The Myth of the Conservative Voter

Note. This post comes from my blog Thinking Slowly. Although I usually only post items that deal specifically with health care at the PUSH website, one of the issues measured in this survey is support for single payer, and its results may help us to understand why it's difficult to get legislators to support universal health care.   L. S.

The obvious fact that majority public opinion is unable to prevail in Washington has set off a flurry of research on why the political system is so unresponsive. The latest contribution comes from David Broockman of the University of California, Berkeley, and Christopher Skovron of the University of Michigan. They sent surveys by mail and email to all of the 2012 candidates for state legislatures in the country. The response rate was 19.5% (1907 candidates), which is about double the typical response rate for mail and email surveys. The candidates were asked to estimate what percentage of their constituents would agree with the following statements:

1. Same sex couples should be allowed to marry.
2. Implement a universal healthcare program to guarantee coverage to all Americans, regardless of income.
3. Abolish all federal welfare programs.

They were also asked their own opinions on the first two issues. A new technique called multilevel regression and poststratification (MRP) was used to estimate the attitudes of the citizens in each legislative district. It would obviously be very costly to survey the entire voting population each of the country's 6500 state legislative districts. MRP uses national survey data to determine level of agreement with the three statements based on education, race, gender, social class, religiosity and having voted for Obama. The percentage of people in each of these demographic subgroups in each legislative district is determined from the 2010 census. This generates an accurate estimate of the opinions of the people in each district. Although indirect, this method has been validated against real survey data.

There were positive correlations (rs = .43 to .51) across districts between the candidates' estimates and actual opinions, but they are not very impressive, accounting for only about 20% of the variance. The interesting thing about the data is that the candidates' perceived their constituents to be about 10% more conservative on these issues than they actually were, a difference roughly equal to the average difference between voters in California and Alabama. Stated differently, 60% of citizens would have to favor a liberal policy in order for their legislators to perceive them as a majority.

The responses were analyzed separately for liberal and conservative candidates based on their own answers to political questions. These data are shown in the table above. The horizontal axis represents the actual opinions in each district, and the vertical axis is the politicians' estimates. The black line is perfect accuracy. Anthing below it means the politicians are overestimating their constituents' conservatism. The blue line is the estimates of the liberal politicians, and the red line, the estimates of the conservatives. Although both groups believed their constituents were more conservative than they actually were, the conservatives seemed to be living in another world. They were off by over 20%. Nearly half the conservative candidates believed their district was more conservative than the actual opinions of the most conservative district in the entire country.

These findings may help us understand differences in the personal style of politicians. The well-known tendency of liberal politicians not to stand up for their beliefs contrasts sharply with the overconfidence of conservatives. Both may be explained by their fundamental misperceptions of public opinion.

Candidates were surveyed again after the election, but there was no evidence that they had learned anything. They were no more accurate than before, and their accuracy was unrelated to any of the activities they reported during the campaign, i.e., time spent talking with voters.

The first question about these data is their generalizability. The study should be replicated using federal and local as well as state candidates, and with a wider variety of issues. However, the differences are quite large, so I assume these findings are robust. How can they be explained? Broockman and Skovron do not speculate other than to suggest that political elites are not motivated to learn the attitudes of the people they represent.

Before giving them a political spin, we must be sure these errors are unique to politicians. It's possible that a random sample of the population might make errors of a similar magnitude and direction. If so, the data represent cultural influences to which we are all exposed. For example, the corporate media present an almost unrelentingly conservative view of the American public opinion, insisting that this is a “center-right” nation and referring to right-wing politicians as “moderates.” These data may reflect back what the media inaccurately tell us. The liberal-conservative difference may mean that the media outlets preferred by conservatives are even less accurate than those preferred by liberals.

Suppose the general public does not make errors that are comparable to these candidates—that is, these biases are unique to politicians. If these politicians are themselves more conservative than the general public, there might be a false consensus effect. False consensus refers to the tendency to assume that other people's opinions are more similar to our own than they actually are, to project our own beliefs onto others. There is reason to believe that political candidates are more conservative than the people they seek to represent, since so much money is required to run for office—either their own money or funds obtained from wealthy donors.

This shades into a second possibility, which we might call the “loudest voices” hypothesis. When considering this hypothesis, remember that money talks too. In fact, the Supremes have ruled that money is speech.

Suppose there are two types of political issues, economic and social. Economic issues are those issues that have major economic consequences, even they are sometimes debated using non-economic arguments. Therefore, they include not just taxation and public spending, but issues like climate change, health care, and foreign policy, including debates over war and peace. In the present study, health care and welfare are economic issues.

When the issue is economic, the loudest voices politicians are exposed to are those of campaign donors, whose views are well to the right of the general public. In fact, politicians may spend much of their time inside a bubble filled with rich contributors and corporate lobbyists. If you spend most of your time talking to these people, you are not likely to arrive at an accurate perception of what the general public thinks.

Social issues are those that have only minor economic consequences, such as abortion, gay rights and gun control. Although they are sometimes called “sideshow issues,” they are as important to some people as economic issues. For example, if you are pregnant, whether you have access to a safe, legal abortion is a matter of life and death. Social issues are represented in this study by gay marriage.

When the issue is social, political pressure comes primarily from grassroots organizations. Sadly, the loudest voices the politicians hear almost invariably come from the right. Conservatives are better organized, perhaps because they hold their attitudes with greater strength. Of course, what we call “grassroots” is sometimes actually astroturf. These groups receive financial and logistical help from the wealthy, since rich people know that they benefit when conservative candidates are elected.

Therefore, the loudest voices hypothesis suggests that, regardless of whether the issue is economic or social, the candidates hear mainly conservative voices. This is especially true of candidates who are themselves to the right of center. You can get a pretty distorted view of public opinion that way. Ask Mitt Romney.

Legalized Bribery

Ever wonder why health care costs so much in this country, and why we get such poor outcomes in return? Here's a small piece of the puzzle.

The New York Times reports that an obscure paragraph in the recent “fiscal cliff” bill extends a delay in implementation of Medicare price controls on Sensipar, a drug used by kidney dialysis patients, for two years. The drug is manufactured by Amgen. The delay will cost Medicare—and ultimately taxpayers—$500 million. The section of the bill (Section 762) is not tranparent and does not mention Amgen by name. It's one of many examples of pork that are buried in a bill that was supposed to reduce the deficit.

Here are the details. Currently, Medicare pays for dialysis drugs individually. They determined that this created an incentive to overprescribe medication that was useless and possibly harmful. The change, now postponed, was that Medicare would pay a single, bundled rate for dialysis treatment.  That was a threat to Amgen's profits.

According to the Times, this decision was made by Senator Max Baucus (D-MT), chair of the Senate Finance Committee, and Senator Orrin Hatch (R-UT), the ranking Republican on the committee. It was subsequently approved by Senate Minority Leader Mitch McConnell (R-KY) and Vice President Joe Biden, who negotiated the “fiscal cliff” agreement. Amgen has made over $5 million in political contributions since 2007, including $67,750 to Senator Baucus, $59,000 to Senator Hatch, $73,000 to Senator McConnell, and $141,000 to President Obama's two presidential campaigns.

Sen. Mitch McConnell
(or possibly a turtle)

The Times quotes aides to Senators Baucus and Hatch and an Amgen spokesperson as saying that the delay was justified because it would “give Medicare and health care providers the time they need to accommodate complicated changes in federal reimbursement for kidney care.” The price restraints were originally scheduled to begin in 2012. Congress granted Amgen a two year delay until 2014. The “fiscal cliff” bill extends that delay until 2016. How much time do they need?

An aide to Senator Baucus added that, “What is the best policy for Montanans and people across the country is at the heart of every decision Chairman Baucus makes.” But none of the people contacted attempted to justify the decision on medical grounds.

Amgen is the world's largest biotech corporation, with $15.6 billion in revenue in 2011. It has 74 lobbyists in Washington, including former chiefs of staff of both Senators Baucus and McConnell. Senator Hatch's leading staff member on health care policy is a former Amgen employee.

On December 19, Amgen pleaded guilty to illegally marketing Aranesp, an anti-anemia drug, for purposes the FDA had explicitly not approved. The $762 million settlement was a new record for a biotech company.

I think incidents like this pose a serious threat for single-payer advocates. One of the major arguments against single payer, which resonates strongly with the general public, is that the federal government can't be trusted to run a health care system that will provide quality medical care at a reasonable price. We usually try to counter that argument by pointing out that all other countries with single-payer systems achieve better health outcomes than we do at lower cost.

However, the United States is not like other industrialized countries. It's possible that our level of political corruption is so much higher than other countries as to make us not comparable to them. If so, it's impossible to predict how single payer would fare in this country. Of course, despite our corruption, Medicare is still cheaper than private insurance. However, if Congress ever passes a single payer bill, it is important that it contain safeguards that insulate the system from corporate and political interference.

Update (1/31/13)

The liberal organization Progressives United has latched onto this story and is asking people to sign a petition to the CEO of Amgen asking him to give back the $500 million. (Good luck on that!) The petition can be found here.