Personal Health

Town Hall Lunacy Includes Outraged Calls to 'Keep Government Out of Medicare,' When Medicare Is Government

Some can't reconcile what they believe about the propaganda that is fed to them with their own positive experiences with public programs like Medicare.

As the health care discussion has descended from contentious to surreal, there is perhaps one message that encapsulates better than any other the incoherence of those expressions of rage seen at town hall meetings across the country: "Keep government out of my Medicare!"

The rallying cry has been heard again and again as lawmakers have returned home to discuss health reform during the summer recess.

In South Carolina, an enraged constituent told Republican Rep. Bob Inglis to "keep your government hands off my Medicare!"; a woman reportedly sent a letter to the White House stating in no uncertain terms, "I don't want government-run health care, I don't want socialized medicine and don't touch my Medicare." Slate's Timothy Noah put out an open invitation for readers to submit more examples of this kind of confusion.

The incoherence isn't limited to the low-information rubes turning out at town halls either. Supply-side, "voodoo economist" Arthur Laffer cautioned during a recent interview on CNN, "If you like the post office and the Department of Motor Vehicles, and you think they're run well, just wait till you see Medicare, Medicaid and health care done by the government." And in a wildly convolutedinterview on Fox News this week, RNC Chairman Michael Steele argued simultaneously that Medicare is an inefficient, deeply flawed program that must be protected at all costs.

The outrage is a perfect picture of right-populism, argues Chip Berlet, an expert on right-wing movements. "The town meeting confrontations over health care are an example of right-wing populist protests that periodically sweep across the United States," he says. "The anger, fear and resentment are often mobilized by cynical political elites as part of an orchestrated response."

Many observing these debates from abroad have probably concluded that we, as a nation, have finally gone completely mad. And it's hard to argue otherwise.

How sane could be a polity that sits by with relative complacence when its leaders launch devastating and groundless invasions of foreign lands but approach a full-on rebellion when those leaders make some modest moves to deliver decent health care at a price people can afford?

And how could these people be so divorced from the dynamics of their own health care that they don't appear to understand that the Medicare they value so highly is very much a government-run health care program?

The most frequent answer from liberals is that these people are simply uneducated buffoons who listen to too much Rush Limbaugh, an argument that's not without merit.

But historian Rick Perlstein thinks that the statement reflects, at least in part, zero-sum thinking among one of the few groups of Americans whose health care is guaranteed by the government.

"It's almost like: 'I got mine and screw you.' People think that any expansion of the [public] health care pie means that their slice will get smaller," he told me.

Perhaps a more straightforward explanation can be found in the psychological literature.

In their 1950 classic, The Authoritarian Personality, UCLA psychologists Theodor Adorno, Else Frenkel-Brunswik, Daniel Levinson and Nevitt Sanford identified a cluster of traits that they argued were inherent in the conservative worldview, including a fierce protectiveness of the status quo, a tendency to lash out at opponents, an embrace of stereotypes and cynicism.

All are traits that have been on display in abundance as conservatives lash out at lawmakers for what they believe, erroneously, to be in the health care bill.

More recently, Bob Altemeyer, a professor of psychology at the University of Manitoba, added to the literature with his model of "right-wing authoritarianism." Drawing on years of empirical research, Altemeyer found that the right-wing authoritarian personality is "almost totally uninfluenced by reasoning and evidence."

They are likely to believe those they perceive as authorities on an issue without question, even when, as in the health reform debate, those leaders come out with fantastic lies about what the measure would look like, complete with ashen bureaucrats deciding how much health care you deserve based on your lifestyle and elderly people being forced to argue their worth in front of Sarah Palin's now-infamous "death panels."

But one aspect of the right-wing authoritarian personality is especially relevant to the question of how someone might demand that government's hands be kept off of Medicare.

Altemeyer found in the personality a tendency to avoid cognitive dissonance -- the discomfort caused by holding two contradictory ideas -- at all costs and to lash out when confronted with it.

In this case, the conservative mind simply overrides the inherently contradictory ideas, "Medicare is good" and "government health care is bad" by imagining the former as something other than the popular publicly administered program that it is.

Those yelling at town hall meetings across the country are deeply indoctrinated with all of the major tenets of right-wing anti-governmentalism. They believe there's "rot at the top," that government intervention in the "free market" is "socialism" -- and not in the Swedish style, but as a brutal and totalitarian system epitomized by the former Soviet Union or today's North Korea.

"Government," in their view, is not represented by a heroic firefighter or an organization that is incredibly effective at its task like the United States military. It's a long line at the DMV.

So they believe, as Ronald Reagan said, that government cannot be a solution to their problems, only a cause. And yet … they have Medicare.

Not only does the program have lower administrative costs than private health insurance, but people who take part in it express a great deal of satisfaction with their coverage. In fact, study after study after study show that people on Medicare are more satisfied with their access to care and the quality of that care than the rest of the population.

That's just the tip of the iceberg. There is arguably no area of public policy in which reality more profoundly clashes with the cherished right-wing myth that the government can do no right -- and the "free market" no wrong -- than in health care.

Recipients of Medicare, Medicaid and the State Children's Health Insurance Program are the beneficiaries of health care covered by the functional equivalent of a government-run, single-payer program, and most are quite satisfied.

Not only does their care come with less overhead, but, according to a study by the Rand Corp., the even smaller group of Americans, veterans, who have truly socialized medicine -- government-run clinics providing care directly -- have the best health care in the country in every measure, except for emergency care. (That's because the emergency care available to veterans is the same as that available to anyone else: Everyone can get treatment in any emergency room, regardless of the ability to pay).

The push to reform the system runs headlong into another cherished belief -- one not limited to conservatives: American exceptionalism.

In the U.S., we take it for granted that We're No. 1! And while we are number one by a long way in terms of the amount per person that we spend on health care, the World Health Organization ranks our system as the 37th in the world; we lag behind all other developed countries in terms of deaths prevented by medical treatment.

And, according to a Gallup survey of the citizens of 30 advanced democracies, Americans come in 18th in terms of their satisfaction with the health care they receive.

Chip Berlet admonishes: "Calling these protesters 'extremists' or 'wing nuts' suggesting they are mere puppets of elite rightist spinmasters or demanding they be silenced, undercuts the basic concepts of the democratic process." Berlet recommends that Democrats and progressives "need to learn how to rebut false and misleading statements and beliefs without name-calling; calmly rebuke those spreading the misinformation as harming civil society; and develop strong and clear arguments to defend their proposed programs."

He's right, but it's easier said than done when communicating with people who are fighting to establish some degree of cognitive consonance between what they believe about the pernicious nature of government in general and their own experience with good public programs like Medicare.

It's hard to respond with anything more than condescension when faced with an angry person screaming at you to keep your dirty government paws off their pristine Medicare program.

Joshua Holland is an editor and senior writer at AlterNet.