Critical Condition

History’s Painful Lessons

It is August recess. Members of Congress have returned home, where their constituents besiege them with letters, phone calls, and angry confrontations over health-care reform. It seems Congress badly misjudged the public’s mood. In one ugly confrontation, angry senior citizens surround the car of one of the most powerful Democrats in Congress — waving signs and shouting, “Coward! Recall! Impeach!” — until they force the 30-year congressional veteran to flee the scene on foot.

Congress and the media dismiss the protesters. The New York Times editorializes, “There’s little reason to sympathize with the aggrieved,” calling their complaints “short-sighted and narrow-minded.” A commentator in The New Republic condemns the protesters’ “selfishness.” The experts agree: Those who oppose the legislation are either misinformed or rabble-rousing troublemakers who can safely be ignored.

Public reaction to President Obama’s health plan? Think again.

Those scenes describe the protests over the Medicare Catastrophic Coverage Act of 1988, which led elderly constituents to chase House Ways and Means Committee chairman Dan Rostenkowski down a Chicago street 20 years ago this week. When Rostenkowski asked whether the issue would blow over, his press secretary reportedly replied, “Let me put it this way, Congressman. When you die, they will play this clip on television.”

There are numerous parallels between the debate over the Medicare Catastrophic Coverage Act and the current health-care-reform debate. Both sought to extend coverage to those who did not have it, or had only limited coverage. Both placed much of the cost burden on those who already had coverage. Both front-loaded the spinach (taxes, higher premiums) and back-loaded the dessert (coverage/subsidies and lower health-care costs). Both were supported by the AARP, at least initially. Finally, both made clear there was a mismatch between the priorities of legislators and voters.

Despite overwhelming bipartisan support in Congress and the Reagan administration, and despite the elite consensus, the public backlash led Congress to repeal the Medicare Catastrophic Coverage Act within three months of the Rostenkowski Affair. ABC News reporter Andrea Mitchell nicely summarized the elderly’s attitude: “The elderly are not against the new benefits . . . they just don’t want to pay for them.”

No one can predict whether the latest effort at health-care reform will meet a similar ignominious defeat. But this story does hold lessons for the current debate.

First, health care is personal. If you mess with people’s health coverage, they won’t just write a nasty letter to the editor. They will show up at demonstrations with home-made signs, scream at you, chase you down the street, and maybe vote you out of office. So you’d better have a good reason for doing what you’re doing, and a compelling explanation of how your plan would personally benefit your constituents.

Second, framing is critical. The Obama administration has shifted ground several times, trying to find a frame that will persuade voters. It remains to be seen whether the latest frame — it’s about providing people with insurance; insurers are evil, and the reforms will make them behave — will stick.

Third, don’t assume that people who disagree with you are stupid, misinformed, greedy, or evil. They may just have different preferences about health insurance, taxes, income redistribution, or the role of government in health care. If preferences differ, telling people they can’t understand the complexities won’t help matters. Such condescension just makes aggrieved citizens angrier.

Fourth, be lucky. The administration had better hope that the elderly don’t figure out that reform will be paid for, in part, with hundreds of billions in “savings” from cutting Medicare. (In past years, Democrats routinely savaged Republicans for proposing far smaller Medicare cuts.) If seniors figure this one out, support from AARP’s national office won’t be any more help this time than it was last time — even if AARP stays on board, and there are already indications that it won’t.

Finally, embrace your sense of humor and irony. The administration of a former teacher of constitutional law complains about Americans exercising their constitutional right to petition the government for redress of grievances. A party that elected a community organizer president complains about organized communities. One of the architects of the Democrats’ current health-care strategy (Rep. Jan Schakowsky) is the very community organizer responsible for the horde of seniors that surrounded Rostenkowski’s car. Last year, dissent was the highest form of patriotism. Now, dissent is un-American, and reporting dissent is suddenly patriotic. Who knows what fresh irony tomorrow will bring?

David A. Hyman is the Richard W. and Marie L. Corman Professor of Law and Medicine at the University of Illinois, and an adjunct scholar at the Cato Institute.

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