[I]n truth, differences between parties are often small. Democrats want to spend more and don't want to raise taxes, except on higher earners. Republicans want to reduce taxes but don't want to spend less. Vast budget deficits reflect both parties' unwillingness to make unpopular choices of whose benefits to cut or whose taxes to boost.
Given this evasion, the public agenda gravitates toward issues framed as moral matters. Global warming is about "saving the planet." Abortion and gay marriage evoke deep values, each side believing it commands the high ground. Certainly, President Obama pitched his health care plan as a moral issue. It embodies "the core principle that everybody should have some basic security when it comes to their health care," as he said when signing the legislation. Health care is a "right"; opponents are, by extension, less moral.
Obama's approach was politically necessary. On a simple calculus of benefits, his proposal would have failed. Perhaps 32 million Americans will receive insurance coverage -- about 10 percent of the population. Other provisions add somewhat to total beneficiaries. Still, for most Americans, the bill won't do much. It may impose costs: higher taxes, longer waits for appointments.
People backed it because they thought it "the right thing"; it made them feel good about themselves. What they got from the political process are what I call "psychic benefits." Economic benefits aim to make people richer. Psychic benefits strive to make them feel morally upright and superior. But this emphasis often obscures practical realities and qualifications. For example: The uninsured already receive substantial medical care, and it's unclear how much insurance will improve their health.