The Divide Between Elite and Public Opinion on Healthcare Highlights America's Democratic Deficit

In 2014, the political scientists Martin Gilens and Benjamin Page released a study revealing that, "In the United States...the majority does not rule -- at least not in the causal sense of actually determining policy outcomes. When a majority of citizens disagrees with economic elites or with organized interests, they generally lose."

Often called the "democratic deficit," this disconnect between public policy and public opinion is one that, for many, supports the conclusion that the United States is a democracy in name only.

In their rhetorical flourishes and stump speeches, American political figures, from the president to members of Congress to this year's presidential candidates, pay fealty to the desires of the public, some more genuinely than others. But even the most cursory examination is enough to show that actual policy decisions often differ wildly from those promised on the campaign trail.

While it is far from a new development, America's democratic deficit has been laid bare in several striking ways throughout this tumultuous election cycle, in which the American people are expressing their discontent with politics as usual at an increasingly high, urgent pitch. This has terrified elites on both sides of the aisle who feel that the disruption will permanently damage the legitimacy of their platforms.

The problem, of course, is that they have done the most significant damage on their own. By ignoring the needs of their constituencies and disproportionately favoring the desires of organized wealth, both Democrats and Republicans have invited the disruption that is now shaking the foundations upon which they have constructed their establishments.

Some, in response to the insurgent candidacies of Donald Trump and Bernie Sanders, have argued that America is, in fact, suffering from a surplus of democracy. Adding to the lamentations of John Adams -- who often referred to the populous as "the mob" -- and Walter Lippmann -- who famously characterized the American public as a "bewildered herd" that must be "put in its place" -- conservative journalist Andrew Sullivan recently argued that America, through an excess of democracy, has become "a breeding ground for tyranny."

The rise of a loudmouthed strongman like Trump, Sullivan contends, is the result of a system in which "barriers to the popular will, especially when it comes to choosing our president, are now almost nonexistent."

On the contrary, as Michael Lind argues in the New York Times, the rise of Trump has more to do with the anger fostered by a system that has consistently ignored the will of the public, not by a system that pays too much attention to it.

"In the United States," Lind observes, "the problem is not an excess of democracy, but a democratic deficit that has provoked a demagogic backlash."

This democratic deficit pervades many areas of debate in American politics.

Last week, for instance, a Gallup poll revealed that 58% of American adults support "a federally funded healthcare system that provides insurance for all Americans." Interestingly, 41% of Republicans favor replacing the Affordable Care Act with the system that Bernie Sanders has advocated -- a Medicare-for-All, single-payer system.

Hillary Clinton, the standard-bearer of the Democratic establishment, has, however, expressed deep reservations about such a proposal, despite frequently boasting about her record of fighting for universal healthcare. Clinton has repeatedly attacked Sanders on this front, insisting that the plan he supports will "never, ever come to pass."

Some have argued that Clinton's change of heart is not surprising, given the amount of money she has received from the powerful and politically influential health insurance industry -- an industry that is currently at war with Colorado's single-payer ballot initiative.

In the 1990's, as David Sirota of the International Business Timesnotes, Clinton was declaring that a single-payer system was nothing short of a political inevitability -- and a political necessity, given the public's support for such a system. "I think the momentum for a single-payer system will sweep the country," she said.

"Between that declaration and her now saying single-payer can never pass," Sirota observes, "Clinton has vacuumed in roughly $13.2 million from sources in the health sector, according to data compiled by the nonpartisan Center for Responsive Politics. That includes $11.2 million from the sector when Clinton was a senator and $2 million from health industry sources during her 2016 presidential campaign."

Clinton has also, as Zaid Jilani reported in January, "made $2,847,000 from 13 paid speeches to the industry."

"This means," Jilani adds, "that Clinton brought in almost as much in speech fees from the health care industry as she did from the banking industry."

Clinton's healthcare reversal embodies the argument made by Gilens and Page in 2014: When the views of elite sectors of the population and special interests, from the insurance industry to pharmaceutical companies to oil giants, come into conflict with those of the public, elites almost always win.

Though Gilens and Page don't use the word oligarchy in their conclusion, the implications of their findings are clear: A system dictated by the needs and desires of the wealthiest cannot, with any honesty, be called democratic.

And the disconnect between public and elite opinion on healthcare is just one of many.

As this disconnect is publicized, and as anger festers, the appeal of figures like Trump -- figures who ridicule the establishment and who pretend to represent the interests of the disaffected -- will only continue to soar.

There is another side, though -- an opening for a more democratic process.

Bernie Sanders, by articulating the alternative to Trump's narcissistic, strongman populism and the establishment's deference to elite sectors, has done much to spark activism and organization that could, if these elements combine to create a cohesive mass movement, give a voice to those who have been left behind -- and change the system in such a way that benefits the many, rather than just those at the top.

"If we want to avert the sense of powerlessness among voters that fuels demagogy," Michael Lind concludes, "the answer is not less democracy in America, but more."