August 14, 2009 6:39 pm

Healthcare paranoia is part of America’s culture war

Barack Obama has been accused by his more constructive critics of mishandling America’s increasingly deranged debate over healthcare reform: The president should have spelt out his own plan, they say, rather than outsourcing the details to his colleagues on Capitol Hill.

On a tactical level such advice may have some merit – although it ignores the fact that Mr Obama was seeking to avoid the approach of Bill and Hillary Clinton in 1994. They did precisely what Mr Obama’s critics say he should have done, only to watch their efforts shredded in Congress.

In truth, such advice almost certainly misses the point. By dwelling on tactics rather than strategy and on Washington rather than America it mistakes the nature of the challenge. To its surprise, the Obama administration is faced with a full-scale culture war over healthcare which has very little to do with arguments and everything to do with identity.

“We want our country back,” is the refrain of many of the protesters who turn up to the rowdy town hall meetings that have become venues for “tea party” protests against the effort to impose “socialism”, “Nazism” or “big government liberalism” – take your pick – on America.

Some of the protesters, particularly the elderly, who already benefit from government largesse under Medicare, are worried about what will happen to their benefits. But by far the largest chunk know little about the proposed reforms and have no intention of rectifying their ignorance.

More than a generation ago, the great American historian Richard Hofstadter wrote the classic The Paranoid Style in American Politics. Having watched many public servants and colleagues in academia hounded out of their jobs on the flimsiest of pretexts during the “red scare” of the McCarthy era in the 1950s, Hofstadter identified what he saw as a peculiarly American pathology of proneness to conspiracy theory.

America, he pointed out, was a relatively rootless society, which meant that anyone suffering from economic or status anxiety, particularly its struggling white middle classes, was particularly susceptible to the politics of scapegoating. Although also exhibited on the American left – think of the indefatigable Noam Chomsky, who sees a conspiracy under every rock, or Ralph Nader, the former consumer activist who believes corporations run everything – Hofstadter saw the paranoid style mostly as a right-wing phenomenon.

His theory holds up very well in 2009. Anyone who visits a few of this month’s rowdy town hall meetings can grasp that opposition to Mr Obama’s healthcare proposals is a lightning rod to a far larger world view, which seeks to protect American values and the US constitution from an alien takeover.

The word “alien” is appropriate. A poll last week found that only 42 per cent of Republicans believe Mr Obama was born in America. “Birthers”, or those who believe the election of the president is a conspiracy that dates back at least to Hawaii in 1961, the place and time of Mr Obama’s birth, made up a slim majority of respondents in the south. Foreign-born candidates are ineligible for the presidency under the constitution.

Then there is the gun lobby, one armed member of which protested outside Mr Obama’s own healthcare town hall in New Hampshire earlier this week. Not all of them are marginal nutcases. According to the Federal Bureau of Investigation, which conducts background checks on new gun buyers, the volume of gun sales has risen by more than a quarter since January. Last November, the month Mr Obama was elected, saw a record 42 per cent surge in gun sales.

With little evidence, since Mr Obama has shelved his already modest plans for gun control, many of the purchasers were stockpiling ahead of an expected crackdown. Others, however, belong to the “black helicopter” school of paranoia which believes government bureaucrats in concert with the United Nations are planning to take over the country. Such sentiments are visible in spades at the healthcare town hall meetings – along with the more mainstream anti-abortion, anti-tax and libertarian groups.

Their issues are diverse. But their sentiment is common: America’s constitution is being trashed by un-American values. Which brings us to another important strain in US politics that Mr Obama, along with other educated liberals, shares with the Clintons: the belief that the fight is won or lost over the quality of reason.

No amount of contrary evidence will puncture the view that Mr Obama plans to establish “death panels” that will decide which grannies get to live or die. Nor will reason counter the view that countries such as Canada and the UK push their weakest to the back of the queue. “Who will suffer the most when they ration care?” asked Sarah Palin, the former governor of Alaska on Thursday. “The sick, the elderly and the disabled, of course.”

Mr Obama’s proposals have many flaws. Reasonable people can disagree on whether the reforms would bring down the cost of healthcare, an overriding priority, or sufficiently expand coverage to include the uninsured, a twin, but not always compatible, goal. For all their impact, reasonable people may as well be living on Venus.

The multi-generation battle to reform healthcare will be won or lost over faith rather than reason. The more nuanced Mr Obama appears, the more frenzy it will provoke in his critics. The more he mentions his mother, denied healthcare by the insurance companies when she was dying of cancer, the more progress he will make. What happened to her was un-American, Mr Obama should say. Forget the details of healthcare reform. The side that identifies with American values will get the upper hand.

The writer is Washington bureau chief

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