Healthcare Is a Family Issue

When I was in graduate school, one of my professors told me that when you did good sociology and told your next-door neighbor about it, their reply was “you spent all that time proving that? I already knew that.” He wasn’t being facetious; he was teaching us that when you analyze society well, it makes intuitive sense—even to people who don’t have a clue why the evidence from your final model is more persuasive than if you hadn’t controlled for fixed effects.

This is certainly the case with the lead article in the October 2013 issue of the American Sociological Review. Its publication was concurrent with our government shutting down because the House would not pass a continuing resolution without Obamacare-related riders. The authors, Clem Brooks and Jeff Manza, found evidence of recent increases in political partisanship, particularly with respect to government social programs. That is, attitudes regarding social programs like the Affordable Care Act are formed more by existing attachments to either the Republican or the Democratic party than anything else.

What happened during the Great Recession was not at all expected: Americans actually became less supportive of government activism.

Ok, we knew that (and so did our next door neighbor); why did they bother with an elaborate study proving it? Well, it turns out their work showed the importance of partisanship over and above other reasonable theories about how attitudes are formed. First and foremost, history has taught us that attitudes about the role and size of government tend to follow business cycles. That is, in a faltering economy when personal incomes are becoming less secure, people want government to do more, but when times are prosperous, people tend to want the government to back off. That’s why the Great Depression was followed by the New Deal, but also why the New Deal advocating benefits for everyone according to need lost out to the G.I. Bill that gave benefits based on service. But what happened during the Great Recession starting in late 2007 was not at all expected: Americans actually became less supportive of government activism.

So Brooks and Manza take up the question of why attitudes ran counter to business cycles during the Great Recession. They tested a number of possible explanations, including racist responses to a black president (rejecting government intervention because of rejecting Obama), evaluations of economic performance, and backlash against government overreach. But partisan affiliation mattered more than any of these, and even factors like economic performance mattered differently to Democrats and Republicans. Recent polls show that more people disapprove of Obamacare than disapprove of the Affordable Care Act; sometimes the name matters more than the substance.

Why is this a family issue? The current shutdown is affecting hundreds of thousands of American families like mine whose budgets depend on salaries from the federal government, plus millions of others who are indirectly dependent on normal government functioning. But when the government officially shut down last week, I thought more about Bear and Amber than about my family’s budget.

Healthcare isn’t just about physical, dental, and mental health: it is also about family health.

Who are Bear and Amber? Those are the pseudonyms that Kathryn Edin and Timothy Nelson assigned to a couple in their recent book, Doing the Best I Can. Bear and Amber lived in an inner city neighborhood of North Philadelphia. Their relationship was hardly storybook, but they were trying to raise five children together—two of their own, plus three of Amber’s from her deceased husband. When their first child was young, Amber kicked Bear out of the house after discovering that he’d been selling drugs there while she was waitressing, but their second pregnancy brought a turn-around: Bear got a legitimate job, picked up multiple odd jobs, stopped using drugs, avoided old friends including addicts, and became engaged to Amber. They still lived in a lousy neighborhood and were scraping by with lousy jobs, but they were doing it together.

Then she kicked him out again. The precipitating factor? He hurt his back on a roofing job, she had an abscessed tooth, and, lacking health insurance, they agreed that he would buy Percocet on the street for them both. He came back with neither money nor drugs after having been beaten by police, but she was convinced he’d gotten high on his own.

Because of Bear and Amber’s story, I keep thinking about how health insurance is a family issue. Even though much was stacked against them, it was the lack of health insurance that led to the events that caused their breakup. I keep thinking about how private markets haven’t reached the Bears and Ambers, and how their split hurt their children. There’s nothing in the Affordable Care Act that will build trust between a former drug user and his fiancée who needs to protect herself and her children. There’s also nothing in the Act that will stop police from beating and robbing lawbreakers rather than arresting them. But we shouldn’t forget that healthcare isn’t just about physical, dental, and mental health: it is also about family health.