Articles and Analysis


Health Care Reform: What Americans Believe and What Happens Next

Topics: Health care , Health Care Reform , Kaiser Family Foundation , National Journal column , Pew Research Center

My column for this week looks at how Americans came to believe what they do about health care reform, with a focus on this puzzle: If American's followed news coverage about the health reform debate as closely as the Pew Research Center news interest surveys say they did, why are so many "unfamiliar with key elements of the major bills," as reported by the Kaiser Family Foundation survey last month?

The short version is that perceptions of health insurance reform appear to have been shaped by both the typically process-oriented coverage of the health care debate and the larger context of double-digit unemployment and massive increases in government spending over the last year. I end the column with the obvious conclusion: Months of more legislative wrangling on this issue is unlikely to change impressions or increase awareness of what's actually in the bill. Please click through for the whole thing.

But what about the question of greatest consequence right now? What if Congress were to quickly pass the existing legislation or, alternatively, just let it drop? How would voters react? This topic was the subject of a lot of discussion over the past week, from voices such as Megan McArdle and (since I filed the column) from Nate Silver and Jonathan Chait.

Looking forward, we are on much more shaky and speculative ground but I find Chait most persuasive in arguing that the rationale for Democrats to move forward and pass the bill is that they've already voted for it and thus "already own the downside." They will be attacked for "having voted for tax hikes and Medicare cuts and death panels" regardless of the outcome. He continues:

Suppose there's no upside at all to passing health care reform. McArdle assumes, without explicating her reasons, that walking away from the issue is a way for Democrats to cut their losses. Why, though, would that be the case? Passing the bill may or may not make it more popular, letting it die is surely going to make it less popular. If the bill dies, then it's the subject of lengthy, painful postmortem coverage detailing its flaws and mistakes. It becomes the symbol of big government run amok, and the 60 Senate Democrats and 220 House Democrats who voted for it will suffer politically all the more. Moreover, the already-demoralized liberal base would become apoplectic with the Democratic Party. 1994 was bad, but passing a bill through both chambers then sitting by and letting it die is the kind of behavior that makes even the most pragmatic Democratic voter want to punish his own party.

It's hard to guess at where public opinion will move next, but if I were still offering political advice to Democrats, I'd side with Chait.



Chait's argument is completely unconvincing. The damage to letting the bill die because it is unpopular will be the same as ramming through an unpopular bill that people don't want using a process designed solely to bypass Scott Brown? Give me a break. Those who voted for it the first time and not a second time would be able to tell their constituents they realized it was unpopular and thus they were against it the second time around. What is the excuse going to be if they vote for it twice, even though they know their constituents don't like it?

The "they already voted for it so the damage is done" argument is weak.

Furthermore, if damage has been done, it has been done for one reason: the bill is unpopular. Chait and the others who advocate passing this thing are telling representatives to deliberately ignore the will of their constituents, and for one reason: because he thinks it will be a "win" for the Democrats. Such arrogance is absolutely breathtaking.



Mark Blumenthal wrote:
"The short version is that perceptions of health insurance reform appear to have been shaped by both the typically process-oriented coverage of the health care debate and the larger context of double-digit unemployment and massive increases in government spending over the last year."

The "massive increases in government spending over the past year" is itself a victory of rhetoric over reality.

According to the Congressional Budget Office's January 2009 estimate for fiscal year 2009, outlays were projected to be $3,543 billion. Keep in mind that these estimates were made before President Obama took office, based on existing law and policy, and did not take into account any actions that the President might implement. Now let's fast forward to the end of fiscal year 2009, which ended on September 30. According to CBO, it ended with spending at $3,515 billion.

To recap, spending was $28 billion *less* than expected one year ago despite the fact the economy performed much worse than projected a year ago and that a discretionary fiscal stimulus bill was passed. Where is this "massive increase in government spending"? (Must be with the WMDs and Dick Cheney in the "undisclosed location.")



I don't accept the Chair argument at all. First of all for the reasons laid out by masnf.

Additionally, if the public doesn't like this bill just because they don't understand it, then just what is it in the next 9 months to make voters fall in love with it? Even more, what would make the public fall in love with it before 2012 if it is passed, the huge tax increases kick in, and there are no benefits because they don't even begin until 2013.

The public doesn't support this bill because the public doesn't support or believe anything coming out of congress. People are not so stupid that they don't see the smoke in mirrors and gimmicks used to cover up the real costs. People see billions in bribes and kickbacks and know that is probably just the tip of the iceberg.

The Kaiser foundation poll asks mythical questions. "Would you be more likely to support this bill if it reduced the deficit?". Of course people are going to say yes. I would say yes. But then they should ask the question, "But do you believe the claim that it will?" No. Absolutely not.

The problem is not a lack of understanding. It is a lack of trust. Look at some recent poll results.

Do you think this bill will lower healthcare costs? 17% say yes.

Do you think Obama's plan to freeze spending will reduce the deficit? 9% say yes. Only 9% believe him on this.

On the "stimulus" bill:

75% believe the money is being wasted and
63% believe that the projects are solely for political purposes and will have no economic benefit. 56% believe that the bill should be cancelled before any more money is spent.

69% of economists (economists - not the poor stupid teabagger racist rednecks who watch Fox News) say that the stimulus had absolutely no effect on jobs since it was inacted.

83% don't believe Obamacare will reduce costs.
91% don't believe Obama's "freeze" will lower the deficit.
75% say the stimulus is wasted.
69% say the stimulus created no jobs.

Yet you have Obama and congress out there every day stating these things that the public overwhelmingly thinks are false.

When you have between 70% to 90% of the public believing that Obama and Congress is lying to them, this isn't a problem with right-wingers or left-wingers. This is a problem with a huge majority of the nation.



It doesn't matter who is responsible for some of the mistakes in being able to pass health reform. This isn't about a victory for Obama. This blame game is useless, because it isn't going to change anything or improve anything. What people don't realize is we have an epidemic in our health system. Lack of preventive care lowers the life expectancy considerably. The United states ranks anywhere between 40th and 50th in life expectancy, and in waste we are at the bottom. The arguing is not going to change these facts, and people have to come together, not as Washington bureacrats or Democrats or Republicans, but show their human side. Obama has been in a tough position and he has gotten further than Clinton ever got. I keep saying until I am blue in the face, health care is a human right not a popularity contest.



I haven't seen that poll Gary mentioned, but he is probably right. America is a very cynical pessimistic country. When it comes to politics, it is part of the AMerican character to be negative. Obama never promised the stimulus was going to solve all of Americas problems. It is really unfortunate.



From masanf: "Those who voted for it the first time and not a second time would be able to tell their constituents they realized it was unpopular and thus they were against it the second time around."

This makes no sense - why would you say this in a contest where you just have to be better than the other guy? You're basically saying that you have unpopular ideas but might maybe listen to the people, and then you *also* make yourself look like a flip-flopper. You deflate supporters, drive away swing votes, and give opponents a club to beat you with.

Plus, evidence points to the *policy* being popular (but "the bill" has been slandered enough to make it unpopular). So a united defense based on what the policies actually do seems like a much more promising route.

If you click through the Nate Silver article, you can see that Gallup polled the most unpopular policy (based on Kaiser, the individual mandate) at something like 3% attributing their opposition to that. Much of the rest of the real opposition ends up being fundamental differences like role of government or "big government" or "socialized medicine" -- and for better or worse, the Democrats have effectively shoved these people into the Republican Party via "Party of No" and such. There could be some genuine opposition based on "costs" and such -- a little unclear. The rest is mostly misunderstandings: there's no public option anymore, it's fully funded now, it lessens deficit instead of raising it.

So while it's difficult to defend against a headwind from a hodge-podge of misconceptions, it's at least not handing the other guy a club to beat you over the head with.



I agree with AySz88. A platform of "I voted for healthcare but then I saw the light and voted against it" is a very bad idea, more likely to embolden your opponents rather than assuage them. It sounds a lot to me like John Kerry.

Frankly, I find the republicans newfound love of governance by public polling highly hypocritical. They used to lambast Bill Clinton for governing via poll numbers all the time, and we only recently exited an era of governance that disregarded public opinion for the most part.



AySz88:, You say, "The rest is mostly misunderstandings: there's no public option anymore, it's fully funded now, it lessens deficit instead of raising it."

Those aren't misunderstandings.

The public option is still in the house bill.

It isn't "fully funded". Part of the funding is based on $500 billion in mythical cuts in Medicare. Not one single dime of the $500 billion has been identified. Part of the "fully funding" is also the gimmick of pre-collecting taxes for 3 years before expenses start. It makes this look 10 year revenue neutral but if you go out 15 years, it costs $200 billion more per year than it would take in.

It lessens the deficit? That's really funny. Show me those $500 billion in medicare cuts and that might hold a tiny bit of weight. Even if those were real, it doesn't lessen the deficit. It simply moves the debt from one part of the budget to another and takes some of the cost off-budget altogether.

The more people keep making these outrageous claims, the more people are going to be opposed to this bill in its current form.

These claims are coming out of the mouths of proven career liars. If you happen to put your trust in lying politicians you believe all of these outrageous claims. About 60% of the country don't believe them.-


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