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Monday, March 22, 2010

The People's Perspective as Healthcare Reform Passes the House

We’ll know more about the short-term reaction to the historic House passage of healthcare reform on Tuesday. That’s when we will have the results of a new Monday night Gallup poll gauging attitudes a day after passage.
Meanwhile: Do we have a good fix on where the public stood on healthcare reform just as it was passed by the House Sunday night?

I’ve been studying a series of polls conducted on this issue over the last two weeks. One conclusion: A good deal of variance in the public’s response across surveys.

Our most recent Gallup poll found a three percentage point tilt against Congress passing the legislation. Two other recent polls (Pew and Fox News/Opinion Dynamics) showed the healthcare legislation opposed by 10-point margins or higher. The Wall Street Journal/NBC News poll asked two separate questions about the legislation. One showed a one-point favor over oppose margin. The other showed an eight-point opposition margin. A new poll by the Kaiser Family Foundation finds a four-point favor over oppose margin.

We note differences across surveys in how the questions were asked. Some survey questions included explicit references to Democrats and to the president. Others do not. Some asked a basic favor or oppose question about the plan. Others asked more explicitly about Congress voting for or against the plan. The aforementioned Wall Street Journal/NBC News poll asked a favor or oppose question and a more complex “want the plan to pass” question. The latter got the one-point affirmative margin. The former received the eight-point opposition margin. Each question in each poll was placed in a different spot in different poll contexts. One poll used registered voters. The rest used national adults.

On her new show "State of the Union" Sunday, Candy Crowley of CNN Sunday reviewed some of these healthcare reform poll results.  She then asked: "Is it in the way the question is asked? Are more people more likely to support it when it's called the Obama plan or is it that people think some change is better than no change?"

The answers to Crowley's rhetorical questions may be "yes." But. I don’t find any immediate indications of specific patterns that pin down what those differences are. I don’t detect any specific independent variables that appear to explain the variation in the dependent variables (attitude towards the healthcare bill). If you, the reader do, please comment on this post and tell us all what you see.

If nothing else, this type of variation across questions asking about a specific policy issue (at roughly the same time period) suggests the potential for future shifts in support or opposition. The healthcare debate is now going to turn to the “after vote” spin. And the “after vote” responses of Americans will be closely monitored. Will there be growing appreciation for the bill? Will there be a growing backlash against the bill? The variation in the current data underscores a fairly banal but real conclusion that we don’t know. That’s why we are going to continue to conduct surveys.

More observations from public opinion data on healthcare reform.

1. If Republican opponents want to build off of existing public opinion, they will focus on the costs of the bill and its implications for an expanded role for federal government. These are the existing reasons given by Americans for opposing the bill. In other words, big picture objections. If Democrats build off of existing public opinion, they will focus on the benefits the bill will provide to the less fortunate and those without insurance. These are the most prominent reasons given by those who favor the bill. In other words, smaller picture specific benefits.

2. Which way will the “who benefits” elements of the bill play? The average American is not expecting a great deal from the bill personally. The majority of Americans say the situation for them and their family will either stay the same or get worse after passage of the bill. So there will not be huge groups of Americans bitterly disappointed if they do not see immediate benefits from the bill’s passage. They are not expecting any. This could be positive news for the Democrats.  But, this could play both ways.  The fact that the average American is not expecting any benefit from the bill could mean that they won’t have any reason to be enthusiastic about it.

3. There is nothing new under the sun. Back in 1993-1994 the major reasons given by Americans for objecting to a new healthcare bill were costs and government involvement. Fast forward to today. Same set of pros and cons to the bill.

4. Everyone is asking what the impact of the passage of the bill will be on the coming midterm elections. Well. I am an empiricist. Which means, to some degree, that we are going to have to wait and see. Here, however, are three things to keep in mind.
  • Congressional Job approval is at 16% now. Congress is controlled by the Democrats. The Pew Research Center recently asked Americans what word came to mind first when respondents heard the word 'Congress'. The most frequent response was “dysfunctional.” Another frequently mentioned word was “inept.” Now Congress has actually done something and passed a new plan .  This could counter these existing perceptions. Congressional job approval could grow. Democrats could gain some positioning.
  • The economy is going to be a major factor in the midterm elections. If the economy recovers by the fall, the resulting good vibrations will push healthcare reform to more of a back burner. And obviously benefit the Democrats. If the economy continues to falter, it could also swamp healthcare reform as an issue -- but benefit the Republicans. 
  • For those who argue that the Democrats will suffer significant losses because a healthcare reform bill was passed, please look back to the 1994 midterm elections. Here Bill Clinton did not get his healthcare reform bill passed. It failed, at that time in line with popular opinion. Did the failure of healthcare to pass therefore mean that the Democrats averted major losses in the 1994 November election? Not hardly. The Democrats suffered one of their most significant defeats in modern history. It’s hard to believe that it would have been worse had Bill and Hillary Clinton been able to pass healthcare. I’m not sure of the exact lesson to be learned here. But I guess one point is: Don’t be too quick to jump to conclusions about the impact of the passage of the healthcare reform bill.


Eshaneh said...
March 22, 2010 at 1:49 PM  

Great insights, thanks much! I think that one variable that might have affected variation in attitudes towards the bill is factual knowledge of what is in the bill. One issue is that the bill is huge and in legal language that many Americans do not understand (the media has helped to clarify what is in the bill, but of course, these clarifications are "interpretations.") Another issue is that there have been several versions of the bill and it is hard to keep up with what is in and what is out! The New York Times has a nice interactive page that contrasts the Senate bill with the Reconciliation bill. I have not seen anything presented as clearly as this piece in other media outlets, though certainly they could be out there. Finally, there is the human bias factor. We all taint our interpretations of proposed policies with our likes and dislikes. And even a little bit of human bias can be an obstacle in understanding the proposals stated within any bill (and especially this one!).

Ken Berwitz said...
March 22, 2010 at 2:28 PM  

I'm more than a little surprised that, unless they are suppressing them, the studies you've mentioned overlook several extremely important anylitical issues.

One such issue is where support and non-support for this legislation comes from. If, for example, the preponderance of support comes from congressional districts that invariably vote Democratic (as I suspect is the case) then, for obvious reasons, the data are not as good for Democrats as they may seem.

Another such issue is breaking the data by Democrats, Republicans and Independent voters (i.e. the segment without party loyalty).

I assume we agree that most people affiliated with a party will reflect that party's line. But if independents - i.e. the people most likely to swing an election one way or the other - are strongly to one side? Then we have something genuinely significant to talk about.

I hope that Gallup's study tonight incorporates these issues. If so, good for Gallup. If not, there is still time to revise the questionnaire. I'll wait and see.

Anonymous said...
March 22, 2010 at 2:42 PM  

You miss the point. It is not what you ask as much as who you ask. The numbers based on Adults asked, Registered Voters asked and Likely Voters asked are more relevant. The numbers based on who you ask tell us likely voters we are not alone.

The Steel General said...
March 22, 2010 at 4:15 PM  

A simple oppose or favor question is not accurate. It only measures the influence media has on that persons opinion.

Why not ask questions on specific measures? Like:
Do you favor a public option?
Do you think a public option will bring more competition or not?
Do you favor the end of previous condition?
Do you favor an insurance pool with everybody or just with the old and the sick?

If you didn't conducted such a poll, I am very curious why Gallup hasn't done it.

Basically, yes, a majority opposes Obamacare. But not when they hear what's really in it.

Also, the health care bill is a very complex issue. It's fundamentally a flawed approach to ask about the whole thing in one question.

Then, what is REALLY flawed is the approach of "Based on what you know about the health care reform legislation"
This measures NOTHING of real relevance, only the degree of what that person has chosen to inform him or herself.

Finally, in all of the Western world there's distrust of Government, but this is the highest in America. Any poll should correct for that.

Anonymous said...
March 22, 2010 at 4:22 PM  

I think the variance is because when you ask a simple "oppose or support" question, progressives might vote oppose because it isn't progressive enough (public option, single payer).

But when you ask whether they want the current bill to pass or not, those same progressives might prefer this bill to pass rather than keep the status quo. Better than nothing, would be the general thought.

Are there any Gallup polls on how many Americans are aligned with the Republican plan? That might validate my theory, if that number is well below the number of people that said "oppose".

Lam said...
March 22, 2010 at 5:35 PM  

I accept the polls from Gallup as the most accurate, which I'm sure is reasonable and unbiased.

So 45% support and 48% oppose.

The Steel General said...
March 22, 2010 at 7:37 PM  

Gallup and others, assumed that respondents had an accurate picture of what is in the plan. Going by the number of screechers about Death Panels, and calling Bart Stupak (! of all people) a "Baby killer", it's a safe bet that at least the right wing was completely clueless about this the contents of this bill, or had a highly distorted view of it.

"Do you oppose the present plan?" is like asking:
"Do you oppose or support the Swiss laws on cuckoo?"

Right wingers didn't really care.
That is why i'm puzzled as to why Gallup would conduct such a poll which only measures how well some believed propaganda and lies.

Brian Fraiser said...
March 26, 2010 at 8:31 AM  

I agree with most of these comments.

The question of :
Do you like THIS bill?
Would you like to see a DIFFERENT bill passed instead of this bill if possible?

Instead Gallup tried to phrase questions as if its this bill or nothing at all.

People want reform but most people seem to not like THIS bill as reform. It seems like gallup is working for the administration to have this bill seem as the only reform available.

Anonymous said...
March 30, 2010 at 1:27 PM  

I was called for a poll and had the questions:
1. Do you think Obama accomplished his goals in his first term in office, or
do you think the Republicans obstructed his efforts.
(How Can I Answer That??)

2. Would you like Healthcare the way it is currently? (Well no I dont but I dont want the universal healthcare. --sorry sir its yes or no)

it went on and on like this..this was a local NBC poll in Tampa FL...The questions were designed for specific results. Statistics can be manipulated to whatever result is Pre-determined.

I think with every Poll result, the core Questions and Data should be made available.

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