The images of 83-year-old Rep. John Dingell, in his sixth decade in Congress, jeered and shouted down at a town meeting on health care last week brought to mind a long-forgotten episode that, when I went to work on Capitol Hill in the summer of 1990, seemed to loom over everything. It was often referred to by a single word: "Catastrophic."
Two years earlier, in 1988, Congress had passed, by overwhelming bipartisan majorities, what was then the largest expansion of Medicare to cover catastrophic illness, long hospital stays, and some pharmaceutical costs. In 1989, by equally large majorities, Congress repealed the law. The bill had put most of the cost on a small group of wealthy seniors, and after passage, a a direct-mail organization stoked backlash over the funding structure, convincing many seniors they would pay the same $800 surtax as the wealthiest. It is remembered today mostly for the televised scene of Rep. Dan Rostenkowski, then chair of the House Ways and Means Committee and, like Dingell, a baron whose authority had gone unquestioned, besieged by angry seniors blocking his car as he tried to exit a similar town meeting.
Everyone I worked with at the time seemed still stunned by the painstaking work that went into crafting the bill and the suddenness and irrationality of its repeal. It was not just a setback on a long-overdue domestic priority; it seemed to knock out the foundations of everything they knew about the relationship between citizens and public policy. Until then, the assumption had been that if a policy would have generally good effects, there would be public consent, and in much policy-making, there was no public engagement at all. Major policy reforms, like the expansion of Medicaid or the law known as ERISA (the Employee Retirement Income Security Act) that has huge consequences for your health insurance and your pension, were barely noticed even in the elite press. Policy-making was an insiders' game.
Catastrophic, and the public engagement that blew it up, changed all that. The Democrats who were squeamish about health reform in the early Clinton years clearly had the still-recent Catastrophic experience in mind, and all through the 1990s, politicians seemed to struggle with a new democratic ferment. The public, it seemed, intended to be constructively engaged with policy decisions. The process had to open up. If it didn't open up to real citizen engagement, policy would be brought down, as in Catastrophic, by misinformation and backlash. But somehow we have not yet found a way for the public to be heard.
There was a period during the debate over the North American Free Trade Agreement when, spurred by Ross Perot, many thousands of Americans decided that they should "read NAFTA" in order to understand for themselves what the trade agreement would do, and congressional offices found themselves doing nothing but Xeroxing and mailing out the massive agreement, even though reading the text of NAFTA could hardly answer questions about whether it would benefit the U.S. economy. Similarly, Elizabeth McCaughey, an academic and later lieutenant governor of New York, claimed special authority on health care in her 1993 article in The New Republic on the basis that she alone had read the entire bill. Now she's back with a similar pitch, stoking the "euthanasia" claims that were picked up by Rep. Michelle Bachmann and became a "death panel" in the hands of former Gov. Sarah Palin.
Later in the decade came the "patch through" calls -- citizens' phones would ring, they would be told about some horrible thing Congress was about to do and then were asked if they wanted to be patched through to their representative, after which they would berate some poor receptionist or intern with their fierce opposition to something they had first heard about 30 seconds earlier.
This month's disrupted town hall meetings, fake grass-roots campaigns, and organized misinformation efforts on health care and other policies return us to that period. (During the Bush years, for whatever reason, the public was more quiescent except on the Iraq War – partly because the Republicans didn't seem to care much about the opinions of those who disagreed with them.) At times of big, transformational change, citizens must have a way into the policy-making process, but it can't be one that's dominated by the loudest, most disruptive, or best-funded voices. Technology means that people can acquire the text of legislation for themselves, can research members' voting records, can organize themselves to be heard in a hundred new ways. But it doesn't make it any easier for a member of Congress to figure out what they think, whether their views are based on misinformation or deeply held beliefs, or how intense their views are.
"Lobbying" is part of the problem, but lobbying reform of the type that President Barack Obama has embraced focuses exclusively -- for sound constitutional reasons -- on "direct lobbying" of elected officials by professional lobbyists. "Grass-roots lobbying," on the other hand, is unregulated. The revelation that the leading grass-roots lobbying firm, Bonner & Associates, had forged letters in opposition to cap-and-trade legislation sent to several representatives on the letterhead of civil-rights groups brought new attention to this exception. But, such fraud aside, the act of encouraging members of the public to speak out is deeply protected by the spirit and letter of the First Amendment.
But look at it from the point of view of a legislator who actually wants to do the right thing -- support sound policies but also be responsive to her constituents. Direct lobbying is easy to deal with -- let the lobbyists be heard, in normal meetings, not at meals or sporting events, and see if the information they have is useful or persuasive. [Grass-roots lobbying -- the crowds, the letters, phone calls, and e-mails -- is much harder for a legislator to make sense of. What's real? What matters? Will any of these people ever consider voting for me anyway? It is, in a sense, a corruption of that process of democratic engagement itself.
A progressive activist at a meeting I attended recently complained that she had brought 300 constituents to Washington to visit a liberal Democratic senator who had not yet committed to support the public option in health reform, and at the end of the meeting, the senator still wouldn't commit. "Why isn't she accountable to her constituents?" the activist asked, surmising that corporate lobbyists had her under their thumb. Which may be. But it's also possible that in the fog of meetings, visits, letters, phone calls, and petitions, it's just very difficult for an elected official to know how responsive she should be to any particular set of 300 constituents. The direct lobbyists may have more influence because their interests are clear and their demands sharply focused on actual changes to the legislation.
The solution is certainly not restrictions on grass-roots activity, because the price of cracking down on Bonner (other than for forgery) will be to suppress much real public engagement. For those legislators who really want to understand public opinion on health care and other issues, who want their constituents to be engaged and informed, the solution may lie in creating some new structures for democratic engagement, not the friends-only town hall meetings of the Bush years, but structured meetings in which participants are asked to engage with each other as well as the podium, and to deliberate about questions that are framed in advance.
There has been considerable progress in creating such structures in the last decade or so. America Speaks, for example, created a model for large-scale, heavily facilitated face-to-face engagement, best known for its use in a huge town meeting discussion about Lower Manhattan development after September 11 but which has also been used in Washington, D.C., and New Orleans. A series of such town halls at the start of the health-care debate might have given elected officials a better sense of where public opinion actually stood before the shouting began.
James Fishkin's deliberative polling project tries to reveal public opinion after people have had a chance to fully absorb the issues and discuss it with others of different views and backgrounds. Everyday Democracyis an organization that promotes "study circles," usually long-term efforts to solve local problems.
Citizens need to be engaged in these debates, but it's not going to work by just ramping up the volume on our side: The Tea Party crowd is bringing a hundred people to the town meeting; we'll bring 300. They deliver 5,000 phone calls in to Congressman Jones; we'll deliver 10,000. Ever since Catastrophic, we've needed to create some entirely new structures so that people not only feel heard, they really are heard. Now that need is urgent.