Nativism and opposition to health care reform

In 2009, former President Jimmy Carter came under a lot of criticism for claiming that at least some of the opposition to President Obama and his policies (specifically health care reform) was racially motivated (see story here). Of course, most people who oppose Obama are not racists, nor were most of the people who did not support his health care reform plan. Research has shown, however, that at least some of the opposition to the president and his policy proposals is linked to racial prejudice (see here, here, here, and here, e.g.).

It recently occurred to me that opposition to health care reform might also be linked to nativism, at least for some people. Why might this be the case? Nativism is the attitude that a distinctly American way of life needs to be protected against foreign influence. Might some people have perceived health care reform to be “foreign” or “un-American”?

A 2010 NPR story describes a gathering of Tea Party activists in southern Nevada. Referring to the new health care reform law, one activist stated: “I think it’s totally un-American, really.” Headline speaker Sarah Palin said: “Something’s not quite right when Fidel Castro comes out and says he likes Obamacare, but we don’t like Obamacare?” Another activist in attendance said: “If I was socialist I’d probably be for him [Obama], but I’m not a socialist.”

This is, of course, anecdotal evidence, but it suggests that some may have perceived health care reform to be distinctly un-American and associated with non-American cultures or systems such as Cuban communism or European social democracy.

A 2010 Hawkeye Poll, designed and fielded in part by yours truly, contained survey questions both on nativism and support for the health care law. Among Americans who opposed the health care reform law, 78% said that they believed that “our American way of life needs to be protected against foreign influence.” In other words, 78% of those opposed to health care also expressed nativist sentiments.

This can be further examined with a multivariate regression analysis. This isolates the effect of one variable (nativism) on another variable (support for the health care law), while controlling for the effect of all other variables in the analysis (such as demographics, religiosity, racial prejudice, and political ideology and partisanship). This analysis reveals that higher levels of nativism are associated with greater opposition to health care reform, even controlling for a host of other factors (for statistics geeks: p=0.006).

Not surprisingly, partisanship is the strongest factor in predicting opposition to health care reform (strong Republicans are 63% more likely to oppose the law than strong Democrats). Ideology comes next (strong conservatives are 51% more likely to oppose than strong liberal). Nativism is the third strongest predictor of opposition to the health care law, with strong nativists 34% more likely to oppose the law than non-nativists. In other words, even Democrats and liberals who are strong nativists are more likely to oppose the health care reform law. Anti-black racial prejudice also makes a difference, with those who are higher on racism 26% more likely to oppose the health care law. Apparently, nativism has a stronger effect on support for the health care law than racial prejudice.

The most interesting finding is that none of the other demographic variables made a difference once these other factors were controlled for. In this sample, at least, opposition to health care can be explained by a combination of partisanship, ideology, nativism, and racism.

The third and final piece of evidence is the results of a nativism “list experiment” that was also included in the 2010 Hawkeye Poll. A list experiment is useful because some people might be shy or embarrassed to admit that they think that “our American way of life needs to be protected against foreign influence.” So this experiment is able to measure “hidden” agreement with a particular statement or attitude. It does this by splitting up the survey respondents into two groups. Each group gets this question: “I’m going to read a list of things statements about things that some people think. Please tell me how many of the following items you agree with. Not which ones, just how many.” The first group gets four statements that are completely unrelated to the attitude you want to measure (in this case, nativism). The second group gets the exact same list and adds a fifth statement about protecting our American way of life against foreign influence. Theoretically, the difference in the average number of answers given by the respondents between the two groups is the amount of the population who has that attitude. In this survey experiment, “hidden” nativism is referred to as “latent nativism” (as opposed to “express” nativism).

The results of the survey experiment show that 62% of those who opposed health care reform were also latent nativists (p<0.00001 = very strong relationship). On the other hand, only 9% of those who supported health care reform were latent nativists, and this 9% difference was not “statistically significant”, meaning the results could have just as likely occurred at random.

Collectively, all this provides strong evidence that nativism accounts for at least some of the opposition to health care reform. Again, this is not to say that all people who oppose health care reform are nativists. However, this does suggest that it would be inaccurate to say that opposition to health care reform is purely a philosophical position based on the size and scope of government.

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