Harvard Faculty and Public Policy Experts Talk Health Care and Polarization at HSPH Event

Harvard faculty and public policy experts discussed health care policy in an era of extreme partisan polarization at an event hosted by the Harvard School of Public Health, Politico, and The Commonwealth Fund on Wednesday.

Joanne Kenen ’79, health care editor-at-large for Politico, moderated the discussion, which featured Robert J. Blendon, a professor at the School of Public Health; Guy-Uriel E. Charles, a law professor at Duke University; Sabrina Corlette ’94, a research professor at Georgetown University; and David C. King, a senior lecturer at the Harvard Kennedy School.

The event opened with a discussion of President Joe Biden’s campaign promise to unite the country after a tumultuous election season conducted in the midst of a pandemic and a national movement for racial justice. The panelists debated whether this promise has materialized in Congress, where representatives often vote based on party lines rather than their constituents’ opinions.

“When I grew up, you believed that public opinion is what the Congress voted on — and in the last 15 years, this has declined dramatically,” Blendon said.

As an example, he cited former President Barack Obama’s Affordable Care Act, which passed in 2010 with the support of the majority of Congressional Democrats, despite its unpopularity in national public opinion polls at the time.

Blendon and Corlette discussed a variety of health care reforms in the ACA, and emphasized that the legislation has endured a plethora of partisan battles in the decade since it was enacted.

King said partisanship will likely limit what legislation Biden is able to pass.

“It’ll be limited to what he can get through with Democrats only, plus executive orders, plus signing statements. You know, we keep hearing about gridlock, but I think we should begin talking about living off the grid,” King said.

The panelists turned to a discussion of broader political divisions among elected officials on issues like infrastructure and the role of government.

Blendon posited that the structure of primary elections helps fuel polarization amongst representatives. He argued that the demographics of primary voters skew towards the extremes of their party.

“Twenty percent of adults show up in a primary on either side,” he said. “All the polling shows [primary voters] do not represent America, they do not represent the party.”

Blendon commissioned public opinion polls following the 2020 election that laid bare several of the country’s partisan divisions.

For example, 64 percent of Democrats responded that the federal government should be mainly responsible for Covid-19, while 68 percent of Republicans felt that the issue is largely the responsibility of state and local governments.

King said political divisions also manifest within the parties, which are often gripped by conflicts between more extreme and more moderate factions — though they rarely materialize in votes.

“Those are certainly there, but you’re not going to see them in how the votes are cast,” he said. “Because neither party can lose enough of their members, so you have the most moderate members that are going to be controlling the outcome within each party.”

King — who serves as Faculty Chair of Harvard’s bipartisan program for newly-elected members of Congress — said recently-elected representatives “certainly” have more belief in bipartisanship than seasoned members.

“They want to get to know each other as people, they want to know about each other’s families. And before they go to D.C., their openness and ability are really right there,” he said. “There’s just too brief of a window when they can see each other as new members without a strong party label on their foreheads.”

After the event, King said in an interview that the current uptick in polarization is not without precedent, citing the lead-up to the Civil War and the 1920s as past periods of division.

“We’re probably in the third great wave of polarization in American history,” he said.