I’ve seen conservatives circulating this YouTube clip, in which Andrea Mitchell, discussing polling numbers showing low support for Obama’s health care reforms, notes in an aside that opponents “may not know what’s good for them.” This incredibly tone-deaf choice of words, naturally, prompts cries of “elitism” and “arrogance.” Insofar as “elitism” has recently been used primarily as a bludgeon against anyone who thinks knowledge or education are good, I’m certainly much happier to see it deployed as a surrogate for “paternalism.” But I’m also not quite sure it fits the bill. After all, if you disapprove of Obamacare, what’s your opinion of all the people who favor it? Presumably that they’re mistaken about what would be good for them. Maybe it’s only elitist when the people you disagree with are (barely) in the majority or plurality?
Now, someone might object that if health care reform will have winners and losers, you could believe that the people who think it will be better for them and the ones who think it will be worse are both likely to be correct. And maybe many of them are. But I suspect that for a lot of people, their view of whether reform will be good or bad for them is pretty tightly bound up with what they think the system will look like on the whole. If you’re totally without coverage now, you can guess that almost any reform has a good chance of being an improvement, and if you’re extremely happy with your current coverage and cost, you might reasonably expect that tinkering is more likely to muck things up than to result in still further improvement. If you’re somewhere in the middle, though, your opinion probably turns on which of a range of general scenarios you find most plausible. That is, it’s not so much anything specific to do with you, but rather how you answer broad questions about the systemic effects of the policy: Will costs be controlled? Will rationing be severe? Will patients have more or less control over the course of their care? Will innovation be encouraged?
To the extent people’s predictions turn on those sorts of questions, “knowing what’s good for you” just amounts to “knowing whether the policy is good.” And while we should expect people to routinely be in the best position to know what’s good for them—to know what their own values and priorities are, what their specific options and constraints are, and how to trade off between them—there’s not much reason to expect that expertise to translate to national-level policies, even when those policies will naturally have some effect on the welfare of each individual. Insofar as there’s sharp disagreement, it’s practically a tautology that large numbers of people will turn out to be wrong about “what’s good for them” in this sense.
I mention all this, by the way, not because I have any interest in defending Obama’s health proposals, but because I’m loath to see anti-paternalist rhetoric conscripted in service of crude majoritarianism.