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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

Complex Public Attitudes Dog Health Care Reform

Anyone who thinks that public opinion about health care reform is any less complicated than our health care system should give TDS Co-editor William Galston’s article on the topic in The New Republic a slow read. On policy-holders self interest:

I take as my point of departure a survey Kaiser conducted in October of 2008, on the threshold of the presidential election. It shows that twice as many voters cared about making health care and health insurance more affordable as about expanding coverage for the uninsured, and that only one in ten gave high priority to improving the quality of care and reducing medical errors. Not surprisingly, voters were very concerned about increases in their health insurance premiums and other out-of-pocket costs–indeed, more concerned about this than about increasing employer, government, and national spending combined. It is hard to avoid the conclusion that in evaluating proposed health reform legislation, voters will be looking first and foremost at its impact on their own pocketbooks, with broader issues trailing well behind.

On funding:

…58 percent believed that “if policymakers made the right changes, they could reform the health care system without spending more money to do it.” If the people mean what they say, they are likely to regard requests for additional funds as evidence that Congress has made the wrong changes–that is, unless President Obama and congressional leaders explain why health reform cannot succeed without substantial upfront investments.
…As for financing options, majorities support increasing taxes on cigarettes, alcohol, and “unhealthy snack foods” but not soda and soft drinks, which experts regard as major contributors to the rising tide of obesity. (When those who favored this approach heard the argument that so-called “sin taxes” would hit low-income people the hardest, however, six in ten changed their minds and opposed it.) As for taxing employer-provided benefits, a solid majority are opposed, even when they are told that only the “most generous” benefits would be affected.

On health care as a national priority:

This brings me to the April tracking survey. It showed that respondents think reforming health care is only the fourth most important priority (on a list of eight), behind improving the economy, stabilizing Medicare and Social Security, and reducing the federal budget deficit. It is hardly surprising that partisans divide sharply: Democrats rank health reform second from the top, Republicans second from the bottom. Independents, whose ranks have swelled since the election, place it fifth.

Galston has an interesting section on the experts opinions vs. public opinion, with this nugget about the proposed compulsory purchase of health insurance:

Consider, finally, the proposition that all individuals, including those who are young and healthy, should be required to purchase health insurance. Most experts and policymakers agree that without this “individual mandate,” insurance companies will continue to screen out prospective beneficiaries with preexisting conditions and other discouraging health profiles, and the linchpin of current reform proposals will snap. Unfortunately, the people don’t agree: A Rasmussen survey published in late May indicates that only 31 percent of Americans favor requiring everyone–including young adults and those in good health–to purchase insurance. And when they were asked what should happen when those who choose not to buy insurance end up in emergency rooms, three quarters say they should receive treatment even if they can’t pay.

Galston concludes with a warning to political leaders to level with the American people about “the choices they face if we are finally to achieve universal health insurance with meaningful cost containment.” He urges bringing the public into the discussion to help avert “another catastrophic failure.” Such a buy-in can increase public confidence in the reforms that are enacted — and help strengthen the Obama Administration and congressional Democrats.

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