Obamacare: Not everyone thinks the same way you do

“Everyone I know agrees that President Obama’s problem is that he isn’t liberal enough.  Everyone I know believes that the problem with Obamacare is that it gives insurance companies too much power, when what we really need is a single payer system where the government runs everything, like Canada.  Everyone I know believes that  the answer to gun violence is to ban guns,  and if the Supreme Court won’t allow that, to at least license, regulate and restrict them. After all, no one I know would even think of owning a gun.”

“Everyone I know agrees that President Obama’s problem is that he is too liberal — heck, he’s probably a socialist.  Everyone I know believes that the problem with Obamacare is that it gives the government too much power, when what we really need is a free market system that gets government out of the way. Everyone I know understands that banning or restricting guns won’t reduce injuries and deaths — guns don’t kill, people do. After all, everyone I know owns a gun, it is the way we’ve grown up, and every gun owner that I know is a law abiding citizen.”

I made up the above quotes, but they are representative of what I hear from many physicians (and others).  Recently, I received an email from an ACP member who is very unhappy with how I graded the Affordable Care Act; his view is that Obamacare is a failure and, “this is the sentiment of 100% of the physicians that I meet.”  I have heard from liberal members of ACP who similarly claim that everyone they know wants strict gun control and a single payer system, and wonder why ACP doesn’t do more to speak for them.

And therein lays the problem: Just because everyone we know agrees with us doesn’t mean our views are right or representative of how others think.  Surely, in a country as large and diverse as the United States, there is someone with a contrary perspective, informed by their own cultural influences, circumstances, gender, age, ethnicity and place of residence and life experiences. But we would never know it if we surround ourselves only with people who think the same way as us.  And if information about how others might think comes mainly from the vitriol and distortions of cable TV and talk radio and blast e-mails, well then, we’ll never really understand why others might hold opposing views.

Regrettably, a major, new survey of 10,000 adults by the Pew Research Center shows that more of us choose to be surrounded by people who think just like us, creating the greatest polarization in decades. “Republicans and Democrats” the researchers found, “are more divided along ideological lines — and partisan antipathy is deeper and more extensive — than at any point in the last two decades. These trends manifest themselves in myriad ways, both in politics and in everyday life … these divisions are greatest among those who are the most engaged and active in the political process.”

One consequence is the “growing contempt” and “mutual antipathy” between Republicans and Democrats; “among all Democrats, 27% say the GOP is a threat to the well-being of the country. That figure is even higher among Republicans, 36% of whom think Democratic policies threaten the nation.”

It gets worse.  The researchers found that committed liberals and conservatives love to talk about politics but usually within their own ideological echo chambers. “For many, particularly on the right, those conversations may not include much in the way of opposing opinions.”

The growing polarization even carries over to where we choose to live.  “People on the right and left also are more likely to say it is important to them to live in a place where most people share their political views, though again, that desire is more widespread on the right (50%) than on the left (35%).”   Conservatives prefer to live in places where the houses are larger and farther apart but schools, stores and restaurants are several miles away; liberals where houses are smaller and closer to each other but schools, restaurants and stores are within walking distance.

There is a center — about 39% of the population — that does not hold consistently or mostly liberal or conservative views, but they are less likely to vote and participate in politics than the ideologues on the right and left.  “Most Americans in the center of the electorate think that Obama and Republican leaders should simply meet each other halfway in addressing the issues facing the nation” yet “an equitable deal is in the eye of the beholder, as both liberals and conservatives define the optimal political outcome as one in which their side gets more of what it wants.”

And, to be sure, while views have hardened on both ends of the political spectrum,  the “partisan antipathy is more pronounced among Republicans, especially consistently conservative Republicans … Fully 66% of consistently conservative Republicans think the Democrats’ policies threaten the nation’s well-being. By comparison, half (50%) of consistently liberal Democrats say Republican policies jeopardize the nation’s well-being. Conservatives also exhibit more partisan behavior in their personal lives; they are the most likely to have friends and prefer communities of like-minded people.”

All of this bodes very poorly for the American system of governance.  Unlike parliamentary systems, where the majority party controls all the levers of government until they are voted out, the United States is founded on a system of  checks and balances as established by the U.S. Constitution.  Especially at a time when one party (Democrats) control the White House and Senate, and another party (Republicans) control the House of Representatives, the only way to advance legislation is through bipartisan compromise.  Yet committed ideologues don’t see compromise as a virtue.

I don’t have the answers, only a hope that at some point, the tide will turn and voters will choose to cast their votes for politicians who are committed to getting things done.  In the meantime, I see little prospect for achieving a consensus on changes that might be made in the Affordable Care Act, or to reach agreement on reforming entitlement programs or creating a fairer tax system.

There are some things each of us can begin to do, though, on our own and together, to try to reduce polarization.  Support policy and advocacy organizations, like ACP,  that ensure that  the people who sit on their policy committees  represent the broad range of views, partisan leanings, and experiences of the membership.  For instance, the ACP committee that developed our new position paper on preventing injuries and deaths from firearms, which was published in the Annals of Internal Medicine, included physician gun owners from conservative communities and non-gun owner physicians who hailed from more liberal communities. They were able to openly share their perspectives, listen to each other, and reach a consensus informed by evidence.

We can all try every day to listen to what the other side has to say; I personally follow people on Twitter who are from all across the political spectrum.

We can get out of our echo chambers and travel to other parts of the country and meet people who have different experiences and views,  like I do when I travel to a dozen or more ACP chapter meetings each year. (Over the next several months, I will be attending chapter meetings in Bozeman, Montana; Pierre, South Dakota; Seattle, Washington; and San Francisco, California.) Sure, for me, listening to ACP members who have different views and political leanings, and being able and willing to consider a wide range of opinions from politicians, think tanks, and advocacy organizations across the spectrum of right to left, is built into my job description.  But even if it wasn’t, I have an inherent curiosity about how others view things and the circumstance that inform their views.

And finally, we all need to constantly remind ourselves that even if everyone we know thinks the same as we do (or at least we think they do), there are many other Americans who have a different view that also needs to be considered and respected.

Bob Doherty is senior vice president, governmental affairs and public policy, American College of Physicians and blogs at The ACP Advocate Blog

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