In recent weeks the debate over the Democrats’ ambitious health care changes has turned decidedly negative for the proponents.  In a beautiful occasion of irony, it is the fundamental principle of the free market that has undermined support for a government takeover of sixteen percent of our economy. 

While many have pointed out the unlikelihood or sheer impossibility of the administration’s promised improvements coming to fruition, it has been a core axiom promulgated in Adam Smith’s The Wealth of Nations that seems to be moving opinion. 

Smith believed that self-interest ultimately guides, and guides best, the economic decisions of individuals.  And when it comes to health care, the President and his allies deemphasized their usual moralizing to define health care as an economic issue.  This strategy seemed wise at the outset of the debate.  

In flush years Americans can often be convinced that altruistic objectives should be pursued using the public purse.  When 401k’s are healthy we, as a individuals and as a society, can indulge in luxuries that make us more comfortable.  We can devote resources to helping our planet and helping others, with little regard for the ultimate utility of such actions—only a desire for an added degree of satisfaction.  But when times are tough, we collectively tend towards much more narrow economic decisions, rooted in the immediate needs of ourselves and our families. 

That is why the Democrats’ attempts to appeal to our own economic self-interest began to trump altruism as the recession took hold.  The Democrats’ support of a universal health care program is rooted in their advocacy of social justice and equality.  They believe it is the “right” thing to do.  That is a praiseworthy and, for many Republicans and independents also, a valid cause.  But, rarely do purely altruistic goals win a political battle, and never in a deep economic downturn.  And so a change of message became necessary. 

So the exhortations began to highlight the economic doom that would befall individual Americans if they did not support government restructuring of the entire health system.  If you didn’t support the Democrats’ plan to deal with the uninsured and rising costs you were sentencing yourself to higher insurance premiums and taxes, and you may even lose your existing coverage.  The plight of the uninsured and our moral duty became buried deeper in the speeches.  

But in spite of the frenzied rush to pass the biggest government expansion ever in the span of a few weeks, Americans, helped by the countless skeptics who took the time to read the actual legislative proposals, began to question the impacts of this proposal.  And as they did so, they came to see that it brought most working families little benefit and an enormous potential downside—and the exact negative impacts, higher taxes, diminished economic growth and lower-quality care, that Democrats claim will result from failure to pass their proposal immediately.  And the poll numbers on “reform” have shifted as a result.  And now, as they lose momentum on the issue they have begun to panic and fall back on the last refuge of the rhetorical scoundrel, ad hominem attacks on insurance companies, doctors, and Republicans, vilifying them as a way to distract from the valid and troubling questions they are incapable of answering honestly. 

The administration arguments and the passionate urgings and reassurances of the President have failed miserably to convey the one message that millions of families want to hear—“what’s in it for me?”  Unfortunately for the Democrats, for most Americans that question results in vague assurances of “bending the cost curve,” a cliché that the CBO blew up in its most recent analysis.  If there were going to actually be savings realized by families wouldn’t the administration and its allies be loudly touting them?  Their problem is you cannot tell the average family that they will see a real reduction in their spending on health care because they won’t.  And even those lower-income families without existing insurance won’t see promised subsidies for several years. 

And in exchange for essentially no direct financial benefit Americans are beginning to wake up to the potential real costs that this plan will entail.  They realize that their employer may get hit with a tax to pay for uninsured workers which will hurt their chances of getting a raise.  They realize that a big government insurance plan is likely to prompt employers to end coverage and dump workers into the taxpayer-subsidized plan.  They realize that the government will take a much bigger role in telling doctors and hospitals what they can and can’t do.  And they realize that the whole thing will cost trillions and will add vast amounts to the ballooning national debt.

Close on the heels of two federal stimulus packages that have benefited liberal pet causes and failed to stanch rising unemployment, corporate and financial bailouts that have nationalized key industries, and a cap and trade bill that stands to hit families square in the pocketbook, they just aren’t buying the bill of goods the Democrats are trying to sell.  No matter how glib or charming the salesman, you don’t buy a car without crunching the numbers and as Americans drill deeper into the cost-benefit relationships of health care “reform” the numbers just don’t add up to the advantage of ordinary families. 

Douglas O’Brien is a public affairs consultant and former official with the Department of Health and Human Services