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The Washington Post

Health Care, Race and Political Polarization

Marc J. Hetherington & Jonathan D. Weiler

Former president Jimmy Carter caused a stir when he suggested that opposition to health care reform reflected negative racial attitudes. While there is surely anecdotal evidence to suggest Carter is onto something -- a widely circulated image of President Obama clad in a loincloth and sporting a bone through his nose comes to mind - commentators, conservatives, and the White House dispute the former president.

Our research favors Carter's interpretation and adds some hard data to the debate. In fact, the partisan divide today is even more troubling than if it was driven by race alone.

Americans' views of political issues and their partisan attachments are being increasingly shaped by gut-level worldviews. On one side of many issues are those who see the world in terms of hierarchy, think about problems in black and white terms, and struggle to tolerate difference. On the other are those who favor independence over hierarchy, shades of gray over black-white distinctions, and diversity over sameness.

We call this dividing line an authoritarian one, and we find that what side of the line people fall on explains their positions on a wide ranging set of issues, including race, immigration, gay rights, civil liberties, and terrorism. This is because what lies behind these preferences is a larger difference in worldview, where people understand reality in starkly different ways. This, in turn, leads to rancorous and irreconcilable-seeming political conflicts.

As evidence of the link between health care and racial attitudes, we analyzed survey data gathered in late 2008. The survey asked people whether they favored a government run health insurance plan, a system like we have now, or something in between. It also asked four questions about how people feel about blacks.

Taken together the four items form a measure of what scholars call racial resentment. We find an extraordinarily strong correlation between racial resentment of blacks and opposition to health care reform.


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Among whites with above average racial resentment, only 19 percent favored fundamental health care reforms and 57 percent favored the present system. Among those who have below average racial resentment, more than twice as many (45 percent) favored government run health care and less than half as many (25 percent) favored the status quo.

No such relationship between racial attitudes and opinions on health care existed in the mid-1990s during the Clinton effort.

It would be silly to assert that all, or even most, opposition to President Obama, including his plans for health care reform, is motivated by the color of his skin. But our research suggests that a key to understanding people's feelings about partisan politics runs far deeper than the mere pros and cons of actual policy proposals. It is also about a collision of worldviews.

Viewed through that lens, it is not at all surprising that Rep. Joe Wilson blurted out "You lie!" following a reference to illegal immigrants, another object of grave concern to the more authoritarian.

Beneath the arguments about government intrusion into the health care market, death panels, and such, a much more emotionally-laden dynamic is at work. Views about race along with a suite of other visceral matters are linked to people's opinions about health care reform, which likely explains why the present debate has caused a much stronger uproar than it did in 1994.

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Hetherington is a professor of political science at Vanderbilt University and Weiler is director of undergraduate studies and adjunct assistant professor of international and area studies at the University of North Carolina at Chapel Hill. Their book "Authoritarianism & Polarization in American Politics," was published last month by Cambridge University Press.

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