Michael Gerson

There is, however, a deeper explanation for public skepticism about health reform. Since the New Deal, Democrats have viewed times of economic crisis as opportunities for government expansion. In the current case, government itself was implicated in the crisis. According to a poll by the Pew Research Center, public satisfaction with government plunged just as the financial collapse took place. Twenty-two percent of Americans report that they trust government all or most of the time -- among the lowest levels in 50 years. One and a half years after a financial meltdown that some supposed would be a crisis for capitalism itself, 58 percent of Americans agree that "the government has gone too far in regulating business and interfering with the free enterprise system." Favorable opinion of the Democratic Party -- now firmly associated with the stimulus package, assorted bailouts and health reform -- has fallen 21 points in one year.

In this ideological environment, the administration's emphasis on publicizing the desirable details of the health law is beside the point. Americans are troubled with health reform, not because they lack knowledge of its provisions, but because they are uncomfortable with social democracy.

When entitlements began in America, they were mainly focused on the elderly (through Social Security and Medicare) and the poor and disabled (through Aid to Families with Dependent Children and Medicaid). Benefits for the middle class were largely given through tax deductions for mortgage interest and the purchase of health coverage by businesses. America eventually retreated from some entitlement commitments to the poor because they involved a moral hazard -- discouraging work and responsibility. Entitlements for the elderly have remained a strong, national consensus.

But the idea of a middle-class entitlement to health care, achieved through an individual mandate, subsidies and aggressive insurance regulation, seems to change the nature of American society. Entitlements in the Obama era are no longer a decent provision for the vulnerable; they are intended for citizens at every stage of life.

Americans resist taking this lollipop precisely because America is not Europe -- which even Europe, it seems, can no longer afford to be.

Michael Gerson

Michael Gerson writes a twice-weekly column for The Post on issues that include politics, global health, development, religion and foreign policy. Michael Gerson is the author of the book "Heroic Conservatism" and a contributor to Newsweek magazine.
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