By Sally Bagshaw
Dr. Robert J. Blendon is currently the Richard L. Menschel Professor of Public Health and Professor of Health Policy and Political Analysis, Emeritus, at the Harvard T.H. Chan School of Public Health. He holds appointments as a Professor of Health Policy and Political Analysis at both the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School of Government. In addition, he directs the Harvard Opinion Research Program, which focuses on better understanding of public knowledge, attitudes, and beliefs about major social policy issues in the U.S. and other nations. He currently co-directs the Robert Wood Johnson Foundation/Harvard T.H. Chan School of Public Health project on understanding Americans’ Health Agenda, including a joint series with National Public Radio and POLITICO.
Sally Bagshaw: As head of the Harvard Opinion Research Program, you recently analyzed 19 national public opinion polls. What can you share about values and preferences across our nation?
Robert Blendon: We published our findings in the New England Journal of Medicine article titled Implications of the 2020 Election for U.S. Health Policy. This data confirms that Republicans and Democrats have grown further apart in their policy preferences. Our study showed that average Republicans differ from average Democrats in their views across 30 policy-related issues, and these differences more than doubled the gap identified in 1994.
Twenty-five years ago, we had our political differences, but vast differences apply now to many more issues including the handling of the Coronavirus, gun control and abortion rights as examples. More than half of Republicans polled (56%) thought the real problem with the COVID-19 response was that the country wasn’t lifting restrictions quickly enough, whereas 82% of Democrats thought the country was lifting restrictions too quickly. Significantly less than half of Republicans (39%) favored stricter gun control laws compared to 85% of Democrats who want tighter controls. When the question of abortion is posed, 27% of Republicans believe abortion should be illegal in all circumstances as opposed to 49% of Democrats who believe abortion should be legal under any circumstance. Those are large gaps to fill.
Bagshaw: Is it true that the majority of Republican voters truly dislike Democrats?
Blendon: I have seen incredible hostility in Middle America and the South. There’s a big difference between cultures and in perception of what people believe on the East Coast and West Coast. In the red states, over half the voters didn’t graduate from college and resent the “coastal cultures.” There’s a feeling among some of the non-college graduates that there’s a Democratic elite, that you have to have a college degree or you’re on your own. And as a Harvard professor looking at the data, I’ve felt resentment that we college graduates give advice about how the country should be run.
Biden escaped some of this. He was accepted in some communities more than other Democrats running for election, because people in battleground states relate more to him. He may not generate a lot of enthusiasm, but he emphasized his working class family background and his summer work in Scranton, Pennsylvania.
Some polls show that Democrats are perceived as not appreciating rural issues, they don’t appear to respect rural cultures or needs. That’s one of the reasons why the deep division remains, and where Democrats must seek to understand and be understood if they want to gain votes for 2022 and 2024.
Bagshaw: Can Republicans and Democrats reach common ground on anything major?
Blendon: This election did not settle the question of the direction our country is going to go. For example, health care ranked among the top issues for a large percentage of both Republicans and Democrats, but there are significant differences in views on the role of government in this sphere. Among Democratic party voters, 82% believe the federal government has responsibility to provide all Americans with some form of health care, but only 39% of Republicans share that view. We are pulling in decidedly different directions.
That said, everyone wants to see the end of COVID-19 and quarantines. Everyone wants to get back to work and see their kids in school. We don’t have agreement on how to achieve this yet, but the goals are similar.
Bagshaw: Can President-elect Biden change the course of COVID-19?
Blendon: He is right to assemble his first advisory committee to target COVID, and there’s much riding on this. The public is impatient. With cases skyrocketing, over 160,000 per day as of this writing, he has six months to show his administration can do better than Trump’s. He’s assembled some of the brightest scientific and experienced minds to solve the problem. If the vaccine works, if it can be distributed rapidly, if people are back to work and their children back in school early in 2021, there will be a major sigh of relief. His administration will be credited. On the other hand, if the vaccine efforts fail and more businesses close, voters are likely to show their impatience quickly.
Bagshaw: Will President-elect Biden solve problems relating to COVID and the economy in the first year or two of his term?
Blendon: These two issues will top the charts. President-elect Biden and his scientific team will have to get an effective vaccine distributed fast and fairly. If he can get people back to work and back to school, he’ll get credit for it. If his efforts fail and people continue to get sick and the economy worsens, he will be blamed and the pendulum will swing back toward the Republicans. Since he’s not likely to get help from Senate Majority Leader Mitch McConnell, President-elect Biden must rely on his team to develop the public health and economic recovery plans.
Bagshaw: What happens if people refuse to take the vaccine?
Blendon: This can be a real problem for the incoming President and for the country’s health and welfare as a whole. Polls show that many more Republicans and Black Americans are unwilling at this point to be vaccinated against COVID than Democrats who are willing to believe the medical science community. Convincing a broad range of people that the vaccine is safe and effective is critical.
Beyond a scientist like Dr. Fauci who is highly regarded by Democrats, many red state voters will need unexpected advocates such as the Governor of Wyoming or Montana to encourage them to get vaccinated against COVID. Some key groups such as nurses currently have mixed views about taking flu shots; they will have to be convinced of the efficacy of the COVID vaccine. This group can play an important part in the Biden/Harris strategic plan because as a group nurses are trusted; and assuming the program is widely supported, the public will demand a safe vaccine that is as easy to get as a flu shot is now. If the program is successful, Democrats will see their stock rise. If it’s a visible failure, you can anticipate a Republican backlash in 2022.
Bagshaw: Are there any areas of agreement that the Biden/Harris administration can find with a Republican majority U.S. Senate?
Blendon: Maybe. Infrastructure improvements are needed in nearly every state, and it’s possible to get Republican support if the Democrats compromise on how the money is invested. For example, one senior Republican told me he’d vote yes on a transportation bill so long as Democrats didn’t make his state invest in “everything green.” To him state highways and ports are really important and he said about the Democrats “If you’ll sign an agreement that will allow money to go in my rural areas for redoing highways, I will sign an agreement to build subways all over New York.”
We’ll see whether Rep. Alexandria Ocasio-Cortez and the Green Team will be willing to say yes to a compromise like this. It will be tough because environment and climate change advocates will feel this is their time to push hard left.
President-elect Biden is going to want some wins, and it’s in his nature to look for successes. He will try to get some bills through this year that aren’t one-sided. Infrastructure is possible; so are investments in international trade and public education. And maybe incremental progress can be made in health care/health insurance if advocates acknowledge that we can mix and match options. For example, many people really like their own employer insurance, let them keep it until a public option is proven better and cheaper; Medicare can be extended to people fifty-five and over bringing millions more into the system; use pricing power to negotiate lower prices for drugs and medical procedures; continue private programs like Medicare Advantage.
Republican voters have no interest in universal coverage and in the short term they are not going to be very enthusiastic for a big change. Yet, if the pricing powers are strong, there will be a real financial advantage over time. It’s doable, because this approach doesn’t take anything away in the short term. It’s not universal healthcare, but it moves us in the right direction.
Bagshaw: You were the first person I heard say that Joe Biden owes his good fortune to South Carolina Black voters. How will he address this debt during his administration?
Blendon: It’s true. Candidate Joe Biden was struggling last February. Fourth in Iowa, Fifth in New Hampshire. Before Super Tuesday, South Carolina Congressman James Clyburn came to his rescue and endorsed him. Within the South Carolina Democratic party, 60% of primary voters are Black, and they showed up for Joe Biden. Black voters in other states followed South Carolina’s lead. The Biden administration will pay a lot of attention to their concerns, and we’ll see more people of color in his cabinet and departments reflecting a balance of gender, race, and geography.
Bagshaw: Can racial disparity be addressed with a Republican Senate?
Blendon: Even if two Democratic Senators are elected from Georgia in January, the Biden/Harris team will govern primarily through administrative regulations. Getting major legislation through the Senate will be extremely difficult.
Specifically, every federal program will put forward an antiracism component. Institutions receiving money will put renewed efforts toward recruiting people of color for special programs and employment opportunities, and institutions will be expected to address disparities. Hospitals, for example, will look at differences in outcomes for minority patients, with active committees to investigate and reduce those disparities. The attitude will be 180 degrees different from the current administration.
Bagshaw: Will the President spend more time with Congress?
Blendon: If I were he, that’s what I would do. Joe Biden has friendships developed over decades, although neither Mitch McConnell nor Lindsey Graham are likely to be publicly supportive. Biden could get something through the Senate if he gave them what they wanted to sell to their Republican base back home and help fellow Republicans win their primaries. Joe Biden is trusted, however, and that’s very important.
Bagshaw: Primary elections are contentious. Where do you see Republican and Democrat party leaders moving in the foreseeable future?
Blendon: The primaries have gotten to be a major barrier for finding middle of the road consensus. The candidate who has the support of the more liberal leaders on the left and conservative leaders on the right win the primaries.
Take the primary race between 74-year old Ed Markey and 39-year old Joe Kennedy in Massachusetts for example. Sen. Ed Markey had co-authored the Green New Deal resolution with Rep. Alexandria Ocasio-Cortez and received AOC’s endorsement in his campaign. Rep. Kennedy campaigned closer to the middle and failed to fill the energy vacuum left after Bernie Sanders and Elizabeth Warren ended their Presidential bids. Ed Mackey capitalized on that energy and won in liberal Massachusetts.
Similarly, Republicans gained eight congressional seats and won “trifecta” majorities of state House, Senate, and Governor in the New Hampshire and Montana. Many state legislatures have also gained Republican seats. This will make a big difference in 2021 when the state legislatures lead the redistricting efforts.
Bagshaw: While you were analyzing all this data, did you anticipate that the vote would be the largest turnout ever?
Blendon: My work is not on election prediction but on analyzing national trends and opinions. Yet in the polling world we could see that both parties were mobilizing voters -- Republicans registering more voters in Florida where I live now. What will be interesting to analyze is that Florida moved further right overall yet voted over 60% for the progressive $15 per hour minimum wage. That measure passed because it was referendum, a vote of the people.
One of the reasons we saw such a high turnout across the nation is because of COVID-19 and the unprecedented use of mail-in ballots. Many states allowed people to vote by mail, with or without an excuse. In the future, that may change again. Some states made it tougher to vote, like Texas that limited drop boxes to just one per county; or Pennsylvania that allowed different rules in the sixty-seven counties; or some states that closed the polls early making after work voting difficult. By contrast, Washington State has 100% vote by mail making voting as easy as possible. As we saw clearly this year in some states, making voting difficult is not accidental. It’s quite political.
Bagshaw: What will Vice President-elect Kamala Harris’s role be in the new administration?
Blendon: There are two types of Vice Presidents. One becomes the roving UN Ambassador and you never see them for three years. Ms. Harris is smart enough to know she does not want to be consigned to opening dams in Sudan. The second type of Vice President is the one she will be. She will promote the Biden/Harris agenda; she will rally the Democrats to be active and support their initiatives. She’s going to play a very vocal role dealing with race, police accountability, and criminal justice reform issues. She will appear regularly on Sunday talk shows and at major events where she will enthusiastically promote their agenda. She won’t be used to convince Mitch McConnell to compromise, that will be the President’s job.
Bagshaw: President Trump has been a polarizing figure. Why do so many millions of people still embrace him?
Blendon: Before the pandemic, a majority of Trump’s supporters say they were better off than they were four years before. Businesses and very wealthy people got tax breaks, all kinds of regulations were lifted allowing businesses to expand, at least in the short term. Developers could develop faster with immediate financial gains -- it was an economic sugar high because environmental restrictions were reversed and they could build and make profits. Businesses large and small were paying less federal taxes and most people who wanted jobs had them.
And shocking as it is to many of my colleagues and students, Trump’s supporters take great pleasure in Trump’s political incorrectness. During election week, a long car-parade of Women for Trump drove by my Palm Beach home waving signs and cheering for him. At the same time, somebody bought a billboard next to the Palm Beach airport where the President parks his plane that says “Impeach Trump.” The political division is evident here and there are no signs of reconciliation.
Bagshaw: Do you have any prescriptions to encourage reconciliation between people across our country?
Blendon: I’ve read every article I can find on the topic, and I’ve researched the question on what it will take to bring the parties together. History shows us that threats to our country -- the kind we don’t want to contemplate like another world war or rogue countries with nuclear weapons -- are examples of what galvanizes people. I don’t want to be cynical. It’s up to leadership to find common ground and reach out to each other. Short of a that, I haven’t found the penicillin.
Personal note from Sally Bagshaw: Professor Blendon is one of my favorite Harvard Professors. I took a class on U.S. Health Policy/Politics class from him the Spring semester, 2020. Every seat was filled in our Harvard Kennedy School classroom with a mix of students from the Chan School of Public Health, from physicians returning to get their Masters of Public Health, and with graduate students and mid-career students from the Kennedy School. Professor Blendon welcomed four of us from the 2020 ALI cohort. We all learned and debated about Congressional and state politics, disparate values and the strength of initiatives/referenda. He retired from teaching at the end of Spring 2020. He is beloved and appreciated.
About the Author:
Sally Bagshaw is a 2020 ALI Fellow, former three-term Seattle City Councilmember, and Chief Civil Deputy for the King County Prosecuting Attorney’s Office. Sally is a lawyer, mediator, and advocates for government that functions responsibly.
This interview has been edited for length and clarity.