There’s very little question that two basic decisions by the Obama administration on health care reform have significantly complicated efforts to mobilize public support for actual legislation. The first, which was actually made during the early stages of the 2008 presidential campaign, was to adopt a relatively complicated approach to reform that involved competing public and private plans, health insurance “exchanges,” and subsidies, among other technical-sounding features. The second, after the election, was to promote reform generally through the congressional committee system, without issuing a detailed blueprint the President would insist that Congress follow.
There were very good substantive and political reasons for both these decisions, but inevitably, they have made it harder for Americans who only vaguely want health care reform to embrace Obama’s approach, and easier for reform opponents to cherry-pick provisions in various bills that can be blown out of proportion or demonized, and to simply lie about features that are difficult to explain.
This has created a gap in public opinion between what people might support if they understood it, and what they support in the absence of any understanding. In a new post at The Atlantic on recent polling, Ron Brownstein takes a closer look at that gap:

The NBC/Wall Street Journal national survey also released this week…found that just 31 percent of independents now approve of Obama’s handling of health care, while 54 percent disapprove, according to crosstabs from the poll provided by Public Opinion Strategies, one of the pollsters. Asked their view of Obama’s health care plan, just 28 percent of independents said they consider it a good idea, while 43 percent described it as a bad idea, and the rest said they didn’t know.
Yet when the pollsters read a description of the Obama proposal to respondents, the attitude among independents sharply shifted. Opposition among them remained roughly the same at 44 percent. But support jumped to a 52 percent majority. The gap between potential and actual support for Obama’s plan among independents suggests two things: that the White House is losing the struggle to define the plan so far, and that they may have room to increase their support if they can regain the initiative.
Obama faces a formidable gap between potential and actual support even among Democrats in the NBC/WSJ poll. Just 62 percent of Democrats described his plan as a good idea; but after hearing the explanation, 78 percent of them said they would support it. (Even among Republicans, support jumped from just 9 percent to 23 percent when they were provided a description of the plan.)

So voters need to hear this explanation, from the President and every available ally, the moment the White House decides on a reasonably clear vision of what can be ultimately wrested from Congress. There won’t be a lot of time for this to happen, and in the end, some congressional Democrats from competitive districts or states will need to vote for reform in hopes that constituents will like the results even if they are doubtful about what they understand to be the plan. After all, most of the fears being fed by reform opponents will not actually materialize if a bill is enacted; the seniors who are so negative about reform will discover that little or nothing has changed in Medicare; death panels will not be convened; doctors will not lose their right to control treatments.
Reality ought to count for something in the health reform debate; reform proponents need to explain what they can, and also count on the consequences of the legislation to make its enactment a political plus.