Two Conclusions About Healthcare Reform

Two conclusions about healthcare reform reinforced by our weekend USA Today/Gallup poll:

a) Americans tend to believe the most positive benefit of the bill will be to extend healthcare coverage to those who don’t have it.

b) Americans tend to view the most negative aspect of the bill as its cost.

These have been fairly consistent findings in recent months.

When supporters of the bill have been asked to justify their position, they are most likely to refer to the bill’s extension of insurance to those who don’t have it. Our cui bono (who benefits) question sequence of a few weeks ago found Americans most likely to say that lower income people and those without insurance would benefit from the new bill. The just-completed weekend survey found that Americans are most positive about the extension of healthcare coverage to Americans.

Discussions of costs are ubiquitous in our data. These show up in response to each of the several open-ended questions we have asked Americans about healthcare. Costs are the number one reason given open-endedly by those who oppose the bill. Over the weekend, concern about costs were clearly seen as the most negative aspect of the bill.

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What's Next?

With all of the activity swirling around healthcare reform, what kind of swirling can we expect as far as public opinion is concerned?

As I said on a cable news television show a few days ago when asked that question, the best answer is probably, "We don't know. That's why we continue to poll."

Still, we have been studying and tracking American public opinion for many years now. It's not unreasonable to bring some reasoned analysis to the table.

We are in the midst of a concerted "post-bill" effort by all involved to sway public opinion. Both sides of the debate are in the full spin zone.

President Obama was in Iowa Thursday. He told an audience at the University of Iowa Field House: "So this is your victory . . . And today, because of what you did, that future looks stronger and more hopeful and brighter than it has in some time -- because of you. ”

Meanwhile, Senate Republican Leader Mitch McConnell has called the bill a “monstrosity” and said his goal is to “repeal and replace” the entire bill. The New York Times reported that House Republican Leader John Boehner labeled the healthcare legislation as “a sloppy mess that the majority of the American people believe should be repealed and replaced,” and one that “We’re going to have to come back and fix this bill time and time again.”

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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.

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Who Benefits if a New Healthcare Plan is Passed Into Law?

Assuming the new healthcare reform bill does in fact become law over the next several days, cui bono? Who will reap real-world, tangible benefits from the new legislation?

Americans appear to have an answer to this question: The pending healthcare legislation is the functional equivalent of a Medicaid bill. The legislation will help the poor and those who currently don’t have health insurance, but at the cost of a net negative impact for most other groups affected.

This conclusion comes from the remarkable findings of Wednesday Gallup polling. The survey question asked Americans if the “bill now being considered in Congress” would make things better or worse for a list of 10 different entities.

Results: Only two entities would gain more than they lose if the healthcare legislation now being considered in Congress is passed into law. These are:

• Americans who do not have health insurance
• Lower income families

All other entities tested are perceived by John and Jane Doe out there across America as being net losers from the passage of the new bill.

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Dueling Pollsters

The White House is pushing for a House vote on healthcare reform law by the end of the week. The New York Times predicts a week of “arm-twisting and high drama.”
And, we have a continuation of dueling claims about polls on this issue.

Two former Democrat pollsters penned an op-ed piece in The Washington Post. They claim that the battle for “public opinion has been lost.” The White House’s pollster shot back on Saturday in The Washington Post -- saying that “the American public is closely divided” on healthcare. [Note:  both pieces go on to talk about a number of other aspects of polling on healthcare as well.]

Here’s part of what the two Democratic pollsters (Patrick H. Caddell and Douglas E. Schoen) said:

"First, the battle for public opinion has been lost……. Nothing has been more disconcerting than to watch Democratic politicians and their media supporters deceive themselves into believing that the public favors the Democrats' current health-care plan. Yes, most Americans believe, as we do, that real health-care reform is needed. And yes, certain proposals in the plan are supported by the public. However, a solid majority of Americans opposes the massive health-reform plan."

And here's part of what the White House pollster, Joel Benenson, came back with:

"No pollster, including me, could look at the recent data and responsibly say anything other than that the American public is closely divided when it comes to supporting or opposing various health-care plans."

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The Definitive Look at Presidential Job Approval

Don’t miss the new Gallup Presidential Approval Center on Gallup.com. This brand new tool allows you to slice, dice, and parse presidential approval in all kinds of fascinating and important ways.

The Presidential Approval Center uses Gallup data for all presidents back through President Harry Truman.

• What was the lowest Gallup presidential approval rating in history? The answer is right there in the Center (22%, Harry Truman).
• What was the highest job approval rating in history? The answer is there (90%, George W. Bush).
• Which president had the lowest average job approval rating for his entire time in office? The answer is there (Truman, by a hair over James Carter).
• Which president had the highest average job approval rating for his entire time in office? (You will have to go find that one yourself).

Most importantly, the Center allows the interested reader to compare and contrast job approval across presidents based on exactly the same time period of days in office. As an example (as Politico’s Ben Smith has already figured out), this allows one to note how similar the trajectory of Obama’s job approval is to that of President Ronald Reagan for their first year and two months of their terms in office.

Similarly, one can figure out just how similar the approval trends are for Reagan and Bill Clinton. Or answer the question: how is Obama doing at this point in his first term compared to the average president since Truman at this point in his first term?

And, since Gallup has conducted almost 200,000 interviews in which Obama’s job approval has been measured since January 2009, one can have a field day looking at the weekly trends in Obama's approval within a number of important demographic, political, and ideological subgroups.

Check it out. It’s the definitive way to look at this key metric of today’s political landscape. We will be updating the Presidential Approval Center continually as new data on the current president come in.

Most Frequently Used Words When Americans Talk About Healthcare Reform

Here's a word graph that displays the prevalence of the actual words used by Americans when they are asked to discuss their support or opposition to President Obama’s healthcare plan. We removed the words “healthcare” and “think” from the graph since they were very frequently used, but not particularly meaningful.

Note that three of the most prevalent words used by Americans in discussing Obama's plan are “government” and “cost” and “insurance.” This underscores the pivotal role of these concepts in the healthcare reform debate. Clearly advocates of healthcare reform evoke the need for insurance on the part of those now uninsured. Cost is used by those on both sides of the issue. Those in favor of healthcare reform are most likely to talk about the cost of access to healthcare. Those opposed to healthcare reform are most likely to talk about the big picture cost of healthcare per se.

Quite a few people also use cost-related words such as "money" and "expensive."

Evocations of the government are primarily used by those who oppose healthcare reform.

Note that "abortion" shows up, but it's by no means highly prevalent.

Again, the full review of the coded categories of responses to the healthcare legislation question are included in my colleague Jeff Jones' analysis.

940 Americans' Reasons for Favoring or Opposing Obama's Healthcare Plan

Our latest Gallup poll results show that 45% of Americans favor President Obama’s healthcare plan, while 48% oppose it.

We sometimes lose sight of the fact that numbers like these represent the views of actual, real Americans living out there across the country. Each of those percentage points is comprised of about 10 Americans who told an interviewer that they either favored or opposed the healthcare bill. And most of these Americans have actual, real reasons behind their favor or oppose response. We know this because we asked respondents in our weekend poll to tell us in their own words why they held the position that they did on the healthcare reform bill. The results, based on the actual words spoken by respondents and typed into the computer by our interviewers, are displayed here, one by one.

I think it’s a wonderful exercise to go through these responses and get an up close and personal feel for what Americans are thinking on this critical issue. Read them yourself.

Obama's White Coat Ceremony

President Obama appeared in the White House Wednesday talking to a group of white-coated people -- nurses and other healthcare professionals, some of whom were doctors. It is reasonable to assume that these individuals wore their white coats not by accident. The White House apparently wanted to use white coats to emphasize that medical professionals were on the White House side of the healthcare debate. (Concerns about the potential health hazards of all those white coats not withstanding.) Check out the White House Web site for vivid pictures.

Some observers have decried the appearance of these white-coated individuals as a “prop.” Prop or not, it was a shrewd move as far as public opinion is concerned. Doctors and nurses are held in high esteem by the American public.

Nurses have the highest perceived honesty and ethics ratings of any individual profession Gallup tests. Our recent analysis of the healthcare reform credibility of various political and medical groups puts doctors at the top of the list -- significantly ahead of President Obama himself. Indeed, doctors’ credibility on healthcare reform has increased over the last nine months, while Obama’s has decreased.

The White House no doubt assumed that the presence of these white-coated individuals connoted tacit approval for the Obama healthcare reform legislation.

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Obama and Smoking

The physicians who conducted President Obama’s recent physical exam reported to the world that Obama is still smoking.

Here’s how the Associated Press wrote it up: “The president's doctor recommended that he continue his efforts to quit smoking. The post-exam report indicated that Obama uses a self-administered 'nicotine replacement therapy' as part of this goal. He has said in the past that he chewed Nicorette gum.”

No indication of how often Obama smokes. Or where he smokes. Federal law bans smoking in Federal buildings, but provides an exception for buildings in which people voluntarily or involuntarily reside. This would appear to exempt the White House from the ban.

Gallup's data from 2009 shows that about 22% of all Americans reported smoking. Average smoking rates within some subgroups are higher than within others. Obama's demographic and political characteristics put him at odds with these subgroup tendencies in some situations, but in sync with them in others.

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John McCain, Nancy Pelosi, and Medicare

Republican Sen. John McCain of Arizona McCain faces a tough primary challenge from conservative former talk show host J.D. Hayworth. Inevitably McCain was asked about the views of his opponent on Meet the Press Sunday. Host David Gregory reminded McCain that Hayworth’s Web site calls President Obama’s agenda “socialist.” Gregory then asks McCain if the term “socialist agenda” goes too far. McCain demurred from a direct answer, telling Gregory that he should ask Hayworth to explain his own views. (Of course, McCain could have riffed into a discussion of Gallup’s recent data exploring Americans’ reaction to the term "socialism." He didn’t.)

But, of more immediate interest is what McCain said thereafter:

Look, look, there is no doubt in my mind America's a right-of-center nation and this administration is governing from the left. That's why the president's approval rating's continued to, to decline.

Are the president’s approval ratings continuing to decline? Certainly not recently. Obama’s ratings have of course declined from the point at which he first took office. Obama began with a 67% rating in his first week in office. He had a 50% average last week, more than a year later. But, Obama’s ratings have actually been remarkably stable in recent months, as reviewed in some depth by my colleague Jeff Jones. McCain’s use of the word “continue” implies that Obama's ratings are still sliding -- right up to this point in time. And that’s not the case.

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