Articles and Analysis


What's Up With the Health Care Reform Polls?

Topics: Bob Blendon , Health Care Reform

If you look at our chart mashing up the various pollster questions that track support or opposition to health care reform, it is hard to miss that the red "opposition" line has been rising during October. Why?

Keep in mind that differences in methodology (question wording, populations sampled) produce huge variation in the results. Use the chart's "plot" tool to hide the trend lines, and you see quite a bit of overlap between the dots representing individual poll results for favor (black) and oppose (red). As such, the "nose" of this particular chart gets fooled more often than election charts when the most recent polls come from pollsters that are typically skewed in one direction or another.

In this case, however, the change looks to be real. First, try using the "smoothing" tool to change to the "less sensitive" setting, which effectively reduces the influence of the most recent surveys on the trend line. Doing so in this case shows the same upward drift in the oppose line.

Second, forget the chart and focus on apples-to-apples comparisons for three pollsters that released new surveys over the last week:

  • Last week, CNN/ORC showed 45% of adults favoring "Barack Obama's plan to reform health care" and 53% opposed. That represents a reversal since mid-September, when 51% were in favor and 56% opposed.
  • Gallup shows initial support for the "health care legislation now being considered by Congress" falling sharply from 38% in mid-September and 40% in early October to 28% this week, with opposition remaining flat and "or do you not have an opinion" jumping sharply (from 22% to 33% since mid-September). When Gallup pushes their adult samples to say which way they lean, their results look similar to the CNN poll: 43% support or lean to support while 48% are opposed or lean that way -- a reversal since September and mid-October.
  • Last week's IPSOS/McClatchy poll shows a similar change: Earlier in the month, their adult sample divided on "the health care proposals now being discussed" (40% favor, 42% oppose). Their survey last week shows 39% in favor and 49% opposed.

Mickey Kaus noticed the trend in the IPSOS/McClatchy poll last week and asked what this apparent change might be about. Here is my take.

The most important thing to remember is that Americans most likely to be shifting their opinions are those least engaged in news about the ongoing Congressional health care debate. And even though most of the Pew Research News Index surveys in recent months show large majorities who say they are "closely" following the debate, they also find that nearly half of adults (44%) do not know that the "public option" deals with health care, while four-out-of-five cannot pick Max Baucus' name from a list of four senators as the chair of the Senate Finance committee working on health care.

Bob Blendon, the widely respected Harvard academic who has studied public opinion on health for much of his career, makes a similar point in a just published article in the New England Journal of Medicine (co-authored by John Benson, summarized on Kaiser Health News and blogged about yesterday by Karen Tumulty):

Most Americans are not health policy specialists, and they are unlikely to read a long and complex piece of legislation. Instead, they will rely on trusted intermediaries to clarify its likely impact on them. The President and congressional leaders play a critical role, but public confidence in leaders in Washington is not universally high.

As he has argued all along, Blendon believes that as the health care debate comes to a close, the "most important factor in determining the level of public approval" will be "Americans' impressions of the legislation's likely impact on their own situation. Support for or opposition to specific elements of the legislation and concerns about the need for reform in general will be secondary influences."

In that context, here are two theories about what might be behind the October trend:

1) More negative ads from reform opponents - CNN reports:

Opponents of President Obama's approach to health care reform have outspent supporters by more than $7 million in the past 30 days... "We are starting to see a separation in the messaging," said Evan Tracey, president of CMAG and CNN's consultant on political television advertising. "Groups that are opposed to President Obama's health care plan are starting to turn up the volume in key states to put pressure on lawmakers to vote against these bills."

2) Process coverage and Democratic disunity - As always, news coverage tends to focus on the legislative process - who is up, who is down and what tactics are working or not working. In September, President Obama's speech largely rallied Democrats who were generally upbeat and supportive in public comments. Over the last few weeks, however, the story reverted to previous form: Most coverage focused on threats of filibuster or non-support from Senators Landrieu, Bayh, Lieberman, etc. in contrast to the relatively unified opposition of the Republicans. My guess is that the contrast of Republican opposition and Democratic squabbling gives greater credibility to the Republican arguments against reform.

I called Blendon for his reaction, and he largely agrees. He points to the Gallup result showing 26% of adults who say the health care bill will "make your own health care situation better," 36% who say it will make it worse and 31% who think it will not make much difference. "In the absence of not having a fixed view of what this [reform bill] is and how it will work out for me," he said, Americans are "more susceptible to advertising."

In the same context, Americans are also watching the news coverage focused on the legislative process and "getting more scared." He said he watched the cable news coverage following passage of the bill on Saturday night and saw "not a word telling you why you should care if the thing passes."

Blendon still believes, as he and Benson argue in NEJM, that "public opinion is still fluid on the key question about the impact of the legislation." Again, the percentage that say they will be worse off still falls far below a majority, and Gallup has tracked in increase in the initial "not sure" response (from 22% to 33%) over the last month. Proponents of health care, Blendon argues, must invest time telling seniors and others who stand to benefit "how they will be better off...that's the thing they have to do to turn this around."


Kevin Collins:

These trends, and the seeming disjuncture between 'global' support/opposition of the current health care policy, seem to me to call out for closer thinking about how respondents are thinking about answering these questions - and better questions on public polls to get to those processes.

The Ipsos/McClatchy poll cited above shows growing opposition "the healthcare reform proposals presently being discussed," immediately before demonstrating that a majority of respondents support a public option which (along with perhaps the abortion policy aspects of the legislation) is one of the most contested aspects of the bills working their way through Congress. Attitudes towards a public option are relatively consistent across surveys (CNN reports similar findings) and are relatively stable over time.

So to recap, surveys from multiple firms show both growing opposition to the health care legislation before Congress, but shows consistent and stable support for the specific provisions within that bill, including those which have been the subject of the greatest internal debate and external contention (town halls, ads, etc). What is going on here?

There are a variety possibilities that could sort out this conundrum. First, when asked the generic support/oppose questions, people may think first of the aspects of the policies that they like least and a negativity bias emerges. These aspects of the plan may not have anything to do with the public option; as evidenced in the Stupak amendment vote attitudes towards abortion may be kicking in. Second, the contentious process might be driving attitudes. According to the CNN poll at least 60% of respondents consistently report "no, not enough" when asked "In your view, are the Republicans in Congress doing enough to cooperate with the Barack Obama, or not?" Third, as suggested in the NEJM article, uncertainty about the affect of the overall legislation on respondents may produce antipathy.

The process that is driving this discrepancy between stable support for (even contentious) policies within the health care legislation and growing opposition to the legislation as a whole could be uncovered with the cooperation of the media pollsters working on this issue. First, free the cross-tabs and provide raw data to academics. That way, we can unpack these polling toplines to reveal the story in greater detail.

Second, ask deeper questions. Ask supporters about policy changes that would make them oppose the bill, and opponents about policy changes that would make them support it. Alternatively, use survey experiments to test claims about the causes of support or opposition. Or randomize question ordering to prime respondents to think about various aspects of the overall policy before asking the global support/oppose question.

Without better data, any theory describing the basis of public attitudes about policy as multi-faceted as the health care legislation now in Congress will be unlikely to amount to more than speculation, to the frustration of not only social scientists, but also of lawmakers seeking guidance on the preferences of their constituents. Since fast-moving issues like this one inhibit rigorous academic studies, we would all be well served if public pollsters would take up the task of asking deeper questions.


I don't think any of these polls are worth anything. Only a tiny fraction of the public has any idea what is actually in any of the legislation, and even calling it "Obama's health care plan" is deeply flawed. The House has written one bill & the Senate has written a totally different one. Which one is "Obamacare?" Answer: the one that both houses end up passing and sending to the President. Who knows what will be in that bill?

If the questions were asked on a policy preferential basis, you might get some better results. For example, a good question might be "Would you prefer to have private health insurance companies make medical decisions for you or would you prefer a government agency to do it?"

Another good question might be: "Should either a private or government operated insurance company have the right to deny coverage due to a person's existing health, age, gender or employment?"

A third question: "Should health insurance companies, either government operated or privately owned, provide cost-effective screening for disease prevention or only cover costs when a person is actually being treated for a disease?"

Maybe if questions on substance, without saying whether they're backed by Democrats or Republicans, could actually get at the crux of the issue that interests the public.



We need to Used the Healthcare Reform Process, to Develop 21st Century National Infrastructure Services.

The Engine for Economic Growth in this 21st Century is "Broadband." We can start by Using Stimulus Investments, to Deploy a pure Packet-based, All Optical/IP, Multi-Service National Transport Network Infrastructure, using Ethernet throughout this National "Network of Networks."

This new "Network of Networks" will Provide Opportunities for New Job Creation, Economic Recovery, as well as Serve as a Business Driver for: e-Healthcare, e-Commerce, e-Education, Energy Systems, Transportation systems, Social Networking, Entertainment, etc. It can also Connect all Optical Islands, Nationwide.

This type of Investment is like the Investments, that were made in the past, in Electrification of Rural Areas, the National Transportation Inter-State Highways, which Increased Productivity, and our Nation's GDP.

Also, with Proper Deployment of Health Information Technology (within the "Network of Networks") Solutions and Training can Increased Productivity (i, e, medical data mining/ware housing, risks treatment, service delivery), Efficiency (i, e, medical errors, rdundant and inappropriate care), and have a Costs Savings of around 20-30% of our Annual National Healthcare Expendiitures ($2.4 Trillions).

Please See: www.gkquoquoi.blogspot.com for Summary Deployment Plan, for the Nationwide Health information Network (NHIN).

Gadema Korboi Quoquoi
President & CEO


Post a comment

Please be patient while your comment posts - sometimes it takes a minute or two. To check your comment, please wait 60 seconds and click your browser's refresh button. Note that comments with three or more hyperlinks will be held for approval.