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Monday, February 22, 2010

Public Opinion and the Pending Bipartisan Healthcare Summit

The White House invitation to the Feb. 25 Blair House bipartisan summit on healthcare reform sketched out an agenda: opening remarks by the president, remarks from a Republican leader, remarks from a Democratic leader, and then a discussion moderated by the president on “on four critical topics: insurance reforms, cost containment, expanding coverage, and the impact health reform legislation will have on deficit reduction.”

No explicit time set aside for remarks reviewing the people's views on healthcare reform.

Is there a need for such a review? The Congressional leaders who show up at the summit -- in theory -- already carry with them the views and opinions of Americans. Members of the House and Senate are elected to represent the views of the people. They are stand-ins for what John and Jane Doe would do if they were able to be in Washington.

However. It does not appear that John and Jane Doe back home are fully appreciative of the degree to which their views are being represented by the people they elect. Approval of the job being done by Congress is very low. Americans have low trust and confidence in their representatives. Americans continue to believe that they personally are better equipped to make judgments than their representatives.

It's not certain, therefore, that Americans will be fully satisfied with how well their opinions are represented in the Blair House meeting room on Thursday.

Maybe a half hour or so for a systematic review of where the people of the country stand on healthcare would have been an important addition to the summit.

Such a review could start out with the current state of public opinion of Americans on current healthcare reform legislation.

"Current healthcare reform legislation" is a bit of a moving target. There is the House bill, the Senate bill, and now the just released "Obama" bill. Dealing with this potential ambiguity, recent polls have described healthcare legislation in different ways: ". . . the health care bills being discussed in Congress," ". . . the proposed changes to the health care system being developed by Congress and the Obama administration," ". . . the health care reform proposals presently being discussed," ". . . Barack Obama's health care plan," ". . . the healthcare bill now being worked out by the Democrats in the House and Senate," and ". . . the proposed changes to the health care system under consideration in Congress.”

It doesn't seem to matter. Most recent polls asking about any of the above have found more negative than positive responses. More Americans opposed than in favor. The only exception to this generalization comes from the Kaiser Family Foundation poll in January, which used the question wording: “As of right now, do you generally (support) or generally (oppose) the health care proposals being discussed in Congress? (Is that strongly support/oppose or somewhat support/oppose?)”, with 19% strongly support, 23% somewhat support, 10% somewhat oppose, and 31% strongly oppose response pattern (16% no opinion). The most recent poll I’m aware of was conducted by Pew Research Feb. 3-9, 2010. It used a very similar wording to that used by Kaiser, but with significantly different results: "As of right now, do you generally favor or generally oppose the health care bills being discussed in Congress?" 38% favor and 50% oppose.

At any rate, as a starting point, I would point out to those assembled at the Blair House that Americans appear to be more against than in favor of the healthcare legislation as it is has been formulated in the House and Senate. If such a bill were put to a national referendum, it would probably fail.

I would then note continuing interest in healthcare reform legislation. The ABC News/Washington Post poll tweeted by White House press secretary Robert Gibbs last week showed majority support for pressing forward toward a healthcare plan. The Kaiser poll in January found majority support for the position that “it is more important than ever to take on health care reform now,” as opposed to the position “we cannot afford to take on health care reform right now.” Our Gallup poll showed that Americans wanted to suspend work on the current healthcare bill the House and Senate are working on. But, the option the public did choose was not to abandon work altogether, but rather to find an alternative bill that would receive more Republican support.

This interest persists despite the fact that healthcare is not the nation’s top priority at the moment. That distinction would belong to the economy and jobs. Our Gallup poll shows that healthcare comes in second as the most important problem after economic measures. An NBC News/Wall Street Journal poll gives healthcare a second-tier priority “for the federal government to address.” That poll asked respondents to make a choice between seven issues. Healthcare is part of a group of four issues that were chosen by 10% to 17% of respondents. Job creation and economic growth number were chosen by 38%. A CNN poll asked about issues one by one. The results showed that healthcare was fifth on the list, with 43% saying it was extremely important. That put it behind the economy -- 61% extremely important, unemployment (58%), terrorism (55%), and the federal budget deficit (46%).

So, a bottom line summary for the attendees would include three points: 1) the American public believes in a general sense that healthcare reform is still worth working toward, 2) healthcare is not the nation’s top priority at this point, and 3) current healthcare legislation as developed and worked out by the House and Senate has found less than majority support.

Those in attendance might ask: “So what would the public like to see come out of our summit?” Much discussion has focused on the nuts and bolts of what is included in a healthcare bill. The aforementioned Kaiser poll, for example, tested support for 27 different specific elements that could or could not be included in a bill. Reaction was at the 73% level for “Provide tax credits to small businesses that want to offer coverage to their employees” (remember, anything that mentions “small” appeals to Americans). The lowest level of support, 19%, was for “Cost at least $871 billion over 10 years.”  There was majority support for a number of the elements tested.

The debate on these types of elements will most probably take up a good part of the summit time on Thursday.  And, of course, the specifics of what ends up being in any legislation are critically important.

My reading of the data, however, suggests that Americans tend to focus on some big picture questions. Namely, whatever its item by item provisions, how does this bill play out in terms of costs? And why should Americans trust the federal government to administer a massive new oversight/regulation/control effort?

In terms of costs, the proponents of the bill believe that the bill itself will solve cost issues. The White House outline of the proposed plan states that Obama's plan “For All Americans Reins In the Cost of Health Care for Our Families, Our Businesses, and Our Government”.

There is not a lot of evidence to suggest that the public understands how this cost savings would work. So one objective of the summit on Thursday would be to explain in some detail how the proposed reforms are going to take place while at the same time decreasing costs for families, businesses, and government.

The second issue is big government. Americans worry about big government. Everyone is aware of this. The president himself, in his recent speech in support of embattled Sen. Harry Reid in Nevada, said in reference to government involvement in fixing the economy: "At the same time, standing before this group of business leaders, it's important to emphasize that there's only so much that government can do -- and only so much that government should do."

Two issues relate to the public's concern about big government and healthcare reform. First, philosophic worry about the role of government in society and in attempting to solve problems. This is obviously a major talking point for the Republicans.

Second, the practical issue of how effective and efficient a huge bureaucracy like the federal government will be in administering, policing, and regulating the healthcare system.

Americans believe that 50 cents or more on every tax dollar sent to the federal government is wasted. So one talking point at the summit on Thursday could be to explain to the public how the government is going to efficiently and effectively be able to control and administer this huge set of new regulations and controls.

Finally, I would remind summit attendees that they themselves are a big part of the problem with selling the idea of massive new healthcare legislation to the American public. The public has a high level of suspicion, cynicism, and a lack of trust in their elected representatives at the moment. Perhaps the nationally televised summit will help mitigate these negative views.


Anonymous said...
February 23, 2010 at 1:04 PM  

For the life of me I cannot understand why pools ignore the big elephant in the room, and they do it consistently. When you throw in the public option question, support jumps dramatically. I find it professionally irresponsible of polling outfits to ignore this fact while pretending an analysis of what the American people want. A person might believe you have a hidden agenda.

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