The Empathy Problem

Mass solidarity is absolutely vital to the success of any social movement.

It is precisely the lack of such solidarity, however, that’s prohibiting mobilization in favor of socialized medicine.  Rather than demand meaningful reform, Americans have left the question of whether there will be a public option or Medicare for all system to politicians – the vast majority of which are reluctant to fight for universal health care.

Congressional Democrats are set to pass a health care bill within the next month through the “reconciliation process” – which seeks to merge competing versions of health care reform previously passed in the House and Senate, and also allows Democrats to circumvent any possible filibuster attempt by Republicans.  President Obama postponed a trip to Indonesia and Australia in order to lead a last PR effort to win over those in the general public who are still undecided on health care.  Obama recently explained that “The United States Congress owes the American people a final, up or down vote on health care… It’s time to make a decision. The time for talk is over. We need to see where people stand.”

Whatever compromise is achieved by Democrats in the final House and Senate bill, it may not contain a public option, and undoubtedly will not include a provision establishing a single payer, Medicare-for-all system.  It’s worth reflecting upon why Democrats consider universal health care to be beyond reach.  It should be noted that opposition doesn’tspring primarily from the American public.  Most Americans have long supported the idea of a public option.  Additionally, universal health care programs such as Medicare are widely popular among a majority of the public.  Primary opposition comes not from the grassroots level – as the tea party would have us believe – but from political officials and corporate America.  America’s political-business class views progressive taxation in the name of universal health care as an unfair burden on the wealthy.  It is this group that has led a successful media coup to convince a growing number of the middle class to oppose reform.

It is increasingly the case that elitist values are supplanting those of the middle class, as recent public opinion surveys demonstrate.  I dub this the empathy problem – average Americans are sympathetic to health care reform in principle, yet they oppose health care reform more generally, and are unwilling to participate in a mass social movement to force officials to implement universal health care.  Increasingly, the well off – those with decent to well paying jobs and with medical coverage – are taken in by fear mongering about health care “rationing,” “death panels” and government socialism (see “War of the Words: How Town Hall Crashers, Media, and Pollsters are Transforming Public Opinion”).  These individuals do not represent the heart and soul of corporate America.  Nonetheless, they are being used by the wealthy to stifle any changes that would cost the leaders of corporate America a significant portion of their wealth.

As recent public opinion polls demonstrate, those who pay closer attention to the media’s reporting on the health care debate in Congress are not only more likely to be confused about the specific reforms being proposed, they’re also more likely to oppose the health care reform (see the Pew Research Center health care surveys from July 2009, September 2009, and March 2010).  In short, reactionary officials and media are actively manipulating Americans into opposing even limited health care reform.  This is all the more disturbing considering that polls show that, while Americans increasingly oppose health care reform, they support the specific provisions promoted by Democrats, including establishing a public option, providing government subsidies for those who can’t afford health care, prohibiting insurance companies from dropping customers for pre-existing conditions, requiring employers to provide health care to all employees, expanding Medicare to cover those 55 and over, expanding state child health insurance programs, and expanding of Medicaid (see Kaiser Foundation Aug. 2009 polling, McClatchy & CNN’s polling from November 2009, and Newsweek’s Feb. 2010 polling).

The indoctrination of middle America on health care reform is evident in public opinion surveys.  Some quick statistical work, employing surveys produced by the Pew Research Center over the last year, put this problem into better perspective.  These surveys demonstrate that there are systematic differences between middle America and those who are struggling to get by:

-Those who have no problems paying for their medical bills or for prescription drugs are more than twice as likely to deny that the medical system needs to be “completely rebuilt.”  In terms of the hard numbers, 59 percent of those with trouble paying for drugs want to see health care completely rebuilt, while just 31 percent of those with no prescription problems feel the same way.  Similarly, 63 percent of those with problems paying for medical care more generally support completely restructuring health care, but just 29 percent of those without problems support such restructuring (see the June 2009, Pew Research Center health care survey).

-Those that already have health care coverage are consistently more likely to oppose Congressional Democrats’ and Obama’s efforts to promote health care reform.  The insured are more likely to oppose a government plan or public option, and less likely to trust the government in general in dealing with reform.  Opposition to reform reaches a majority for the privileged, with 57 percent of those with health care coverage opposing reform, and 60 percent of the uninsured supporting reform (see the July 2009, Pew Research Center survey).

-Following the 2008 economic crisis, wealthier middle class Americans are consistently more likely to oppose increased government spending on social services.  While 55 percent of those making less than $30,000 a year support increasing social services, support declines to just 34 percent among those making more than $50,000 a year.  Wealthier Americans, in addition to the highly educated, are more likely to put their faith in “free markets” over the government when it comes to interventions in their personal lives (see the March 2009, Pew Research Center survey).

The empathy problem extends beyond the figures above.  Privileged Americans tend to think the economy is in better shape than those who are struggling to get by.  This problem is not new, as President Harry Truman famously said about the public’s perceptions of troubled times: “It’s a recession when your neighbor loses his job; it’s a depression when you lose yours.”  Public denial about the dire economic state of contemporary America is strongest among the privileged:

-As of early 2009, Americans who reported strong personal finances and no credit problems were consistently more likely to be optimistic about the future of the economy.  Wealthier middle class earners were more likely to be angry at homeowners for taking out sub-prime mortgages they couldn’t afford, and more likely to be angry about the budget deficit, but were no more likely to harbor anger about the bank bailout.  These trends are precisely what one would expect in a country where well off middle America is indoctrinated by upper class propaganda.  Paradoxically, wealthier middle class earners are enraged about the budget deficit (a common feeling among political and business elites), but not about the bank bailout that contributed greatly to the deficit.  Increasingly, wealthier middle class earners are turning their anger toward social welfare programs – such as health care reform (see the statistics on public opinion and health care above).  This is a common strategy among business and political elites – direct public outrage toward budget deficits that result from social welfare spending, cry and moan about the unsustainability of “entitlement programs,” and direct attention away from growing deficits that are fueled by corporate welfare.

-As of mid 2009 (more than 8 months after the economic collapse), a substantial minority of Americans (39 percent) still thought the U.S. economy was in fair shape.  Those who had no problems paying for medical bills and those who reported stronger personal finances were consistently more likely to say the economy was in decent shape.  The gap here remains tremendous – with those enjoying “good” or “excellent” personal finances nearly twice as likely to think  the economy was in “fair” shape when compared to those with “poor” finances (June 2009, Pew Research Center).

Unfortunately, public opinion polls in the United States do not effectively distinguish between well off middle class earners and the decadently rich.  Survey questions about individuals’ family income contain seven different categories measuring those who make between $0 and $100,000 a year, and no categories distinguishing those who make more than $150,000 a year.  As a result, we are left to assume that a well off married couple – for example two well established public school teachers making a combined $150,000 a year – are to be counted the same as the average CEO making $10.9 million in 2008.  Assuming that the two cases are the same is absurd, although this isn’t widely acknowledged by pollsters.  Current measurement methods in public opinion surveys do, however, allow us to measure how well business elites’ values are reflected in the general population, and among those who are relatively more or less privileged.  My analysis has shown that the values of business elites are very much transferred to the wealthier part of the middle class.  This is a tremendous problem for those seeking progressive reform, since those who make less than $150,000 a year share far more in common with the poor and disadvantaged than they do with the richest 1 percent, made up overwhelmingly of corporate executives and investors.  Even well off families are in danger of losing their jobs in a bad market.  They’re susceptible to the same economic hardships that plague the poor, considering that unemployment brings with it a loss of health insurance coverage and an inability to pay one’s mortgage and bills.

It’s no longer enough to say that the majority of the public supports health care reform.  It’s one thing for an American to admit in a telephone survey that they think health care for all is a good idea in principle; it’s quite another for them to go out in the streets and to the voting booth and actually fight for that reform.  As progressives, we need to recognize that a mass movement for health care reform should begin with the poor and disadvantaged, but also must win over a majority of those who are relatively well off – those in middle America who are well paid but  have much to potentially gain from universal health care.  Developing and maintaining mass support for real reform is absolutely vital come election time.  Grassroots pressures for socialized medicine need to be backed up by electoral retaliations against any officials who oppose reform.  Until we get past the empathy problem that afflicts the American public, there will be little hope for radical change.

ANTHONY DiMAGGIO teaches American and Global Politics at Illinois State University.  He is the author of Mass Media, Mass Propaganda (2008) and the forthcoming When Media Goes to War (2010).  He can be reached at



Anthony DiMaggio is Associate Professor of Political Science at Lehigh University. He is the author of Rising Fascism in America: It Can Happen Here (Routledge, 2022), in addition to Rebellion in America (Routledge, 2020), and Unequal America (Routledge, 2021). He can be reached at: A digital copy of Rebellion in America can be read for free here.