Articles and Analysis


'Fair and Balanced' Questions on the Public Option

Topics: ABC/Washington Post , Health Care Reform , Public Option , Resurgent Republic

The conservative reaction to Tuesday's new ABC News/Washington Post poll did not stop with claims that the partisan balance of the respondents was "rigged." It also included a furious push-back over the wording of the "public option" question, no doubt fueled by the Post's decision to make that particular result the lede of their front page story (something even Nate Silver found "somewhat bizarre"). In reviewing some of the criticism, I discovered a result overlooked in June that should cheer advocates of the public option almost as much as this week's ABC/Post poll.


Let's start with the text of the ABC/Post question: "Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans?" Their most recent survey of adults, conducted October 15-18, found 57% supporting the proposal, 40% opposing it and 3% with no opinion.

A chorus of conservative critics jumped on the question language:

  • Pollster Ed Goeas: "Nowhere does this question indicate that the program would be government run, and it is a quite a stretch to conclude that the 57% support is for the public option.
  • Blogger Jay Cost: "ABC News/WaPo presents the idea that the government insurance plan would 'compete' with private insurance plans. This is a contested notion, as Republicans think that the public option will drive private insurance away."
  • Fox anchor Gretchen Carlson: "That's a little bit different than "do you support the government run option or not ... saying 'do you like the government run option. That would be more straightforward."
  • Pollsters Gary Andres and Whit Ayres: "When Americans are asked a one-sided question about whether they support a public option that competes with private insurance, it's not surprising a majority says 'yes.' It's just another 'choice,' 'more competition' and it's perceived as a way to make health care more affordable. Why wouldn't a proposal like that generate wide support? Just like 'world peace' or 'ending poverty.'"

There is some truth to this criticism. Given that only 56% of Americans are able to associate the phrase "public option" with the health care debate, it is safe to assume that with questions like the ABC/Post public option measure are closer to testing reactions to possibly unfamiliar concepts than to measuring pre-existing attitudes about the "public option." When you do that, the results are very sensitive to question wording.

In July, for example, the Kaiser Family Foundation found 59% in favor of "creating a government administered public health insurance option similar to Medicare to compete with private insurance plans." But when they threw one-sided arguments against the public option at supporters and one-sided arguments for it at opponents, they found they could push support as low as 35% or as high as 72% (something I reviewed in August in a post that Andres and Ayres linked to yesterday).

I am not opposed to questions that test reactions to unfamiliar concepts. They are part of understanding public opinion on many subjects, including the health care debate. Americans may want something, after all, even if they are not familiar with the terminology. When we test reactions, however, my own preference runs to questions -- mostly shunned by media pollsters -- that present both sides of an argument using the rhetoric typically lobbed by partisans. That's why this passage in the Andres-Ayres post caught my eye:

[I]n our Resurgent Republic Health Care poll we provided voters real world arguments about proposals - the up sides and the down sides - before asking for a response . . . We have no doubt that public attitudes about a public health insurance plan could change. But that all depends on the information presented. As is evidenced from the three questions in the Resurgent Republic health care poll, providing voters with more background and arguments produces mixed results for the public plan option.


I had forgotten about Resurgent Republic's June health care poll so I pulled up the toplines. Here are the results to those three questions:


-47% agree: Congressman A says Americans need a public health insurance plan administered by the federal government to expand choices and control costs by competing with private health insurance companies.

-45% agree: Congressman B says a government-run health insurance plan will use taxpayer subsidies to undercut private insurance rates, and force private companies out of business, resulting in everyone going into a government-run plan.

-8% unsure


-57% agree: Congressman A says a public insurance plan will allow people to keep the plan they have now if they want, or give them the choice of a public plan. It will shift power from insurance bureaucrats to consumers.

-38% agree: Congressman B says a public insurance plan will inevitably force everyone into a "one size fits all" government-run plan that will take away choices. It will shift power from consumers to government bureaucrats.

-5% unsure


-53% agree: Congressman A says a public insurance plan is a limited option to allow citizens to have one more choice for health insurance and will force private plans to stay competitive on costs and services.

-43% agree: Congressman B says a public insurance plan is the first step toward a government take-over of health care similar to Europe and Canada, with fewer covered procedures, long wait times for surgery, and more government bureaucracy.

5% unsure

With the possible exception of the first question, these are not results I would describe as "mixed." All three show more support for the public option than opposition. The last two questions produced majority support among registered voters in June that is fairly close to what the ABC/Post poll found last week among all adults. (I also assume that most public option advocates would react to the language of Q15 as conservatives reacted this week to the ABC/Post question. Does "expand choices" really capture the promised benefit as much as "give them the choice of a public plan?" But I digress...).

The main point here is that a group of Republican pollsters took their best shot at a set of questions that would capture both the costs and benefits of the public option, presenting the very arguments so many found lacking in the Post/ABC question this week. In all three instances, more voters favored the public option than opposed it.

I wonder if they tried "to get the same amount of Democrats and Republicans" in their sample, to be "fair and balanced" and all?

P.S.: To be fair, the Resurgent Public poll was conducted in June, just as general opposition to health care reform was increasing most rapidly. Public Option questions included in polls conducted at about the same time by ABC/Washington Post and CBS News found support that was 5 to 10 percentage points higher than on their most recent surveys. Still, I would expect far more stability in measures like those tested by Resurgent Republic that provide respondents with far more information.  And even if a few points closer than what they found in June, the Resurgent Republic tests suggest more robust support for the Public Option than some assume.



I think it's interesting to note that Nate Silver found it "somewhat bizarre" that the Post ran with the public option story front page because their recent polls found nothing new or interesting - support for the public option is, and has been strong & steady. It's just the media's focus on teabaggers during the summer that make this seem like a shift in general momentum, when the real momentum shift is that of the media's focus. If that fact is included in this article, then Nate Silver's opinion is not quite as interesting to your point...

I liked the Resurgent Republic research, but they do offer a certain bias to their questioning: "Would you prefer a health care reform plan that raises taxes in order to provide health insurance to all
Americans, or a plan that does not provide health insurance to all Americans but keeps taxes at current levels?"

This kind of questioning insinuates that cost to the individual will remain the same if we opt to not allow for universal coverage, and we all know that is anything but true.



The results from the June poll are actually better for public option advocates. I disagree with the premise that if you are for the public option you cannot agree with Congressman B that the public option will destroy the health insurance industry. I think I'm not alone in believing that the HMOs add little or no value compared with a well-run non-profit like Medicare. So they can't compete and go out of business. F**k 'em.



"With the possible exception of the first question, these are not results I would describe as 'mixed.' All three show more support for the public option than opposition."

The problem with the "Resurgent Republic" poll (where do these idiots come up with these hysterical names?) is that the balance between the described benefits and potential costs is pretty skewed, to say the least.

Alleged benefits include expanded consumer choice, cost control and increased competition (i.e. motherhood and apple pie) while the alleged costs include the total destruction of the private insurance industry and the creation of a European-style government-run health care system, with reduced coverage and long surgical waiting lists.

I'm just surprised they didn't throw "death panels" and "Soviet-style socialism" in there.

This is like describing the benefits of aspirin as mild pain relief and possible long-term protection from heart attacks, and the possible costs as a severe allergic reaction, coma and death.

Supporters of the public option may be overselling the benefits (the Congressional Budget Office certainly seems to think so) but opponents are flat out fear mongering -- as if Congress (much less the American people) would stand idly by while the US health care system is turned into a third-rate version of the British National Health Service.

Under the circumstances, the fact that public option retains as much support as it does in the face of the "Resurgent Republic" push poll is even clearer evidence of its underlying popularity.


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