Perhaps no image makes liberals more likely to palm their foreheads than the infamous photo of a Tea Party protestor with a sign declaring, “KEEP GOVERNMENT OUT OF MY MEDICARE!”
But Medicare is a government program! shouts the frustrated liberal. If only these people knew!
But why don’t these people know? For one, most people experience Medicare not as a government service but as a direct interaction with their doctors. Government is frequently invisible in the process. But it isn’t just the government’s invisibility that’s the problem. Most people are quite happy with their Medicare coverage, and many Americans have become so convinced that government programs are low quality and inefficient that the idea that a high-quality service could be from the government doesn’t compute. They think it must be private.
by Amy E. Lerman
University of Chicago Press, 304 pp.
So explains Amy E. Lerman in a new book, Good Enough for Government Work. It’s an important and well-timed publication. Democratic presidential contenders are now proposing major new government programs, such as Medicare for All (most Democrats), universal child care (Elizabeth Warren), and a federal jobs guarantee (Cory Booker).
If these programs are to have a chance of becoming law and succeeding, supporters will need to confront the public reputation crisis head on. To do so, they’ll need to break down its underlying causes and work to change public opinion. Lerman, a professor at the University of California, Berkeley, has provided a great guide for doing so.
First, the good news: in polls, majorities of Americans say they would like government to solve public problems and provide more services. But—and this is the key—many of these same people also think government is inefficient and wasteful. And so while in theory they’d prefer a government solution, in practice they don’t have faith that government can get it done.
This mind-set is the product of more than four decades of undifferentiated government bashing. It began in the 1970s and ’80s as a project of the political right, when undermining faith in government was a way for businesses to shut down economic regulations and for socially conservative whites to weaken civil rights programs. “The nine most terrifying words in the English language are: ‘I’m from the government and I’m here to help,’ ” quipped Ronald Reagan. The credibility of thousands of public servants vanished.
Bill Clinton picked up the baton and, to switch metaphors, dug the knife in deeper. In his 1993 State of the Union address, he told Americans, “It is not enough simply to cut government; we have to rethink the whole way it works. . . . The real engine of economic growth in this country is the private sector.” Democrats still remain more positive about the potential competence of government. But a generation of anti-government rhetoric solidified this perspective on both sides.
Changing these attitudes won’t be easy. We are all prone to motivated reasoning. We see what we expect to see, and most Americans now expect to see waste and inefficiency in the public sector. Take the Department of Veterans Affairs. As documented in these pages, the VA health care system is—by most metrics—faster, more holistic, and of higher quality than the private sector. Veterans routinely say that they’re very satisfied with the care they receive.
But in 2012, the Koch brothers began running an aggressive campaign to tar the VA system and undermine faith in government-run health care. They didn’t have to work that hard. A gullible mainstream press picked up on a few cherry-picked and unrepresentative examples of long wait times to confirm the stereotype that government can’t do anything right. Before these stories, the VA was one of the federal government’s most popular agencies. But in 2017, it was dead last in a Pew survey—ranked less favorably than even the IRS.
Lerman’s research shows that when respondents are given information about garbage collection, emergency medical services, and prisons and told that the services are of high quality, they are considerably more likely to conclude that the services are provided privately. When they are told about the same services but told they are of low quality, they are more likely to conclude that they are provided publicly.
Thus, government programs and their supporters today face a dual challenge in winning public opinion. Not only do they have to deliver high-quality services. They also have to convince people that those high-quality services—like Medicare—are, in fact, provided by the government.
Unfortunately, misperceptions about what the government provides are widespread. Lerman cites the important work of political scientist Suzanne Mettler, who has found that more than half of Americans (56.5 percent) say they have not used a public social program. Most are mistaken. As Mettler documents, 44 percent of people who received Social Security and 40 percent of people who used Medicare said they “have never used a government social program.” The fact that they are either unaware or unwilling to admit that they had is remarkable.
Of course, some people do willingly opt out of public services. Many conservatives, for example, refused to sign up for health care under the Affordable Care Act, even though they needed insurance. After the ACA passed, Republicans became more likely than Democrats to go without health insurance, forgoing the opportunity to sign up through a government exchange. Similarly, some parents don’t send their kids to public schools because they believe private schools are better. Lerman argues that this opting-out has a reinforcing effect. Public services are starved of the resources necessary to support populations that require more help. As a result, these services struggle to perform as well.
But perhaps more importantly, by opting out, people foreclose possibilities for seeing government’s many upsides. Lerman shows that when individuals get “what they consider to be valuable and well-administered public benefits, their attitudes toward public programs improve.” In particular, when Republicans turn sixty-five and start receiving Medicare, they become much more supportive of the program. (Democrats are supportive regardless of their age.) People who benefited from the ACA also became more supportive of it. But those who opted out became less supportive.
In theory, then, the path to rebuilding faith in government is straightforward: get people to sign up, provide excellent service, and then make sure people know they’re getting a government benefit. But in practice, this isn’t as easy. It requires overcoming many citizens’ hard-to-change expectations about the inferiority of public programs—expectations that Lerman shows shape people’s decisions, political preferences, and sheer acceptance of facts. “Even in the face of government successes,” explains Lerman, “citizens’ beliefs about the low quality of government are difficult to change.”
Still, it’s not hopeless. Lerman argues that investments in branding could go a long way. (Governments do remarkably little branding.) So could investing in crisis management, since mistakes are inevitable in any complicated enterprise. In the corporate sector, the standard crisis management advice abides by the four Rs—responsibility, regret, reform, and restitution. In other words: accept fault, say you’re sorry, promise to do better, and compensate users for their losses.
Lerman shows that these tactics would work in the public sector as well. She cites the findings of her own survey experiments, in which respondents report being “much more sanguine about errors when elites take responsibility” for mistakes, but “much less so when elite messaging is defensive.” Had the Obama administration been less defensive and more proactive during the initial healthcare.gov rollout, perhaps the launch hiccups might not have been quite so disastrous.
The author also points to the important role political leaders have in supporting public services, rather than constantly denigrating them as wasteful and inefficient. To really improve faith in the government, politicians will need to sing a more positive tune. But herein lies the big obstacle. To fully fix this problem, it will take not only Democrats but also some Republicans to stand up for the value of government programs. Given how much the GOP’s messaging is built around anti-government rhetoric, this seems unlikely to happen anytime soon.
But even if Republicans don’t change their position, Democrats don’t have to repeat myths of private-sector efficiency and public-sector inefficiency. Instead, they could advertise the savings government services deliver through economies of scale. They must also, of course, work to make sure that government programs function well. If the crisis of public reputation was largely made by anti-government forces’ aggressive storytelling, perhaps it can be unmade by better storytelling on behalf of a government that solves public problems in ways that the private sector simply can’t.
Finally, Democrats must never stop reminding people that popular public programs are, in fact, public. That means somebody needs to keep telling that crazy protestor that government is not going to take over his Medicare. Government is his Medicare.
