buy health insurance, with a penalty if they don't. I don't think it's unreasonable to think the bill doesn't provide enough benefit to justify the penalties and costs.

A member of my family who's opposed to it (strongly enough to be attending a protest rally this weekend) argues that it's unfair to young people. They generally need very little health care, but the government is going to force them to pay lots of money into the plan. That money will almost entirely go to supporting older people. (Of course, a counterargument is that those young people will be older themselves some day, but you asked for the arguments against it.)

Your argument -- "Every system has its pros and cons, but I have read countless articles and anecdotes linked through Metafilter to be able to see that the current system isn't working and shouldn't stay" -- is unconvincing to many people. They will summarize your argument as: "Something must be done; this [the bill] is something; therefore, this must be done." When you put it that way, it's an obvious logical fallacy. I agree that the current system is terrible and must be changed, but considering that we're talking about a complex 2,700-page bill that I don't trust anyone to have actually read, I think it makes sense to be skeptical that the bill would be an improvement.
posted by Jaltcoh at 4:59 AM on March 20, 2010 [16 favorites]

I've heard all of these reasons personally.

1) Have you been to the DMV? Do you really want government running health care?
2) It's going to bankrupt America.
3) The government does not have the authority under the constitution.
4) It's going to get rid of the reasons that America has the best medicine in the world!
5) It's socialism!
6) There will be waiting lists.
7) There will be rationing.
8) It provides a disincentive to holding down a job.
9) It's a government power grab.

There appears to be an element of racism, as well. People imagine white people paying higher taxes and blacks and "illegals" getting free health care.
posted by callmejay at 5:15 AM on March 20, 2010

No one else has mentioned this, but it's also worth noting that there's a lot of corporate money being invested in confusing issues and scaring people for the sake of their bottom line. So they start spreading stories about "death panels" and free abortions for illegal aliens. The persons being targeted by these stories are already pretty scared - they see the country being taken over by this new guy, they probably don't even know anyone who voted for him (suspicious, no?), and they're not even certain he's a citizen. Whatever he's for, they're going to be against it. They're pretty much just begging for someone to tell them why reform is a bad idea, and lobbyists for insurance companies are more than happy to help.
posted by Gilbert at 5:18 AM on March 20, 2010

1. Poor people will get free healthcare.
2. My company's plan will be: a. more expensive. b. inadequate and penalized., c. too expensive, compared to the penalty, and be dropped so I'll have to get on the government plan.
3. It will cost too much (of my tax dollars)
4. It will pay doctors too little, and there will be fewer doctors treating more patients
5. death squads
6. the governments wastes too much money already, we expect them to take care of this too?
7. I want to decide what I buy.
8. Poor people will get free healthcare
posted by Gungho at 5:26 AM on March 20, 2010 [1 favorite]

AltReality is wrong, as I think is obvious. There is no reason why anyone would want all doctors to be 'generalists' and that has nothing to do with the currently proposed legislation. I'm not sure how you would even go about that if you wanted to.

That will be one thing about getting this bill passed, at least the people who believe crazy things like this will figure out that the the healthcare system is not going to be oh so different after it passes. True, it's possible we might take a pay cut, but with the public option off the table, it seems much less likely that we will see any significant change.

As a doctor, I would also like to refute the argument that the majority of us went into medicine because it is a high paying job, and not because we want to help people. Sure, there are a few people who are interested in money, but there are plenty of other ways to make a lot of money like finance or business that don't involve going $200K into debt, seeing people die and other terrible, heart-wrenching things on a daily basis, having to cause people pain who are unable to understand that you are doing it because you are trying to help them, having to flog little old grandparents with expensive and futile, painful procedures because their relatives can't face the fact that they are dying... it's no walk in the park, man, and it's not worth doing if you don't enjoy it. And we already do have to see every Tom, Dick, and Harry who walks through the door. I work in the emergency department and I've seen everything from hangnails to dandruff as chief complaints. So, perhaps you should spend more time learning about doctors and what they do before posting.

p.s. to paulsc, if you don't want to see your family member die an enormously expensive death, then get them a POLST, or, even better, get them a healthcare proxy who actually knows what they would want in a life-threatening situation. Physicians are usually happy to do less rather than more in situations like these. Also, as the article you linked to notes, hospice, hospice, hospice.
posted by treehorn+bunny at 5:54 AM on March 20, 2010 [16 favorites]

"... p.s. to paulsc, if you don't want to see your family member die an enormously expensive death, then get them a POLST, or, even better, get them a healthcare proxy who actually knows what they would want in a life-threatening situation. Physicians are usually happy to do less rather than more in situations like these. Also, as the article you linked to notes, hospice, hospice, hospice. ..."
posted by treehorn+bunny at 8:54 AM on March 20

Would that it were all that simple, near the end, treehorn+bunny. But the POLST you advocate aren't available in most jurisdictions in the U.S. And it is simply facile to say that physicians are happy to do less, rather than more.

At the end of many terminal diseases, days, if not weeks, of mind wrenching pain is before the patient, as a once strong body has to find its particular way to finally fail. At that juncture, it simply takes more courage on the part of many patients, and their families, to face that uncertain period, without a promise of "the best" treatment. And you can bet, that, in a lot of places in the U.S., the moral ambiguities involved in end of life planning resolve, by default, not upon a clean, dignified choice of a painless, medically induced end, but upon the senseless prolonging of life, so long as the patient is medicated to an insensibility of "not suffering." In many cases, it seems that exceptional measures are taken, simply to get the patient into such a deeply medicated state, that his/her clear headed will can't be expressed, so that the failing body can die in its extended fight, relieving the physician from the responsibility to be a treating partner in the actual act of death.

As a family member, you never hear a physician saying to a dying patient, "There's no hope. I recommend you and I pick a time and date, and get you taken care of, for once and for all."

For that level of moral clarity and simple humanity, you have to visit a veterinarian.
posted by paulsc at 6:18 AM on March 20, 2010 [5 favorites]

Best answer: I applaud your curiosity and not just assuming that healthcare reform "opponents" are evil-spirited monsters. I use quotes around "opponents" because those (like me) who are opposed only to the type of reform being proposed as to other types of reform.

I agree that paulsc has enumerated many of the problems I have relating to the current legislation (as opposed, again, to reform of other sorts).

Individualism v. Collectivism
I think opposition to this legislation has a lot to do with the nature of US society. We are a society based on the concept of individualism, not collectivism, so ideas of healthcare being an individual right for all, which will be paid for (by mandate of government) only by some for the benefit of others (who have no liability)--will automatically get some pushback. I personally do not mind helping those truly in need (even by government mandate), but admittedly have problems that there are no corresponding obligations on the part of the recipients of "free" healthcare. For example, some of the people getting subsidies (those making under something like $88,000/yr) may live in an area of the country that is relatively cheap and may have funds available to pay for their own healthcare (or part of it) but that $ is spent on cable tv or cigarettes or a cell phone or in a bigger house than necessary (not necessities), but are not obligated to contribute that money to their own care. I am realistic that there is really no way to reasonably check to see how those recipients spend their $, but knowing that some people will do so irks the hell out of me. And I think there are many people (like me) who have been poor, have foregone luxuries like a cell phone, cable and better housing so that they could pay for health insurance and necessities. But I assume that there are some (not all) people that do not make personally responsible decisions and it irritates me that I have to pay the price for others' irresponsible decisions. Rugged individualism indeed.

Before the pile on, I want to make clear that I do support "free" (for the recipient) health care for the truly needy. I also know that the cost of providing this in a realistic fashion will include some irresponsible folks who might have 100 bucks to contribute, but have a cell phone and cable instead. And there may be some that want to deny health care for all if even a small minority mught game the system. I am not one of them. I am just explaining how it irks people.

Health Insurance v. Health Care

I have heard it argued that health insurance is a right. Huh? Perhaps they mean health care is a right. I don't believe health insurance is a right--just don't and nothing anyone says will convince me otherwise. Health care on the other hand is arguable. I do not think our Constituion makes it a right, per se, but it is a matter of decency in a civilized society. But the legislation does not mandate health care, just health insurance. While insurance will likely help get the care, insurance do not equal care. Just sayin'.

Moreover, if health care is a right, it assumes that people have the "right" to other people's services (in other words, that providers of health care services have the obligation to give of their services). I am simply against a government mandating that any person be required to perform services for another on terms that are unacceptible for the service provider. I believe that this legislation is flawed and that when our limited number of doctors and nurses (they are not an unlimited commodity) stop taking patients on Medicare or Medicaid because they do not like the reimbursement rates, the government will be hard-pressed not to force them to do so (i.e. by making their licensing contingent of taking these patients).

I just don't see that this legislation is the elixir that cures all that ails the current problems and it just costs too much....

We can't afford it

This article sums it up pretty well for me. The United States is broke. And as much as anyone (including me) want to help those in need, the US already has huge unfunded entitlement program liabilities and this seems fiscally reckless to me. While arguments can be made that this might save money in the future, I believe this maybe is something we cannot risk at this point. I just think it is potentially catastrophic finiancially to our country and to our future generations (which selfishly I wish to protect against for the sake of my 7 month old son).

I believe in the goodness and charity of the people of this country

I just do. We do not have the crushing poverty that you see in other countries...yes there are poor people and people who truly struggle for the basic necessities of food and shelter and yes, health care. But I believe that charity (the real kind from the goodness of people's hearts as opposed the the forced-by-the-government-kind) helps many of these people, which is why we do not see the devastaing poverty that is seen in India, Mexico and Africa (among other places) where medical care is lower on the devastatingly needy's list of needs than food, clean water and secure shelter.

There are defects and deficiencies in our current system that I believe most everyone wants (from their charitable hearts) to fix. That is why a majority of Americans want the Congress to start over and draft a better bill.

The Flawed Process
And finally, I wish to expand on paulsc's statement that the sausage-making legislative process has angered people. I (and I will only speak for myself) am royally pissed off at what I believe to be a horribly corrupt process. But even moreso, I am terrified at the dangerous precedent it sets. I believe in the checks and balances placed on our government by the Constituion, I don't like the deals for special interests, vote buying and failure to abide by the clear mandates of the constitutional process. And arguments that it has been done before by the other party, IMO, is a political argument, not a constitutional argument and is a childish to boot ("Johnny hit Susie too!"). If this is allowed to happen now, what safeguards would there be when the other party is in power and doing the same thing against the will of the minority? Doesn't that scare people regardless of political affiliation? Think about you want to see the other sides' political ends justify these means? It will cut both ways to everyone's detriment. Maybe I am too prone to think we are moving towards a Mad Max-ian hellscape, but my fear is real nevertheless.

Perhaps all of these things make me evil, selfish and uncaring in some people's minds. I can't help that. But I believe in my heart of hearts that while I believe some fixes need to be made to the current system so that abuses are curbed, costs are lowered and people get the health care they need, the legislation that is being put forward is just too severely flawed.
posted by bigwoopdeedoo at 6:19 AM on March 20, 2010 [12 favorites]

My boss and I have had this discussion, and I'd like to think that we're both fairly smart people. He opposes it because he does not think it's the government's job to provide healthcare for its citizens. He sees any sort of government-run system as an entitlement system, of which he thinks we need fewer, not more. I, on the other hand, think that governments, when they are able, have a basic obligation to provide for the health of their citizens. It's an ideological divide, premised on our different opinions about the basic function of the government.
posted by craven_morhead at 6:59 AM on March 20, 2010

"I cannot fathom why someone would be opposed to the idea of everyone having the same basic human right to healthcare"

Sure you can: Hate. A significant number, not all of course but enough to matter, hate their neighbour.

They are a martial people with a martial spirit. Their must be a war and an enemy.

You could spend the rest of your life reading their brilliantly written political and social rationalizations. Don't be fooled. They just don't care enough about each other. Again, not all but enough to matter.

It wouldn't be hard to do. Most Western countries have done it. Sane people understand that life is meaningless without health.

If they set their minds to it, they would develop a public system that would be the envy of the world.
posted by larry_darrell at 7:01 AM on March 20, 2010 [10 favorites]

You know that unfortunate leitmotif of the American (well, human, really) character, "Got mine, fuck you"? This is the flip side: "Ain't got mine yet, fuck if I'm gonna let you get yours".
posted by Quietgal at 7:39 AM on March 20, 2010 [1 favorite]

seemingly selfish Americans who only deserve healthcare if they can afford it

I cannot fathom why someone would be opposed to the idea of everyone having the same basic human right to healthcare.

Some people may oppose significant healthcare reforms as currently proposed, or national healthcare in general out of selfishness or hate or prejudice. Others don't.

I know a lot of political conservatives. Although I am not one myself, I continue to be in contact with them because they are not hateful, awful, evil people. I disagree with them, strongly, but they are not uniformly hateful or stupid. I think, at least among the conservatives I know, it has less to do with wanting to limit others' access to healthcare because they don't deserve it and more to do with a belief in the role of "The Government." They seem to believe that The Government is good at triage (you're in desperate need, you can get food stamps and a limited amount of money; you're bleeding from the head, the ER is required to treat you) but that for basic life stuff (you need a job, you need to have a physical, etc.), The Government fails (insert DMV/post office reference here). They believe that The Government both constantly seeks to make and is terrible at making decisions that citizens should be making for themselves.

So, it's not so much about healthcare not being a basic human right so much as it's about The Government's role in helping citizens to access healthcare. (I think that the conservatives in my life would generally object to the phrase "healthcare is a human right" primarily because it is used as an argument in favor of one particular means of providing universal access to it, and that objections to that particular means of access are attacked as cruel and hateful, not because they truly believe low-income families should suffer.)
posted by Meg_Murry at 7:51 AM on March 20, 2010 [3 favorites]

Members of my family have made all those rational-sounding anti-Obamacare arguments above. (To be fair, there are good points among them.) My stepmother actually tried to engage me with that argument that young people are going to infairly take the burden of the cost, but don't really need heathcare. (She didn't get too far with that one, considering I'm young, and letting a few major medical situations go untreated because I have no insurance and no money).

But for my family at least, it's a front. They've convinced themselves to believe these things after the fact, to justify the following core beliefs:

1) Racism, and the attendant rage that the President is black
2) Obama is an agent of Satan. Church said so. Also, Obama will kill your grandmother and force you to kill your babies.
3) I've got mine, fuck everyone else.
4) What works for me is good enough for everybody.
5) I don't actually know anything about socialism, but this is socialism for sure!
6) Women can't be allowed any more freedom to regulate their uteri. We're already a nation full of babykilling sluts.
7) Actually, everything liberals want is rooted in godlessness, and even if a liberal initiative would dramatically improve my life, I'm opposed to it anyway.
posted by Coatlicue at 7:53 AM on March 20, 2010 [10 favorites]

Thanks Pippi for asking this question, I was about to post it myself on askme. And thanks everyone for your answers covering the spectrum from conservatism through political idealism to misanthropy.

But what I do not get is, sorry to piggyback but very related -- what's the alternative to health care reform? The US has the most expensive healthcare system in the world, covering only 80% of its inhabitants, and its quality is so-so, compared to other western countries. Most every change will make things cheaper and better.
Something Has To Change. Right? Please shine a light for a European...
posted by gijsvs at 8:14 AM on March 20, 2010

You can unpack an awful lot from the infamous line "Keep government out of my Medicare" -- the generational schism, the doublethink about government provision and management, the fear that someone else (the 'undeserving' Other) will take away what they already have. While I appreciate the explanations from the opposite side, they come across, to recall Keynes, as a 'superior moral justification for selfishness.'

The bill that's on the table is a dog's breakfast: it it passes, it may give the parasitic, inefficient non-system of healthcare in the US another decade before it collapses. But eventually, segregated healthcare is going to be as unimaginable as segregated lunch counters, schools and bathrooms, which is why the arguments against desegregating healthcare have a 1960s last-days-of-Jim-Crow feel to them.
posted by holgate at 8:26 AM on March 20, 2010 [2 favorites]

As usual, Nate Silver has a good, short summary of one of the basic problems. People don't know what's in the bill. If you ask them about individual items in the bill, people are in favor of most of them. If you ask them "are you in favor of health care reform", they say they're against.

Jumping to one of the conclusions at the end: it's much harder to read the opinion polls as a "mandate" against the health care bill when much of that opinion is based on demonstrably false beliefs, some of which have been perpetuated deliberately by opponents.
posted by gimonca at 8:27 AM on March 20, 2010 [2 favorites]

I think bigwoopdeedoo hit it on the mark. I don't believe the Christian faith is the strongest moral foundation of the general population, but rather individualism.

One thing that I don't think I saw mentioned as well, is that some opponents are concerned that the health care bill is unconstitutional. My mother recently started to say this which surprised me, because it came out of nowhere. I'm assuming that since she was listening to some form of talk radio, she heard it there. It is certainly something being chanted by the Tea Party members.

[I'm not saying that the health care bill actually is unconstitutional. I haven't looked into it. Although, I also don't care. I think the constitution and the Supreme Court are a farce.]
posted by SollosQ at 8:27 AM on March 20, 2010

My analysis:

1- Many of the "ground troops" in the anti-Obamacare movement have no idea what healthcare actually costs. They all appear to be people with jobs, and their idea of what healthcare costs is the $20 that comes out of every paycheck. Or old people who have medicare, and think whatever they pay is the full freight. They forget that everyone who works pays something like 2% of their income to keep them alive.

2- This particular bill is a steaming pile of crap. Hopefully, it is merely an incremental step.

3- There is a long history of FUD about any form of socialized medicine. Reagan was running around in the 60's scaring housewives that their doctor husbands would be working for the government and would have to move to Wyoming or Detroit because the government told them to.

4- Nobody understands the difference between health insurance and health care. The insurance companies are currently griping that their profit margin is only 3-4%. Bully for them. But their entire business, 100% of their revenue, is siphoned off of the money flow from patients to doctors. Since they sit in the middle, they control the prices. They don't absorb risk, they simply spread it around to others. Also, 3-4% might not seem like a lot, but healthcare is a significant portion of the entire US economy. It is in their best interest to protect that. They don't want the government getting in the way of that.

5- Political gamesmanship. Anything the opposition wants, they are opposed to.

6- Example.

7- They do not understand the fundamental disconnect that already exists between who pays for healthcare and who consumes it. Healthcare is *already* socialized. Most everyone who needs care can get it. They might have to lie about their identity, or go bankrupt, or beg for charity care. It's not efficient, pleasant or dignified. Either way, the costs of their care are spread out via higher prices to those who can pay. So in effect, all of healthcare is paid for by the smaller slice of the population that chooses to pay for it. All these proud Americans who pay their own way simply don't understand that (in a perfect world) some kind of real socialization would reduce their costs.

8- OMG, Medicare fraud. Do they not understand how much of their health insurance premiums are soaked up by insurance fraud and the prevention thereof? Fraud exists *because* the insurance companies stand between the doctor and patient. There could be (almost) no fraud if healthcare was simply a transaction between the doctor and the patient.

And yes, this is an excellent way to oppose the president without having to admit racism, even to themselves.
posted by gjc at 8:31 AM on March 20, 2010 [6 favorites]

As an Australian living under a national health-care plan, I cannot fathom why someone would be opposed to the idea of everyone having the same basic human right to healthcare.

Suppose you're in university, taking a tough mathematics course with about three dozen other students. You study hard and long, and then you write the final exam. Grades are shortly thereafter distributed.

You get 90 out of 100. Excellent! You're happy. But wait - that's not all. The professor pulls you aside. A guy sitting across from you, only got 40/100. Since 'pass' is 50%, that would mean he's going to fail. However, the university has decreed that no one should be permitted to fail. This means, then, the professor is going to take 20 of your points, and tack them onto the other guy's grade. He then passes with 60/100 and you get a more modest, but still very good, grade of 70/100.

Understandably you'd be upset. 'Why are you doing this?' you ask. 'I worked hard for that grade! I studied hard! And maybe I'm just better in math than him! It's his fault he failed! It's not fair to me, to take my grades that I earned, and give them to somebody else!!!'

The above analogy is exactly how Americans, or at least those with political-economic power, view their political-economic system.

People are wealthy because they deserve it. They worked harder, or were smarter, or were more motivated that those who are poor. The poverty of the poor, is in and of itself evidence of the fact that they deserve to be poor. Because if they worked harder, they wouldn't be poor.

So, then, those who have wealth and (by their own standards) worked hard for it, resent the idea of the Gov't taking it from them, and distributing it to those who are lazy, for any reason - healthcare, welfare, unemployment insurance, or any other kind of social safety net.

While I agree that universal health care is a right everyone should have, and I don't agree with the above rhetoric, at the same time this is indeed how the "haves", who hold political and economic power, view their relationship to the "have-nots" in the U.S.
posted by thermonuclear.jive.turkey at 8:48 AM on March 20, 2010 [3 favorites]

In fairly simple terms, for those opposing it 'from the right' I would say:

1. Fear of the unknown, vigorously exploited by opponents to the proposals

2. Misinformation, vigorously propagated by the opponents to the proposals

Now those of you intelligent and thoughtful opponents of health care reform are going to chime in and say there are lots of important philosophical and practical reasons to oppose health care reform proposals. And please do chime in and give your thoughtful, insightful, and carefully reasoned answers.

But for the average 'person on the street' who is opposing it, the reason is exploitation of the fear & wide distribution of misinformation feeding that fear through all sorts of media outlets and pundits who make it their job to do so.

(And also of course there is opposition 'from the left' which is mostly about this bill is a massive compromise with groups that shouldn't be compromised with, certainly not to the extent they have been, certainly not if they are all going to vote against it anyway, and the resulting bill doesn't go nearly far enough to solve the systemic problems with our health care system, or create the cost savings that would be easily possible given a different approach.)
posted by flug at 8:50 AM on March 20, 2010

exploitation of the fear & wide distribution of misinformation feeding that fear through all sorts of media outlets and pundits who make it their job to do so.

BTW, speaking as someone whose SO works for one of the largest healthcare companies in the U.S., it is very clear that all of these companies have put massive amounts of money and resources into shaping the national discussion on the issue, so that is one reason the fear & misinformation has reached the wide audience that it has. It's being pushed, hard, by very, very well funded interests.
posted by flug at 9:01 AM on March 20, 2010 [1 favorite]

Sara Robinson's mythbusting two-parter provides useful context for Canadians, Aussies, Brits and other inhabitants of the civilised world w/r/t what Americans are told about universal healthcare; her note about 'medical Calvinism' (part 1, no. 9) also weighs heavily on the politics here:
The virtuous Elect can be discerned by their svelte figures and low cholesterol numbers. From here, it's a short leap to the conviction that those who suffer from chronic conditions are victims of their own weaknesses, and simply getting what they deserve. Part of their punishment is being forced to pay for the expensive, heavily marketed pharmaceuticals needed to alleviate these avoidable illnesses. They can't complain. It was their own damned fault; and it's not our responsibility to pay for their sins.
I think the theology is more complex -- the self-declared healthcare Elect, like the most radical Calvinists, can point to their insurance cards as proof of their salvation, regardless of their actual health. But it's definitely theological.
posted by holgate at 9:01 AM on March 20, 2010 [5 favorites]

It always seems like the ants and the grasshopper to me. In general, one side perceives itself as the hard-working ants, doing what they should, tucking it away for a rainy day, keeping their heads down and their noses clean, storing up for the cold times ahead.

They look over at the grasshoppers who seem to have taken over, and see them plotting to wrest all the ant's hard-earned savings and benefits away in order to support more grasshoppers who have been dicking around and having a good time and now have nothing except the argument that things aren't fair and how can the ants be so cruel as to just watch the suffering of their fellow grasshoppers without helping. How selfish. How evil. All of those poor grasshoppers in need, and the ants refusing to help.

I'm not saying that's how it is, exactly. But that is the way I would distill the story after hanging with some of my more (reasonable) conservative friends. That's the closest I can get to what I think their perception is.
posted by umberto at 9:03 AM on March 20, 2010 [1 favorite]

Wow, there is a lot of hate on this thread. People commenting on how the "uninformed" right and conservatives don't know what is in the bill - do you know what is in it? I truly doubt most of the liberal left knows any more about the specifics of the bill than the conservative right. People who are pro-Obamacare are just as much uninformed as those on the other side, in my experience.

It's a complicated issue, and boiling it down to name-calling about how all conservatives are racists who don't want blacks and illegals to have access to healthcare is ridiculous.

It comes down to whether you believe health care is a fundamental right, or not. Health insurance companies are businesses just like all other companies are businesses - including car insurance, etc. If you are a problem driver, and have lots of accidents and tickets, you pay a higher car insurance premium. The same logic applies to health insurance. How are these private sector companies supposed to make money if they don't follow these basic business/ insurance underwriting principles?

I'm not saying this is right, or that these businesses aren't callous in their treatment of other human beings, but in reality it all boils down to whether you see health care as a universal right, or if you see it as a business transaction.

If it is a universal right, the government should be running the whole she-bang, because you can't expect businesses to make decisions that will lose them money otherwise. If it isn't a universal right, then the health insurers have a right to make a profit just like any other business.

This whole mandating-coverage and not allowing health insurers to reject certain risks is ridiculous - it is government basically telling a private sector company how to run their business. As others have mentioned above, that just isn't how things are historically done in the US - the outcome of the current financial crisis not withstanding.
posted by CharlieSue at 9:06 AM on March 20, 2010 [9 favorites]

From my observations as a layman it boils down to this:

People opposed to health care reform are typically those who have worked in the private sector their whole lives and know or are related to people who relate how "work" is done in the public sector.

Or as an analogy, you've seen the 50's era science fiction movie "The Blob," right? The people screaming and running from the movie theatre? They're those opposed to reform.
posted by digsrus at 9:12 AM on March 20, 2010

I know several people who have complained directly to me about the expense of their own health care, yet they too don't agree with government-run or government-influenced health care. I find this incredibly difficult to understand as well. My own father has no health insurance because he thinks it is too expensive and doesn't want to pay for it. Yet he doesn't think this proposed bill is anything good.

I believe the reason the people I just mentioned are against this current plan is simply a matter of being lazily uninformed about what is in it and what good it stands to do. People who simply listen to the pundits spouting fear about what it all means without actually researching what it all means are not doing their job as citizens.
posted by thorny at 9:56 AM on March 20, 2010

I cannot fathom why someone would be opposed to the idea of everyone having the same basic human right to healthcare.

Mostly what CharlieSue said. One refinement I would add is how you define a right. It is one thing to say I have a right to free speech, or free assembly, quite another to say that I have right to something that requires access to someone else's pocketbook. Which, rightly or wrongly, is how this is largely perceived.

It is especially - emotional - at a time when every headline screams about the trillions of dollars we in the US are already on the hook for and the billions and trillions that are currently being spent on overseas wars and financial bailouts and such.
posted by IndigoJones at 10:03 AM on March 20, 2010

Another analogy:

If everyone NEEDS a car to get by, some believe that it's more important that they have a Mercedes even if it means that 40 million other of their countrymen get no car. Others believe that everyone should get a Ford Taurus, but if you're rich, heck, go out and buy a Lambourghini if you'd like.
posted by teg4rvn at 10:09 AM on March 20, 2010 [2 favorites]

paulsc enumerates a lot of rational objections to the current health-care reform plan (which actually isn't Obama's plan—he pushed lawmakers into coming up with their own bills, he did not bequeath one from on high and say "pass this"). But a lot of the more strident objections do not come from people who have given the bill due consideration and decided it's a bad idea: it comes from people who are viscerally opposed to anything the Democrats would offer. You can't analyze it on a rational basis. Many of their objections through the course of this debate have been utterly unfounded, most notably with death panels. The opposition from the Republicans in Congress has not so much been a matter of principal or policy (IMO), it's been a desire to prevent Democrats from having a legislative victory on an important issue.

You may recall that when Bill Clinton was president, he tried to pass healthcare reform. IIRC, his plan would have made America's system fairly similar to Canada's single-payer system. At the time, the Republicans came up with their own counterproposal. The Democrats' plan today is very similar to the Republicans' from 18 years ago.
posted by adamrice at 10:15 AM on March 20, 2010 [2 favorites]

M y view: it is not by chance that the Insudrance Industry has sp;ent so many millions to advertise and to defeat the bill. The cries of "socialism" and I like my private care etc have
convinced many that a change is not good. Keya to understanding this, though: if 30 milliobn are without health protection, that is their problem and not mine. Thus a selfish view of what the nation might need trumps anything. Addtionally, having gone through all the reasons why the plan is no good, and dropping one after the other, the opposition raises the budget issue...deficit etc. The mark up , though, suggests savings, so the last arguement: but this might change down the road (anything might change so why do anything about anything?)...
Those opposed always present the "arguements" that the bought politicans and the insurance industry issues. Note that doctors, AARP etc are for the Obama plan.
posted by Postroad at 10:16 AM on March 20, 2010

I live near Detroit, which of course is very near Windsor, Ontario. So anyone who has spent any time at Henry Ford Hospital or St. John or Bi-County or Macomb will encounter at least one nurse and doctor (often more than one) who is Canadian and commutes across the border daily. If, to make conversation during an exam, you ask why they tackle the Windsor Tunnel every day, they will regale you with stories of long waits in Canada for certain tests, and that (in some of the hospitals) almost 50% of the staff is Canadian because of the salary caps and (for the nurses, anyway) the vast availability of overtime hours. Long story short, in this part of town folks fear a national health plan because the local media always equates it to Canada, and we've heard our share of horror stories (whether true or not) about the lack of hospital space, doctor shortages and long waiting times for CT scans and things of that nature and we don't want that to happen here. Right now, the indigent can get free treatment for non-emergency conditions in an emergency room, even though he may have to wait many hours, it's better than waiting six months. Also, there's the whole tax thing...again, people from this area are very familiar with the (to us) huge provincial sales tax (8%) and GST (5%) added to any purchase in Ontario. Michigan residents squawked like angry parrots when the state raised our sales tax from 4% to 6% in 1994. So that is the predominant school of thought 'round these parts - Obamacare equals long waits, less doctors, higher taxes.
posted by Oriole Adams at 10:37 AM on March 20, 2010 [1 favorite]

One addition to my comment above - I forgot to mention that metro Detroit is UAW country, and for many, many years companies even tangentially related to the auto industry offered "gold card" benefit packages similar to the UAW's to their employees just to remain competitive. Until the early 1990s, it wasn't "the rich" who had access to the best health care, it was manufacturing personnel and their families. Average Joe's grandfather and dad both worked in factories and carried a Blue Cross card that entitled them to $2 prescriptions and whatever tests/treatments they needed with no co-pays. Average Joe himself received similar benefits for a while when he started at the plant right after high school in 1989 and became accustomed to it. But in recent years, as he approaches retirement, he's seen the UAW make concessions to his contract and many of his perks have been revoked. Joe and his brethren have always been staunch Democrats, but Obama's health plan reeks of socialism; what they want is for Obama to turn the auto industry around and make the plants financially healthy again so they can have the same benefits they enjoyed Back In The Day.
posted by Oriole Adams at 10:58 AM on March 20, 2010

There's another factor: American Exceptionalism. Warning: generalizations ahead.

Compared to liberals, conservatives are less travelled and less familiar with foreign countries. They are also therefore much more convinced of the validity of American exceptionalism.

Look, whenever you attempt something new, there are unknowns, and it is reasonable to anticipate all sorts of danger, and the default position becomes "better the devil we know than the one we don't". For example, when trains were first invented, one big fear was that something terrible might happen to a human body when it is subjected to great speeds, since we as humans never experienced or adapted to such conditions before never having moved as fast. That was a reasonable objection - or at least it was not crazy. But then we had trains and all was well.

Same here. The conservatives have all sorts of fears. Some are even reasonable - as many in this thread enumerated. BUT - and here's the thing. We already know what happens. We've had trains in other countries. We've had "socialized" health care in other countries (and to a degree even in this country). We already know that most of those fears enumerated in this thread, are in the end, unnecessary - because it works, reasonably well in other countries - and certainly better than here.

Well, so how do you, as a conservative counter that - the fact that trains appear to run in other countries without human beings exploding? The answer is right there - "well it would never work HERE". Why? Because America is special. American Exceptionalism. Much aided by conservatives being on average less well informed about other countries and less travelled - so it's easier to believe that "we are different and special".

I will never forget an American exchange student back in the 80's, whom I was talking to back in Sweden. I forget what it was even that we were discussing - so shocked was I by his response. Basically he said "Yeah, that's fine for Sweden, it works in Sweden. But boy, in America we have savages, blacks, all sorts of garbage from all over the world - it would never work". And no amount of arguing will work - it works in France because well, factor X, Z, or Y that's different than in the U.S. In Sweden, it's A, B, and C. In Switzerland it's E, F, and G. and so on and on and on. Oh, but it's Europe. OK, how about Canada, that's North America, no? Yeah, but R, Q, and Z are different. Bottom line, until the country is identical, people who insists that evolution is a scam, the earth is flat etc., will insists that the laws of gravity may work elsewhere but don't apply in the U.S., because, well those places are not the U.S. down to the last speck of dust.

And so, we are deprived of the example of others, because we'll not admit our commonalities. In absence of that we go back to "the devil we know" - and it would take the devil literally squeezing the life out of you before you try the devil you don't know... and with health care that's in fact the life that's being squeezed out of you. And for a certain conservative - even then, he won't look to the devil he doesn't know - convinced as he is that America is generally better than those filthy heathen foreign countries anyway.
posted by VikingSword at 11:44 AM on March 20, 2010 [4 favorites]

I think you are blessed to find the best possible answer to your question here all wrapped up in one. It pretty much typifies the angry non sequitur rants, incoherent arguments, misstatement of facts, illogical conclusions and political ax-grinding that are the hallmark of the health care discussion.
posted by JackFlash at 1:59 PM on March 20, 2010

An issue raised from friends working in hospital is government reimbursement back to the hospital. With Medicare and Medicaid, the hospital only gets a fraction of the actual costs- from what I recall it's around 10%? I can't find any links about this in a quick Google search for exact numbers though.
With the lowered reimbursement rate, the fear is that the government will pay back significantly less than what they already receive- and this is considering the current state of reduced rates for insurance companies and people without insurance who pay nothing. As a result, doctors and hospitals will either a) go bankrupt or b) not be able to afford all the fancy equipment that make them the some best medical facilities in the world (with best correlating only to health care received upon treatment). That, and doctors will make less.

And even if the government promises to pay back 100% back now, there's always the chance they'll say, "nope now you receive 80%" 10 years down the road and so on.

I should note this is all what people working in the medical world have told me, so I would also be interested in articles refuting these claims.
posted by jmd82 at 3:07 PM on March 20, 2010

Here are a few demonstrations of what is motivating the right-wing side behind the anti-reform movement.
posted by Blazecock Pileon at 3:35 PM on March 20, 2010

I'm a Republican who voted for Obama as well as an independent contractor who pays for my own insurance and I am vehemently opposed to all forms of this legislation.

It is not, and has never been, about 'health care' reform but, rather, 'health insurance' reform. Contrary to what all too many people believe, everyone in the US can get health care--but yes: you have to pay for it. And if you don't have insurance or you don't visit a community clinic, it's going to be costly (depending, of course, on the service you receive--surgery costing more than a band-aid).

In order for real health care reform to occur, the United States would need to address the shortages of GPs, geriatric and pediatric doctors. Due to the high cost of medical education (due in part to the rising costs of litigation), med students have been flocking to specialties (plastic surgery, neurology, cardiology, etc.) for at least the last 30 years. Without a solid base of basic care physicians, national health care does not work. Period.

And yes, it's true: I don't want to subsidize anyone else's health insurance. Please note: I said insurance. I already subsidize health care in this country via state and federal taxes.

More to the point, I'm happy with the health insurance I've chosen and I don't fancy being told what coverage I have to purchase to make some legislator I've never met happy.

Look, Americans are, in general, feisty independent spirits. If you need to understand it from a historical/cultural viewpoint, blame it on the frontier and that we never got it out of our blood. We don't like to be told what to do or what to buy--especially by our government.
posted by gsh at 4:28 PM on March 20, 2010 [3 favorites]

A. It will cost the working class more
B. Major problems will cost more (coronary stent anyone?) - there's a lot of "pork" here
C. Someone is trying to make History.

€ .02
posted by Aztekker at 5:42 PM on March 20, 2010

In order for real health care reform to occur, the United States would need to address the shortages of GPs, geriatric and pediatric doctors. Due to the high cost of medical education (due in part to the rising costs of litigation), med students have been flocking to specialties (plastic surgery, neurology, cardiology, etc.) for at least the last 30 years. Without a solid base of basic care physicians, national health care does not work. Period.

No. For health care reform to work, the profit motive would have to be removed from the health care system - or at least, subordinated to the public good. This would mean that individuals and organizations involved in health care, would (heavens!) make less money, and then the whole financial inflation within the system would go down.

Many folks consider the notion of regulating the amount of profit that a business sector can make, to be fundamentally un-American.
posted by thermonuclear.jive.turkey at 7:22 PM on March 20, 2010 [2 favorites]

Like most Americans (I'm assuming), what I want is

1) The right to see any doctor
2) At any time
3) For any reason
4) some reasonable expectation that, for the money I am paying out, I will get a break on the pricetag of those visits.

I am not politically savvy, or particularly tuned in to the debate. My distrust of the healthcare plan comes from the knowledge that (1) our government officials love to sneak things into bills. I distrust intensely what may be in this 1,000+ page document that apparently almost no one has actually read. (2) the fact that, having made less than $15,000 before taxes the last 3 years, I have YET to qualify for any social service offering I have applied for besides WIC. Yes, that's leaving out a lot of relevant details, no I will not bore you with them. But the bottom line for me based on observing who I know who's got Medicare and who hasn't and what my experiences have been trying to get into the system, is that there is obviously a Game you need to know how to play to get insured, and it's a game I'm obviously not good at. I don't want to have to play games to get healthcare, and if what they are producing is run anything like what we already have as a social service, I will be just as up a creek as I am now, only now I will be paying more for things I don't get to use/have limited access to. (3) A complete vote of no-confidence that the government will make Joe/Jane Average the winners in whatever complicated game is prompting this move.

I want healthcare. If the government wants to give me healthcare, great (yes, I understand that I'm not actually getting something for nothing here). If the government wants to give me healthcare with a thousand little strings attached that will ultimately end up in them having enormous control over the general direction and quality of care We The People will get plus a thousand little gotchas... Not so much.

Frankly I suspect We The People are about to get seriously mauled by private (not corporate) interests. I'd rather have my healthcare in the hands of corporations, because at the end of the day, corporations CAN be brought down by wholesale customer dissatisfaction. Politicians get to leave while the sun is still shining, and then what? The rest of us have to live with the results of whatever little poison pills they slipped in to fulfill their own agendas. And the beauracracy they create will churn on and on and on.

Sorry if that is not well-reasoned or factually supported. I consider myself a pretty average American: Informed by sound-bytes and personal experience, & not well-read on government activities or historical precedent.
posted by Ys at 7:43 PM on March 20, 2010

a nod to GSH: Take out every reference I made to "Healthcare" and replace it with "Health Insurance," please. I do get healthcare. I just don't get help paying for it.
posted by Ys at 7:47 PM on March 20, 2010

An issue raised from friends working in hospital is government reimbursement back to the hospital. With Medicare and Medicaid, the hospital only gets a fraction of the actual costs- from what I recall it's around 10%?

Not actual costs, but the inflated MSRP price. If they only got 10% of their costs, they would instantly go out of business. The "negotiated discount" the group plans get is higher than this, but not by much. A few years ago, a couple of family members had some major medical work done. Billed? $100,000. The insurance co paid about $16,000 and that settled it.

It comes down to whether you believe health care is a fundamental right, or not. Health insurance companies are businesses just like all other companies are businesses - including car insurance, etc. If you are a problem driver, and have lots of accidents and tickets, you pay a higher car insurance premium. The same logic applies to health insurance. How are these private sector companies supposed to make money if they don't follow these basic business/ insurance underwriting principles?

That's fine, but who cares about the insurance companies? They don't DO anything, they just stand between the doctor and the patient and extract their 3% profit and all their operating costs off the top. Insurance companies have no more right to stay in business than anyone else.
posted by gjc at 10:16 PM on March 20, 2010

Gallup actually made available the verbatim responses [.xlsx file] on this question from a poll they did a few weeks ago. I found it fascinating because it comes from a random sampling of Americans rather than just the kind of folks who are activists enough to make their voices heard in other ways.

If you don't want to dig through the long Excel file, I actually started putting some of the anti responses up on a blog and tagging them here.

Some of the big themes were: 1) they think this is too much government involvement/control of health care and government control is a bad thing that will lead to costs rising, quality falling, rationing, and/or worse things [sometimes based on the belief that the plan either includes or will lead to government-run health insurance/health care, but sometimes just because they think more government involvement = bad]; 2) they think it will cost the government too much, which they think is a problem because we can't afford it and/or because we shouldn't be spending that money on "those people" who will benefit (see #3); 3) they believe this is about free health insurance for "people who don't work" and/or illegal immigrants and having their tax dollars spent on that really bothers them; 4) they have a problem with people being mandated to buy insurance, they don't think it's right; 5) they're worried/upset about money being taken out of Medicare; 6) miscellaneous conspiracy theories about death panels and socialism and such.
posted by EmilyClimbs at 12:05 AM on March 21, 2010 [2 favorites]

Wow - this thread is filled with a lot of misunderstandings. Health insurance is pretty much equivalent to fire insurance or any other kind of insurance mandated by law for obvious and completely commonsense reasons. Let's not forget that Ben Franklin came up with the idea of insurance!

Anyway, thank you for asking this question, because I wonder the same thing often myself. I've read this thread and it's really helped me. Thanks.
posted by xammerboy at 2:00 AM on March 21, 2010

To clarify even further, I do not believe that healthcare is a fundamental human right--I believe that access to healthcare is a fundamental human right. To believe the former is to take a too-close-to-authoritarianism view for my comfort.

In other words: here are clinics and doctors and medical vans and whatever else. It is now up to you, American person, to decide if you want to pursue the services they offer.

To address the 'yes, we can all get care but damn, it's expensive' -- look ye no further than to the health insurance providers as to why that is. There are (if I recall the article in the Atlantic correctly) 2 insurance workers for every one doctor in the US. The sheer amount of paperwork for a yearly visit to a GP alone is staggering. Paperwork and lawsuits galore, oh my.

So when my government comes to me and says, "Hey, our solution for the ill-defined 'health care crisis' to force people to buy more and specific types of insurance!", you bet your ass I'm gonna run the other way.

My ideal scenario? No insurance, period. All services are paid in cash. The poor and elderly/retired can keep their various and sundry assistance programs.
posted by gsh at 10:47 AM on March 21, 2010 [1 favorite]

My mom is a pretty dedicated, Rush Limbaugh-listening conservative. She likes the idea of health care reform, isn't terribly happy about the raised taxes (esp. because she runs her own small business and thus due to some financial stuff I am blissfully unaware of her income is her business's income), but is concerned about this bill primarily because she doesn't feel the government did enough to lessen the health insurance industry's grip on health care. She's pretty upset that despite Obama's promises he wouldn't tie his decisions to lobbyists, they've been so instrumental in the formation of this bill.

And personally, I agree -- I really, really want health care to be made affordable and available to everyone, but this hasn't really done it. Like someone above said, just because this is the available answer to a glaring problem does not mean it is the right answer. I've looked through some of the bill, and I like some of what I've seen -- the elimination of pre-existing conditions, the tax cuts for businesses -- but it just seems like a plan that's spent too much time being debated and trimmed and cut to be passed and agreed upon by both sides, therefore making no strong stance on the health insurance industry -- which is a ridiculous sham in America and definitely needing of heavy, heavy reform.

I don't want to pretend that I know enough about the bill or health insurance to have much more of an opinion than that. I'm glad something is getting passed, and I do hope this makes it easier and more affordable for everyone, but I just don't see the healthcare horror stories ending. I think prices might still be scarily high, and insurance companies aren't exactly being reigned in. I just wanted to see something stronger, and I run vaguely conservative in my own beliefs. I'm okay with a little higher taxes to help people out.

Ultimately, I just want to get across that not all conservatives are against this because they hate minorities and aren't willing to help out. This isn't a perfect bill, but its being heralded as so by some. It's better than nothing.
posted by elisabethjw at 3:01 PM on March 21, 2010

Nothing is for nothing. The politicians are going after the money. Pensions will be next if they get this.
posted by notned at 3:47 PM on March 21, 2010

During the last few hours today, Talking Points Memo has been following the last few undecided representatives and possible changed votes. Going back to the original question, some of the individual articles on or linked from their site include statements from the congresspersons in question as to why they're voting yes or no. Some of the items from prospective bill opponents with quotes or full statements explaining their 'no' votes include:

Glenn Nye (Virginia-2, Va. Beach and eastern shore)

John Tanner (Tennessee-8, NW Tenn. and Memphis suburbs)

Harry Teague (New Mexico-2, Southern N.M.)

Jason Altmire (Pennsylvania-4, Pittsburgh suburbs and western Pa.)

Jim Matheson (Utah-2, Salt Lake City and eastern/southern Utah)

Note that all these are Democrats; all Republicans have long been assumed to be voting no (with the slight possible exception of Joseph Cao of Louisiana, who is an unusual case and voted yes in the voting last fall, the only Republican to do so).

One thing this selection of reps has in common is that none of them are in completely 'safe' Democratic districts. That could be influencing their positions. (Cao being the flipside of this--a Republican in a district that is normally heavily Democratic, voted in only because his predecessor was chased from office by scandal.)
posted by gimonca at 4:31 PM on March 21, 2010

My ideal scenario? No insurance, period. All services are paid in cash.

Fine if you want to deal with your heartburn or a twisted ankle. Just make sure you have a five-figure sum handy to get you patched up after a car crash or from a cancer diagnosis to remission. "Let's pay it all in cash" stopped being a tenable argument in the developed world around 1940.

Ezra Klein put it well when he said that individuals generally don't have the money to pay for the severest illnesses and accidents that might befall them -- and they're not things you can expect people to save up for, either, given that you don't know if your genetics or environment or bad luck will work against you. Collectively, the bill is just about manageable.

Most systems in which private insurance is used for primary provision (as opposed to supplementary systems) have a tightly defined set of services that can be offered competitively, with actuarial cost-sharing to compensate if a pool has a higher than average incidence of the most costly conditions to treat. This is moot in the context of the current bill, but it's likely to be an issue going forward.
posted by holgate at 6:23 PM on March 21, 2010 [1 favorite]

[...] I would like to be able to understand the reasoning people have for opposing it.

Don't try too hard to find rational explanations for what is at least 75 percent irrational.

1. People are afraid to try something new with health care because they're afraid to try something new with health care. They just don't know what it will be like and they are nervous about finding out the hard way, when they're sick and have relinquished their other options because they can afford just one option.

2. Political parties are tribes. Do not try to think of them as groups of people organized to carry out sensible, rational actions. If the other tribe wants A and your tribe's chief is against A, you will naturally find your chief's arguments to be the more persuasive and you will vote the way your chief wants you to vote.

3. When you have money in your hand and you're not sick, you have plans for that money: a vacation in Hawaii, a big television, a new car. That stuff is near. That stuff is doable. That stuff is pleasant to think about. Becoming seriously injured or ill is not something that is going to happen to you. You will get old, yes, but you will be a sprightly old coot with all of your marbles and money in the bank. You do not want to give that money to some sick old guy you don't even know and who is probably a lazy, good-for-nothing bastard who got sick because he is a lazy, good-for-nothing bastard who didn't have the sense to plan ahead.

Such attitudes aren't unique to Americans. It's just that other developed countries have gotten over this hump and their populations have realized it was for the better of them all to have universal health care.
posted by pracowity at 1:35 AM on March 22, 2010 [1 favorite]

Oriole Adams: "...long waiting times for CT scans and things of that nature... the indigent can get free treatment for non-emergency conditions in an emergency room, even though he may have to wait many hours, it's better than waiting six months. "

Wait, you're comparing waiting times for CT scans to emergency room waits? In Canada, the wait for an emergency room isn't six months, and the indegent can get into the emergency room AND get a CT scan for free. How many homeless people have access to CT scans in the US? Compare apples to apples.
posted by klanawa at 9:43 AM on March 22, 2010

Late to the game, and not to threadjack, but:

I get why some may be opposed to this bill in particular, what I don't get is why there is such an aversion to universal health care (perhaps that's not the right term, but such as we have it in Canada)?

I know the general response is that 'people don't want to pay for other people's health care' but WHY don't they want to pay? I mean, yes, ideally you'd never have to carry your brother on your back, but he might have to carry you also, at some point in the future.

I suspect it's a case of not being able to see the forest for the trees. Having grown up in Canada under universal health care, it just seems so very *basic* to me that yes, health care is a right. Not *access* to health care - the actual care itself. That yes, society as a whole is only as strong as its weakest member (for lack of a less condescending phrase).

Perhaps that's a touch of socialism. Good then. I get that there's a difference in attitudes, what I don't get is *why* there's such a difference. Our countries are very similar in many ways, but this is one difference I just cannot wrap my head around. I mean, even amongst the staunchest (Canadian) conservatives I know, I've never met one who wanted to do away with our system. I know they exist, but wonder about their numbers.

Perhaps I'm naive...
posted by aclevername at 9:45 PM on March 22, 2010

A couple of inaccuracies above:

* While very few of the provisions take effect today, the anti-recission rules and the rule preventing insurance companies from refusing to accept people for "pre-existing conditions" is immediate. There are valid questions on how this will be enforced, but we don't have to wait until 2014.

* You can keep your current employer-sponsored policy. There are explicit "grandfathering" clauses for this purpose. Now, if your employer and the insurers they work with decide to change the group policy they offer, that's another story. But, that's something that would happen on a periodic basis anyway, as contracts between employers and insurers expired and had to be renegotiated. Nothing in the new law affects that. I'm not sure how much the law affects what your next policy will look like, but if insurers feel a pinch on their bottom line, they'll be much more aggressive in negotiations.
posted by Citrus at 10:18 AM on March 23, 2010 [1 favorite]

Most of the people exceedingly opposed to the healthcare plan... don't seem to actually know much about the actual healthcare plan that passed. The folks who are most easily led by the media are off somewhere protesting things that aren't actually in there.

The main gist is that they don't want to pay for lazy people, and the 10% of our population that's completely uninsured, they think are lazy.

It's kind of how many of the same people want all the immigrants sent home, but don't consider that large swaths of our blue collar industry are based on the cheap labor they provide, and removing all the illegal immigrants from America would likely collapse our farming industry entirely.

posted by talldean at 7:57 PM on March 25, 2010

klanawa; all indigent folks in the US also have access to CAT scans and the emergency room, but it's the hospitals that are picking up the bill for that in the current system. If you go to the ER, they'll treat you, and generally treat you well. If they can bill you for money, they will do so; if they can't, they eat the cost, but they won't let you die.
posted by talldean at 8:05 PM on March 25, 2010

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