Health-Care Reform: The Politics of Self-Esteem

Some while back, I proposed a concept that did not stick. I called it "the politics of self-esteem." My argument was that politics increasingly devotes itself to making people feel good about themselves—elevating their sense of self-worth and affirming their belief in their moral superiority. By contrast, the standard view of politics is that it mediates conflicting interests and ideas. The winners receive economic benefits and political privileges; the losers don't. This an apt time to resurrect my rival theory because it helps explain why the health-care debate became so inflamed.

The two theories are not incompatible. They can and do coexist. In fiscal 2010, the federal government will distribute about $2.4 trillion in benefits to individuals. Taxes and regulations discriminate for and against various groups. Politics shapes this process. But in truth, differences between parties are often small. Democrats want to spend more and don't want to raise taxes, except on high earners. Republicans want to reduce taxes but don't want to spend less. Vast budget deficits reflect both parties' unwillingness to make unpopular choices of cutting benefits or boosting taxes.

Given this evasion, the public agenda gravitates toward issues framed as moral matters. Global warming is about "saving the planet." Abortion and gay marriage evoke deep values, each side believing it commands the high ground. Certainly, President Obama pitched his health-care plan as a moral issue. It enshrines "the core principle that everybody should have some basic security when it comes to their health care," as he said on signing the bill. Health care is a "right"; opponents become less moral.

Obama's approach was politically necessary. On a simple calculus of benefits, the proposal would have failed. Perhaps 32 million Americans will receive insurance coverage—about 10 percent of the population. Other provisions add somewhat to total beneficiaries. Still, for most Americans, the bill won't do much. It may impose costs: higher taxes, longer waits for appointments.

People backed it because they thought it "the right thing"; it made them feel good about themselves. What they got from the political process are what I call "psychic benefits." Economic benefits aim to make people richer. Psychic benefits strive to make them feel morally upright and superior. But this emphasis often obscures practical realities and qualifications. For example: the uninsured already receive substantial medical care, and it's unclear how much insurance will improve their health.

Purging moral questions from politics is both impossible and undesirable. But today's tendency to turn every contentious issue into a moral confrontation is divisive. One way of fortifying people's self-esteem is praising them as smart, public-spirited, and virtuous. But an easier way is to portray the "other side" as scum: the more scummy "they" are, the more superior "we" are. On both left and right, this logic governs the political conversation, especially talk-radio, cable channels, and the blogosphere.

Unlike economic benefits, psychic benefits can be dispensed without going through Congress. Mere talk does the trick. Shrillness becomes coin of the realm. The "other side" cannot simply be mistaken. It must be evil, selfish, racist, unpatriotic, immoral, or just stupid. A culture of self-righteousness seizes both left and right. Stridency from one feeds the other. Political polarization deepens; compromise becomes harder.

Dangers are plain, as political scientists Morris Fiorina and Samuel Abrams argue in their book, Disconnect: The Breakdown of Representation in American Politics. Using opinion surveys, they show that polarization is stronger among elites (elected officials, activists, journalists) than the broad public. Various "disconnects" result. Politics that seems too bare-knuckled alienates voters. Or Congress responds to the passionate party "base" and enacts major programs without wide support. That happened with the health overhaul. A new USA Today/Gallup poll finds tepid backing: 40 percent of respondents think the country's health will improve, but 35 percent think it will get worse (the rest: no change); 35 percent think their own health care will worsen, and only 21 percent think it will improve; 50 percent expect higher costs than without the bill, only 21 percent lower.

American politics increasingly caters to people's natural desire to think well of themselves. But in so doing, it often sacrifices pragmatic goals and sows rancor that brings government and the political system into disrepute.

Robert Samuelson is also the author of  The Great Inflation and Its Aftermath: The Past and Future of American Affluence   and  Untruth: Why the Conventional Wisdom Is (Almost Always) Wrong.

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