The Institutionalization of Political Anger: The Case of the Affordable Care Act
Terry Weiner
During the August recess of Congress in 2009, legislators came home to meet with constituents, as they often do, in town-hall-type settings. These members of Congress expected to be asked about a range of topics; however, one topic seemed to dominate most of these meetings—the Affordable Care Act (ACA; referred to derogatorily as “Obamacare”). Members were certainly expecting questions on this topic and were prepared to handle them. What they experienced, though, was far from the usual give-and-take of a question-and-answer session with constituents. Instead, it was more like an ambush by citizens who had apparently been encouraged by radio talk-show hosts and other conservative grass roots organizations to show up at these meetings and demonstrate their opposition to the president’s health care plan. Indeed, at some of these meetings, there were fistfights, arrests, and even some hospitalizations (American Civil Liberties Union, n.d.). Most of the Congress members ambushed were Democrats, but Republicans were not spared, either. A taste of what happened can be garnered from the two descriptions below:
At the beginning of a rowdy forum hosted by Rep. John Dingell, D-Mich., Mike Sola pushed his wheelchair-bound son up to the podium where Dingell stood and began to yell, “I’m his father and I want to talk to you face to face.” Dingell was only accepting questions written in advance on notecards. Sola went on to loudly claim that Obama’s health care plan would provide “no care whatsoever” to his son, who has cerebral palsy. “You’ve ordered a death sentence to this young man,” he shouts before being escorted out of the room by police.
Rep. Kathy Castor, D-Fla., struggled to keep a health care town hall meeting in Tampa under control as protesters crowded the room and the struggle turned physical. Hundreds of people showed up for the meeting to protest Obama’s plan and many were not allowed into the room. That didn’t stop them from banging on the door and drowning out the congresswoman’s remarks with shouts of “You work for us” and “Tyranny.” (Shanahan, 2013)
To many “policy wonks” who follow the history of public policy and its progress from ideas to legislation, this reaction was difficult to understand. To be sure, the legislation that President Obama was proposing was filled with compromises and had many flaws that would trouble legislators on both sides of the aisle. Indeed, many health care experts had raised some concerns, particularly about the likely success of holding health care costs down with the large expansion of coverage. But, and even more importantly, the president’s plan had its origins in conservative think tanks and Republican alternatives to the ill-fated Clinton plan in the mid-1990s (ProCon.org, 2012). Ironically, the first real consideration of an individual mandate for health care came out of the Heritage Foundation, a conservative think tank, in 1989 (Krugman, 2011). The Heritage Foundation set up “Heritage Action,” a political action wing of the Foundation to encourage these very protests described earlier. They were campaigning against their own ideas! And, as we all know, the Republican presidential candidate in 2008, Mitt Romney, had implemented a plan not too different from the Obama plan in Massachusetts, and the plan was seemingly quite successful in significantly expanding coverage at an affordable cost (Robertson, 2011).
Also, it was strange to see that many of the participants in the protests were likely over 65 and benefitting from Medicare, a program entirely funded by the federal government. In the town-hall vignette with the disabled child who had cerebral palsy, it was very likely that the education of the child and his medical needs were partially funded by Medicaid, a joint state and federal program. So why was this citizen outraged at a proposal to expand this type of coverage to millions of others who did not have insurance?
It is difficult to explain the reaction many citizens had to the president’s plan. This level of anger and rage is rarely seen in most legislative proposals considered by Congress. However, it is not unusual in proposals to reform health care. Surprisingly, the outrage we witnessed in the summer of 2009 was indeed similar to the politics we observed in 1993–1994 with the consideration at the time of the proposal from President Clinton (also referred to as “Hillarycare”). Health care reform inevitably strikes at an industry that is one sixth of our economy and consumes currently almost 18% of our gross domestic product (GDP). The number of interest groups that could be impacted and the amount of money at stake is often unimaginable. So, when President Clinton proposed his plan, which also had its origins in a moderate think tank led by the so-called “Jackson Hole group” that proposed managed-competition and managed-care solutions to our troubled health care system, there still were claims that we were going down the road to socialism, that it was a government takeover of health care, and that citizens would lose choice and be at the mercy of uncaring federal bureaucrats for their health care needs (Skocpol, 1997). When the president or first lady hit the campaign trail to push for their plan, they were met with similar expressions of anger. Again, this was not new in the history of health care reform; when President Truman proposed a national health care plan, the American Medical Association (AMA) organized an effort to have doctors lobby their patients in their offices to oppose the plan.
Health care reform is different in another way from popular welfare proposals such as Social Security or unemployment insurance. Most Americans have health care insurance and, although most agree that the “system” needs reform, they report being happy with their providers and often content with their insurance. So, reform is often threatening in that it can raise fears that to extend coverage to the uninsured, the government is going to reduce the quality of the coverage or increase the cost of coverage for the many who are insured (Skocpol, 1997). Those with coverage are often not aware that the coverage they have is often not comprehensive and leaves them at risk for catastrophic health events, for example, cancer or the birth of a baby with serious complications. Consequently, the marketing of health care reform has always been difficult due to the large number of impacted interest groups and the inclination of those who have coverage to be wary of change.
Yet, something still felt different this time. The anger was not just about Obamacare, and the political context in which this anger was expressed was different from past reactions. The United States was in the midst of a “great recession” and was being guided by its first African American president. Public support and trust in government and Congress were at all-time lows. Possibly, this anger was quantitatively and qualitatively different from what had gone on before. In this chapter, we will consider a few possible explanations for this “rage over Obamacare” and consider whether this is indeed something new in our politics.
The Role of Anger in Politics: Some Observations
Anger is not new to politics and many political theorists have observed that it is indeed essential to political action. Lyman, in his work on the “domestication of anger,” says “anger is often described as a wild emotion … and yet anger is an indispensable political emotion—for without angry speech the body politic would lack the voice of the powerless questioning the justice of the dominant order” (Lyman, 2004, p. 133) Indeed, many critical theorists in political science believe conflict is the “engine of change” and that anger is essential to the motivation of those suffering injustice to engage the system (Holmes, 2004).
The dominant political order often uses stereotypes and images of anger by marginalized groups to create fear and delegitimize their complaints. For instance, feminists and Black males who angrily protest injustice are perceived as challenging conventional notions of their roles in society or raising fears among the dominant group (Holmes, 2004). For this reason, many critical theorists are quick to defend the role of anger in politics as a way of challenging both injustice and conventional norms of behavior. They see efforts to repress expressions of anger as part of the tools of domination employed by the powerful.
Democratic theorists, however, have been less supportive of the role of anger because it is seen as inhibiting the ability to compromise, a goal that is essential in a complex and diverse society living under constitutional forms of government. Hattam and Zembylas (2010), in their study of conflict in Australia and Cyprus, point out that anger can “create a backlash against rights for the oppressed” and call for a third way in response to those who wish to silence anger or “cultural workers who call for the mobilization of anger.” In particular, they show that “racism continues to grow in new and alarming ways that demand new conceptual tools.”
When we look at anger in the context of the debate about health care, race will play an essential role in how we explain what has been happening. Interestingly, in one study of the Tea Party movement by Sparks (2015), she points out that the movement gave freedom for Black males and White females to express anger in the public arena. It is likely that this freedom is given to minorities who support the views of the dominant group, but not those who oppose it. The role of race is heightened in this debate because many of the beneficiaries of the Affordable Care Act are citizens of color and the leading proponent of the reform is the first Black president of the United States.
The Racial Resentment Hypothesis
Several political scientists have examined the possibility that race and ethnocentrism played a role in the attitudes of White voters toward the Affordable Care Act. Maxwell and Shields (2014) describe this hypothesis and its relationship to the “anger” we are addressing in this volume:
Many defenders of “Obamacare” insisted that the angry criticism was racially motivated. For example, Jim Winkler (2009), General Secretary of the United Methodist Church, noted that opposition to healthcare reform had “transmogrified into something far deeper, far more elemental.” “Anger” he observed, was “its salient feature” and racism and fear is at the core of the anger. (p. 293)
New York Times columnist Frank Rich also states bluntly that this anger we observed was not about health care. He says:
If Obama’s first legislative priority had been immigration or financial reform or climate change, we would have seen the same trajectory. The conjunction of a black president and a female speaker of the House—topped off by a wise Latina on the Supreme Court and a powerful gay Congressional committee chairman—would sow fear of disenfranchisement among a dwindling and threatened minority in the country no matter what policies were in play … When you hear demonstrators chant the slogan “Take our country back” those are the people they want to take the country back from. (Rich, 2010)
If this is so, it would help us understand why the opposition worked so hard to reframe the proposal as “Obamacare” so as to increase the linkage with the Black president. Before the research was done, there was room for some skepticism about this hypothesis because President Clinton failed as well and of course he was White. So if race is a factor, we need to explain how a “non-racial” issue such as health care reform can in fact increase the divide between Black and White voters.
In their research, Maxwell and Shields (2014) describe three processes by which a non-racial issue can in, fact, be “racialized.” They point first to “racial cues” that link policies with race because they deal with the poor, inner city life, welfare, or crime, all of which imply African Americans as a prime beneficiary of the legislation (p. 294). Supporting this point, Banks, in his study of White racial attitudes toward reform, says:
Because the public mostly associates blacks with welfare, racial attitudes dominate their opinions (Gilens, 1995; Winter 2006). Williamson et al. (2011) suggest that the health care debate has produced similar appraisals and is viewed as another sign of government redistributing resources from hard working Americans to undeserving individuals. (Banks, 2014, p. 493)
In the context of health care reform, then, the focus on the problems of the large number of uninsured in the United States may seem to link the policy with the improvement of conditions for minorities more than Whites. It is probably the mistaken view that the uninsured are not working and undeserving, that they are overwhelmingly living in poverty and on welfare, or just choose not to pay for insurance, that this policy may be linked in the minds of White voters to race and the undeserving poor. However, in fact, the majority of the uninsured are either working or are children or spouses living in the household of an employed individual who has no insurance (Majerol, Newkirk, & Garfield, 2015).
A second mechanism, according to Maxwell and Shields, linking health care policy to race is the strong association of the reform proposal to the Democratic Party. Because the Democrats have been unsuccessful in attracting support from moderate Republicans, health care reform is linked with a party that contains greater numbers of minorities in leadership positions and with overwhelming support from Black voters.
Finally, a third mechanism for linkage is “personal cues” and in this case this means the strong and obvious association of this proposal with the president. The fact that a strong minority of White voters who identify with the Republican Party held extreme views toward President Obama would suggest this was likely a factor in their attitudes toward the plan. For instance, in August 2010, just a few months after the passage of the ACA, 41% of Republicans still believed President Obama was probably not born in the United States (Maxwell & Shields, 2014). To a minority of very active White conservative voters, the president was a “foreigner,” “un-American,” and ineligible to hold the presidency.
In his work on the racial resentment hypothesis, Tesler answers the question whether or not the opposition to health care reform was quantitatively different by race in the Clinton years compared to the Obama presidency. In fact, he shows that the racial divide did grow substantially and was 20 points greater under Obama than under Clinton on health care reform. His work seems to support the idea of the impact of the “personal cue” discussed by Maxwell and Shields. He says:
Aside from polarizing the electorate by racial attitudes, our first African-American president may also drive the political opinions of blacks and whites farther apart. For, as Kinder and Winter put it, “Issues can be formulated and framed in such a way as to light up or downplay racial identity, and therefore, in such a way as to expand or contract the racial divide in opinion” (2001, 452). Attributing policies to black sources seems likely to “light up” racial identity, and therefore expand the racial divide in public opinion. (Tesler, 2012, p. 700)
Tesler also shows that when the provisions of the ACA were identified in an experiment as a proposal from former president Clinton, it had more support than when identified as being from President Obama. Indeed, when survey respondents were asked directly if President Obama’s race was a factor in the health care debate, PEW reported in November 2009 that 54% of all respondents agreed it was at least a minor factor and 52% of African Americans thought it was a major factor (Tesler, 2012, p. 690). Clearly, these studies lend some significant weight to the role that race played in opposition to the ACA and most likely in explaining the anger that many conservative White citizens had regarding it.
Banks, however, in a slightly different take on the relationship of race and the anger observed on the health care debate, argues that anger is, or can be, independently aroused and that anger once produced enhances racial polarization. Here we have a claim that the anger comes first or is activated somehow by other processes and that it then pushes views on policy toward racial polarization:
I contend that anger makes thoughts about race more accessible in many white Americans’ minds—thereby enhancing the effect of their racial attitudes on health care policy opinions. That is anger should push racial liberals to be more supportive of health care and racial conservatives to be more opposing of health policy—adding to the racial polarization over health care reform. I argue that this process occurs because anger is tightly woven into the fabric of whites’ racial predispositions—so that the two are fused together in memory. (Banks, 2014, p. 494)
In his experiments, Banks (2014) shows that when anger is elicited as compared to other emotions, that anger uniquely moves racial conservatives toward opposition to reform. This work I believe is a bridge to other theories that demonstrate that to motivate protest and demonstrations of anger, we need a third force, possibly from elites, to energize average citizens to show up at town hall meetings. It raises the question, how do we make people angry enough to act?
A Vast Right Wing Conspiracy: Elite Mobilization and the Process of Victimization
It is important to ask how the town hall meetings described earlier came to be filled with hundreds of protestors in the first place in August 2009. Was this a spontaneous display of legitimate outrage and anger over a significant and badly flawed health care reform proposal being “rushed” through Congress? Or was this a movement mobilized by conservative elites and media stars who used disreputable tactics to encourage a barrage of incivility at these meetings?
In her thesis on the role language and communication strategies played in the health care debate in the summer of 2009, Duffy (2013) argues that elite conservative organizations headed by Dick Armey, a former Republican congressional leader, and the billionaire Koch brothers, worked to “frame” the debate by vilifying the proposal and the president. She says:
I argue that the rhetorical strategies utilized by these two conservative groups in the weeks and months leading up to the health care town halls relied predominantly on the use of victimage rhetoric to inflame the anxiety of the conservative public. FreedomWorks and Americans for Prosperity complete the two steps of the victimage ritual by first systematically constructing the Obama Administration and the broader health reform movement as the enemy; and second by constituting an ethic of action, imploring the conservative audience to storm the town halls to prevent the constructed dangers posed by the vilified health reforms. (Duffy, 2013, p. 45)
The key to the process Duffy describes is that the audience must begin to see themselves as “victims” of actions by evil and immoral actors such as President Obama and Nancy Pelosi:
The vilification portion of the ritual requires the opponent be cast as “a violator of the ideals of the social order” (Blain, 2005, p. 34). In the instance of the health care debate, these ideals revolve around the notions of individual liberty and patriotism. A key aspect of the vilification step revolves around the use of hyperbolic language to transform a proposed foe into an evil, immoral other that creates group solidarity through opposition to the adversary, an example of Burkean congregation through segregation (Blain, 1994, p. 820). This emphasis on hyperbole to dramatize the “evilness” of the proposed foe is a dominant element of the conservative groups approach to vilifying the Obama Administration. (Duffy, 2013, p. 47)
So those protestors at the town hall meetings were seeing themselves as victims and challenging leaders that for them were un-American, unpatriotic, and a real threat to the values they held dear. But how did conservative elites transform the health care debate into this life and death struggle for the soul of the United States? Well, it helps to have a popular radio talk show, for example, as Sean Hannity does. On this show, Hannity called on his listeners to “become the party of the mob” and storm the town halls.
However, even before the health care debate, the conservative media from Fox News to Rush Limbaugh had worked hard to delegitimize the new president by challenging his constitutional right to hold the office on the basis of his place of birth, which for some talk show hosts varied from Kenya to Indonesia. The constant emphasis, which continues really through his entire term, on President Obama being the “other,” not really an American, someone who might have been educated in a “madras” in Indonesia, made it easier to oppose him and his proposals.
The process of vilification of the President was followed by the use of hyperbole and distortion of the health care proposal so that the legislation was seen as a threat to the core values conservative Americans cherish, such as autonomy, choice and freedom, as well as limited government. The first and probably most successful use of hyperbole in the debate started with Sarah Palin’s and Rush Limbaugh’s characterization of the Advanced Care Planning Consultation for seniors as a “death panel” (Duffy, 2013, pp. 13–43).
This use of hyperbole by Palin took on a life of its own. It had the impact of turning opponents of the law into both victims (the government is trying to convince Grandma to commit suicide) and heroic actors seeking to defeat this evil and immoral legislation. Conservatives were able to convince large numbers of Americans that the president of the United States was actually proposing that government bureaucrats force the elderly into consultations to convince them to either commit suicide or refrain from medical care in the case of serious illness in order to save money (Duffy, 2013). The idea was preposterous on the face of it, but lies told often enough can seem true. Indeed, the media gave more attention, as it usually does, to covering the conflict than sorting out the substance of the debate. Of course, none of this was true and advanced planning consultation was already being done and encouraged by Medicare policies for years. In fact, the idea for this provision had its roots originally in a proposal by a Republican conservative senator (Jacobs & Skocpol, 2012, p. 84). The purpose was to have patients sit with their doctors, not bureaucrats, and consider the options they may face at the end of life. These decisions would be between doctors and patients.
The “death panel” lie also had the added benefit of diverting the debate away from health care security for all to a debate about government over-reach, intrusion into personal autonomy, and an effort to strip seniors of choice about their care. Doing this encouraged conservatives to see themselves again as victims and as defenders of cherished values under attack.
After the death panel diversion, other techniques followed, including the claim repeated over and over again that the plan was really a “government takeover” of the health care system and an attempt to impose a “European style” socialized system on the United States (Duffy, 2013, p. 5). As the plan was similar to the one passed in Massachusetts by then Governor Mitt Romney, it was unclear how Republicans could make this argument, but it is one that has been used by opponents of universal coverage for 100 years. Of course, in reality, Obama was delivering millions of Americans into the hands of private insurers with government subsidies flowing to those insurers to help pay for the premiums, which certainly is not socialism by any definition.
To sum up this argument, then, the protestors at the town halls who were filled with anger and moral outrage were there because they had followed a “call to arms” from conservative media outlets and other grassroots organizations who, through the use of web sites, email, and mailings and, frankly, distortions and lies, as described by Duffy, got conservative listeners out to protest the health care reform proposal. But the main object of attack was really the president and the effort to delegitimize and weaken him and to position the Republicans for a major electoral victory in the upcoming congressional elections, as they had done to President Clinton in 1994 by scuttling his proposals (Jacobs & Skocpol, 2012, p. 85). Consequently, the anger was not just expressed at the grassroots level. It appeared in the halls of Congress and even at the State of the Union address when Representative Joe Wilson cried out “you lie” in the middle of President Obama’s speech when he claimed that illegal immigrants would not be covered by the health care proposal. The anger and incivility of the protestors was merely a reflection of what they were observing on Capitol Hill. Incivility had become a political tactic to mobilize the base. How did this happen? Is the anger we have observed in our politics really a symptom of a much larger problem?
Anger as a Symptom of Political Dysfunction: A Macro Perspective
Although historians are quick to point out that partisanship and strong language have been part of U.S. politics for most of our history, it seems to many observers that the level of hostility and anger that exists in modern politics is at an all-time high. Some political scientists have set out to look at whether or not the level of partisanship has indeed increased. It turns out it has. As Mann and Ornstein point out in their book It’s Even Worse Than It Looks:
Political polarization is undeniably the central and most problematic feature of contemporary American politics. Political parties today are more divided and more internally unified and ideologically distinctive than they have been in over a century. (2012, p. 44)
Mann and Ornstein locate the two major causes of the current dysfunction:
The first is the serious mismatch between the political parties, which have become as vehemently adversarial as parliamentary parties, and a governing system that unlike a parliamentary democracy, makes it very difficult for a majority to act … The second is the fact that, however awkward it may be for traditional press and nonpartisan analysts to acknowledge, one of the two major parties, the Republican Party, has become an insurgent outlier—ideologically extreme, contemptuous of the inherited social and economic policy regime, scornful of compromise; unpersuaded by conventional understanding of facts, evidence, and science; and dismissive of the legitimacy of its political opposition. (2012, p. xiv)
There are many structural factors that help us understand how this polarization occurred. For example, the move toward a candidate nominating system that weighs primaries very heavily and reduces the roles of party elites, which gives advantages in both parties to the most active wings of each party due to the fact that so few voters participate in primary elections. Secondly, the rise of cable news channels and talk shows that allow room in the market for a greater amount of adversarial and partisan platforms such as Fox and MSNBC are also a way of ensuring that many Americans hear the news and views through a filter that conforms to their predispositions. Finally, the Citizens United decision by the Supreme Court equating corporate donations to candidates as a form of “free speech” unleashed a windfall of money to Republican candidates. The growth of the role of money in attaining and keeping political offices has impacted politics so as to give enormous influence to individuals and corporations that support the conservative cause (Mann & Ornstein, 2012, pp. 31–80).
However, it was also during the last health care reform debate, during the Clinton administration, that we saw the origins of the kind of political warfare that was to come. Under the leadership of Representative Newt Gingrich, the newly elected Republicans pledged to kill health care reform. Gingrich made it clear that he thought any successful bill would hurt Republicans for a generation, as it would put Democrats in charge of another “welfare benefit” that millions would depend on. It was Gingrich’s wish to kill any bill, including any potential compromise, even if it included Republican ideas:
Gingrich and Armey turned out to be forerunners of a burgeoning right wing crusade—a campaign to counter not only the Clinton Health Security Plan but also the premise that America faced a “health care crisis” and needed any sort of comprehensive reform through government legislation. In late 1993, insurgent antigovernment Republicans realized that their ideological fortunes within their own party, as well as the Republican partisan interest in weakening the Democrats as a prelude to winning control of Congress and the presidency, could be splendidly served by first demonizing and then defeating the Clinton plan, along with any compromise variant. (Skocpol, 1997, pp. 144–145)
Fifteen years later, Senator McConnell would say much the same thing as he essentially promised to defeat any bills that might lead to the re-election of President Obama in 2012. It was now more important to defeat Obama than to pass any legislation, even if it was based on Republican principles such as individual mandates and private insurance that might provide 50 million uninsured Americans with some health security. The Republicans tried to use the same playbook on the Obama plan as they did on Clinton. But this time the plan would pass anyway.
During the Obama administration, we saw the rise of the Tea Party as a response to the efforts of the administration to help out homeowners who had found that their subprime mortgages left them, as a result of the housing bust and great recession, with homes worth less than their mortgage and many with an inability to pay the new higher rates. The Tea Party saw these homeowners as individuals who took advantage of low rates to buy houses they could not afford and that it was not the responsibility of the government to bail them out. In fairness, most “Tea Party” leaders were also opposed to the bailout of the banks. The Tea Party originally represented a new conservative movement opposed to the growth of government under President Obama, particularly manifested in policies such as the stimulus bill, the bailout of General Motors, and the effort to help homeowners. The Tea Party would grow and elect members of Congress who, though Republican in political identification, were committed to a new style of politics. They wanted no compromises and were willing to shut down government over issues such as raising the debt limit or passing the federal budget. Because they threatened established leaders in the primaries, they pushed the already conservative Republican Party even further to the right.
These events led to what I would call the institutionalization of political anger. Anger became normalized. Republican activists in Congress and in the media were always angry and expressing outrage. Rarely did they provide alternatives or offer compromises when policy disputes existed on health care or immigration. Instead, they would toy with impeachment over disagreements about the use of executive orders by the president on immigration, and they continued to challenge his legitimacy, his place of birth, and his patriotism.
This institutionalization of political anger also can be seen in the effort to reverse the Affordable Care Act even five years after its passage. The Republicans in the House have passed dozens of bills to repeal the bill, only to have it die in the Senate where 60 votes were needed to stop a filibuster. The effort to delegitimize the bill continued even after its passage, with several court cases to challenge parts of the bill or its constitutionality. Anger, for example, was stoked over the provision in the law to require all employers to offer insurance that covers contraception and birth control to women. Religious organizations claimed the law violated their First Amendment rights to religious freedom by making them offer coverage they felt violated church doctrine. Of course, the employers were not paying for the contraception; insurance companies were. The fact that many religious organizations employ thousands of workers, many who may not share the same religious faith, was not seen as relevant. As of now, the Supreme Court has not taken this case, but the government is under restraining orders not to enforce it.
Though the Supreme Court upheld the individual mandate in the law in a narrow 5–4 decision and also rebuffed, by the same margin, the challenge that the law did not allow for subsidies except in states that had their own marketplaces and websites; further, technical challenges are to still be decided. As of this writing, it is unclear if the efforts to undo the Affordable Care Act by a thousand cuts will succeed, though the permanence of the law is increasingly likely.
Anger on the Left
While liberal Democrats did not storm town halls or question the president’s legitimacy to hold office, the health care plan was not popular with many liberals, and the concern that later was confirmed was that the president was seeking a plan that would be bipartisan in nature and gather at least some Republican support.
Liberals were clearly expecting more. They had supported Barack Obama over Hillary Clinton not only because of his opposition to the war in Iraq, but because he was seen as more likely to govern from the left than Hillary. Bill Clinton’s presidency was filled with political compromises, including the unpopular campaign among liberals to “end welfare as we know it” that ended some of the federal guarantees created in the 1935 Social Security Act for mothers of dependent children.
Most liberals, as in 1993, wanted the United States to adopt a plan that was either similar to Canada’s single payer system or one like many European systems that provided guaranteed health care for all. President Clinton rejected that path because he felt it could not pass and would never get the support of key constituencies such as physicians, hospitals or insurance companies. It was clear early on that President Obama felt the same way.
President Obama was also constricted, ironically, by the success of the Democratic Party’s decision to run competitive races in all 50 states. The result was the Obama tide in 2008 that swept in senators and representatives from states where Obama actually lost or were traditionally “red.” These members of Congress would often try to steer a middle course in voting so as to stay close to the views of their constituents. Thus, a substantial number of Democrats would not have supported any plan like what the liberals wanted. Nonetheless, liberals were frustrated because the president early on abandoned one of the main objectives liberals had, which was to create a “non-profit public option” that consumers could choose over private plans and that would compete with these plans in the health exchanges or marketplaces to be created. Liberal columnist Paul Krugman spoke for many on the left:
Paul Krugman hammered Obama, not even six months in office, for “searching for common ground where none exists” and negotiating “with himself” for policies that are far too weak. Zeroing in on Obama’s unwillingness to endorse a public option, Krugman derided him delivering a “gratuitous giveaway in an attempt to sound reasonable” and warned that “reform isn’t worth having if you can only get it on terms so compromised that it’s doomed to fail.” (Jacobs & Skocpol, 2012, p. 80)
Liberal scholars also agreed that the president had missed understanding the “smoldering public anger over the health system” as demonstrated by public opinion polls and as Gottschalk described:
Obama and the Democrats may have squandered an exceptional political moment. There are not many times in US history when the previous administration, the ruling party, and the financial sector have been so thoroughly discredited. (Gottschalk, 2011, pp. 398–399)
Clearly, many felt that the crisis presented by the “great recession” and the huge margin of victory by Obama and the Democrats in 2008, had opened a “window of opportunity” for a health care reform that was not “minimalist” in its approach. They were disappointed that the Obama administration was so concerned to have a bipartisan bill with at least some Republican support. Ironically, in the end, not one Republican would vote for the ultimate legislation.
However, the anger we observed from liberals was quantitatively and qualitatively different from that expressed on the right. Unlike the right, there was no effort to delegitimize the president or see themselves as victims. Liberals tried to pressure the president through conventional methods of advertising, letter campaigns, lobbying, and some threats of non-support for the final bill. Rather, this anger stems from the structural conditions described earlier. Democrats are far more ideologically diverse than the Republicans. Because the Senate is required to essentially have a super majority of 60 votes, typically some support is necessary from the other side. If that support is not forthcoming, it is necessary to have all Democrats united. In 2009 the Democrats had the 60 votes but had at least three to five conservative senators who could not support a public option. The current system of governance prevents majority rule and works to the disadvantage of the Democrats, who are less ideologically homogenous. So liberals, though frustrated, ultimately had to accept a reform that really was quite moderate in approach and filled with provisions that have their origins in conservative proposals of the 1990s.
Are the Three Theories Compatible?
Each of the three theories described above is a window on the problem of anger in the context of the debate on the Affordable Care Act. The first theory sees anger as a “trigger” that releases the racial resentment and prejudice lurking among many conservatives who opposed the reform. The level of analysis is at the micro level and focuses on the predispositions of the actors involved. The second theory looks at how important elites and those able to utilize important resources such as the media and other grassroots mobilization strategies were able to create a sense of victimization and sense of loss among conservative voters and delegitimize both the president and the plan. Here the focus is on the effectiveness of political organizations and conservative activists to create a social movement. Finally, the last model looks at the structural causes of the anger and sees it really as a byproduct—almost inevitable really—of the current political system that ensures partisan polarization. It sees the cures for the polarization in the reform of the political system, including expanding the vote, reducing the role of money, and changing the rules of Congress to restore majority rule (Mann & Ornstein, 2012, pp. 31–80). Much of the anger on the left was clearly a result of the structural forces at work on the politics of the health care reform bill.
So these theories work at different levels of analysis but together form a picture of what went wrong in the summer of 2009. But it is also important to remember that not all anger is bad and some of the anger in the case of the Affordable Care Act was probably fair.
Legitimate Anger?
Obviously, we would all agree that anger is legitimate in the case of gross injustice and poor treatment or in cases where citizens are deceived. Did any of this happen in the case of the Affordable Care Act? Indeed it did.
After the act was passed, conservatives made much of the fact that the president had promised during the campaign and through the debates on the bill that “if you liked your insurance, you would be able to keep it.” However, it turns out that this was not entirely true, and after the ACA was implemented, thousands of Americans found they were dis-enrolled from their current insurance plans and had to seek new plans. The ACA required insurance companies to meet certain conditions and plans had to have a minimum of benefits in order to be certified. Often these plans had poor coverage, high risks for out-of-pocket payments in the case of serious illness, and other similar problems related to adequate coverage. Consumers would in many cases be eligible under the ACA for subsidies to buy better insurance. So they lost their current insurance but still had access to insurance and could not be refused (Robertson, 2014). However, it was likely that the coverage in some cases would still cost more and in other cases might mean the doctors and hospitals that participated would differ from the consumer’s previous plan. There can be no sugar coating of the fact that the promise was not kept and indeed the promise was deceptive.
Of course, conservative organizations like Americans For Prosperity and other opponents of the law launched a political storm over this apparent deception. It was a mistake by the president to offer this promise and he needed to be clearer and more transparent on how the plan would impact millions of Americans with substandard insurance. The irony here is that conservatives seemed to be defending the right of consumers to have poor and substandard insurance instead of the ability to upgrade to better coverage with support from the government if they could not afford it.
This chapter reviewed the events surrounding the rage and anger expressed at town hall meetings and in other forums regarding the Affordable Care Act, particularly in the summer of 2009. The anger has really never let up as we showed with the continuing efforts of the now Republican majority, swept into office in 2014, to overturn the law in Congress and the courts.
All the theories reviewed to explain the phenomenon, including (a) the effect of racial resentment and prejudice that leads citizens to reject ideas proposed by the first African American president, (b) the work of conservative organizations and media outlets to create a social movement against the plan by turning conservative voters into “victims” of a “government takeover” of health care, and (c) a structural perspective that sees the anger as a result of new institutional arrangements in our politics that makes political polarization inevitable, are described as being relevant to help us understand the rage over Obamacare. However, the argument put forth in this chapter concludes that anger and rage have been “institutionalized” and are now a continuing feature of the polarized political system. The anger has been manifested most clearly in the debates over health care, but the fact is the political right would have chosen any issue that President Obama put forward that had the potential to mobilize the grassroots in order to further its cause to take the White House and Congress back, and more importantly to control the political agenda.
Unfortunately, we have a political party now that actually does not accept the legitimacy of rule by the opposition, even when the opposition wins the election by a large margin. Going forward, Americans will either have to find a way to reform the political system by increasing voter turnout, reducing the role of money, and encouraging the adoption of rules that allow congressional majorities to act—or face a future in which the politics of anger is normal. Without these and other possible structural reforms to our politics, it is hard to see how the Republican Party can be encouraged to move closer to the center and restore a commitment to compromise and dialogue with those with whom they disagree that is essential for a democratic form of governance to survive.
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