Political discourse surrounding healthcare reform has included purposeful disruptions of Congressional town hall meetings, the brandishing of firearms at opposition rallies, and the use of Nazi imagery to depict President Obama. Why has opposition to healthcare reform been so contentious? Conventional responses from the political right typically focus on ideological differences, such as varying views on the appropriate role of government in society, or the perceived need to prioritize other issues, such as the economy. Conventional responses from the political left typically focus on the perceived entrenchment of private insurance companies or the unwillingness of Republicans to work in a bi-partisan fashion. Discussion of U.S. political culture is notably absent from efforts to understand opposition to healthcare reform. This essay will illuminate the ways in which the exceptionalism of U.S. political culture provides a context to better understand this opposition.
Exceptionalism is the idea that U.S. society, politics, and economics are unique and better than other societies and peoples. U.S. political culture has a long history of exceptionalism dating back to colonial America. Puritan leaders, such as John Winthrop, viewed the Massachusetts Bay Colony as “a city on a hill with the eyes of the world upon them.” The Puritan goal was to create a model of Christian morality. Theocracy gave way to broadening conceptions of freedom, which eventually led to an irreparable relationship with Great Britain. The Founders articulated their conceptions of freedom using universal language, which was focused on all of humanity, rather than just citizens of the U.S.A. This was remarkable considering how this little group of colonies broke away from the most powerful empire in the world; success was far from likely. Thomas Jefferson began the Declaration by placing the American Revolution “in the course of human events” and explaining that when rebellions occur, reasons had to be provided. The Founders justified the rebellion through dedication to certain natural rights premised on the notion that all “men” were created equal. Essentially, the one thing all human beings have in common is that we are not God, so all people, including government, must respect basic human rights. The Founders believed they were making a grand statement for all people whose government infringed on their natural rights, not just colonial Americans in 1776. The U.S. remains unique in having natural rights written into the country’s founding document, including the right to rebel if government infringes on these rights. To this day U.S. leaders regularly invoke the imagery of “a city on a hill” in speaking about the exceptional character of the U.S. experience.
A second way exceptionalism is manifested through U.S. foreign policy. The U.S. first embraced democracy promotion during World War I under Woodrow Wilson, who famously stated “the world must be made safe for democracy.” This quote is revealing because it highlights the belief that the world must be adapted to suit U.S. political beliefs and values, rather than the other way around. The U.S. emerged as a major superpower after World War II and emerged as the world superpower after the Cold War. From a Western perspective democracy’s major ideological rivals, fascism and communism, were severely discredited after the three major conflicts of the twentieth century. Exceptionalist elements of U.S. political culture now believe that the U.S.’s unique path to the top demonstrates that U.S.-style democracy and capitalism constitute the best of all types of social order. This is personified in President George W. Bush’s 2003 State of the Union, where he stated that “Americans are a free people who know that freedom is the right of every person and the future of every nation.” The exceptionalism of the U.S. tradition is now connected with the geo-political realities of U.S. military and economic power. The U.S. views itself as the model of democracy in an era of globalization where major powers have profound impact on the world at large.
Exceptionalism provides a useful perspective through which to better understand the contemporary healthcare debate given its historical prominence in U.S. development and culture. Senate Republicans, such as Senate Minority Leader Mitch McConnell, Orrin Hatch, Jim DeMint, and Richard Shelby, have argued that the U.S. has the best healthcare system in the world, as did George W. Bush, and President Barack Obama’s rival in the 2008 election, John McCain. These arguments have created controversy and confusion. One of the few things that Republicans and Democrats agree on is that healthcare reform is needed. Major differences emerge over how to do this. How can the U.S. healthcare system simultaneously be the best in the world and be in need of reform? Conservatives inherently want to conserve the pace of change. One way to articulate and justify this political behavior is to laude the status quo, which in this case, is the current healthcare system. One tactical way to do this is to hyperbolize the effectiveness of the current system, which particularly resonates with many U.S. citizens because of the role of exceptionalism in U.S. political culture. The inverse approach has been adopted as well. In addition to lauding the status quo, the enemy, Barack Obama in this case, has been demonized. Prominent examples include Representative Joe Wilson’s unprecedented shout of “you lie” during a presidential address before Congress and popular conservative talk show host Rush Limbaugh comparing Obama to Hitler. “Going negative” and criticizing political rivals is not new. Importantly, however, these criticisms have more traction and can be more outlandish, when framed in a belief that U.S. healthcare is exceptional, so that whoever seeks to change the status quo, threatens national well-being, and is deserving of harsh criticism.
Public opinion is a second way to consider the impact of exceptionalism in the opposition to healthcare reform. Access to healthcare, a major concern of Democrats, does not resonate with broader U.S. culture to the same degree that it does in the Democratic party, even though Democrats received widespread support in the 2006 and 2008 elections. People in the U.S. predominately view poverty as the result of individual failures; this view contrasts to much of Europe, whose people predominately view poverty as the result of structural problems, such as the lack of education or the lack of opportunity. The U.S. view constrains reform efforts because people who are financially successful are considered exceptional and thus more deserving of healthcare coverage than financially challenged Americans, who are blamed for being poor and their inability to gain or purchase healthcare coverage. These attitudes reflect a form of Social Darwinism,. In the nineteenth century, Social Darwinists, such as Herbert Spencer and William Graham Sumner, justified economic inequality as a natural product of competition and used this belief to advocate limited government involvement in social activity, and such attitudes linger in U.S. public exceptionalist sentiments. Not surprisingly, the U.S. has the most limited welfare state in the West. In turn, people in the U.S. are divided over whether the federal government should make sure all U.S. citizens and legal residents have healthcare coverage, again in sharp contrast to European countries, all of which have an increased federal role in healthcare to ensure access.
The divisions that now plague healthcare reform in the U.S. run much deeper than this moment. U.S. political culture is inherently resistant to political change that questions the exceptional nature of how people in the U.S. live and seek to build a more collective understanding of the public good. The U.S. has not decided whether it wants to remain committed to the welfare state, pursue a long term process of deregulation and privatization, or continue shifting back and forth in a highly polarized fashion. Greater understanding and appreciation for the cultural dynamics influencing this situation helps explain why opposition to healthcare reform has been so contentious. Conventional and scholarly examinations of opposition to healthcare reform would be well-served by greater discussion of the role of U.S. political culture. The final bill, regardless of the specific form, will likely raise a new and important set of questions, the answers to which will determine whether a movement toward a more European style welfare state is truly progressive or moving the U.S. away from the exceptionalism that made the country what it is today. This will inevitably shape and be shaped by U.S. political culture, no matter how exceptional and enlightened we think we are.
