Americans Have a Prescription for Congressional Health Care Delirium

Americans in our poll are not in favor of abandoning health reform, and indeed assign it a higher priority than homeland security, education reform, and the environment.
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With their metaphors as mixed as their messages, some Democrats, led by House Speaker Nancy Pelosi, are scrambling to pass health care reform this week, while Senate Majority Leader Harry Reid (D, NV) says, "We're not on health reform now," and Senate Finance Committee chair Max Baucus (D, MT) says it can wait until summer. White House spokesman Robert Gibbs disputes the assessment of Senator Mary Landrieu (D, LA) that health care reform "is on life support." He also disagrees with President Obama's advisor David Axelrod, who said the ball is on the one-yard line: Gibbs now says it's "inside the five." The loss of yardage is attributable to the blitz by walk-on Massachusetts Republican Senator Scott Brown, whose win cost the Democrats their filibuster-proof, 60-vote Senate majority.

The one thing that's clear is that the way ahead is unclear. But the public is showing the way. Congress just has to listen, and not mistake the loudest voices (and lobbyists) for the majority. In an online survey we completed last week, 2,525 representative Americans told us that President Obama and Congress should focus on jobs (46%), excess government spending (26%), health care reform (18%), homeland security (7%), the environment (1%) and education (1%). Only 40% support the House or Senate health reform bills, while 51% oppose them. Though advocates of the bills say the public's skepticism is due to distortions and fear-mongering, 85% of the public say they are somewhat or very familiar with the bills. Indeed, when asked if Congress was "out in front" on health care, or "out of touch," 59% said "out of touch."

But a closer look reveals some surprises: while 81% are fairly or very satisfied with their health care, 87% want some type of health reform. Of these, most want "a fresh start," though nearly half want Congress to pass something now, modifying it later as needed. Indeed, 56% favor step-wise improvements, while 12% want one large health reform bill. Having some Republican support is thought important by 64% of respondents, and 61% advise Senator-elect Brown to work with both parties to find a compromise (versus 36% who say he should oppose health care reform in general). To our surprise, 33% say their support for some type of health reform has increased since a year ago, versus 26% who say their support has decreased.

Exactly what health reforms do they support? Cutting costs is the top priority for 40% (especially Independents and Republicans); expanding coverage is the top goal for 31% (especially Democrats); improving the quality of care was the top priority of 14%. When asked to rank what is essential, Americans place highest priority on requiring insurers to offer coverage to those with pre-existing conditions, not permitting them to drop people who get sick or hurt, and establishing health exchanges where individuals and small businesses can pool risks to reduce premiums and comparison shop online. Slightly fewer (50-55%) believe it is important to bar premium differences based on sex, to require employers to offer health insurance, and to extend coverage to all children. Nearly half say it is important to cap out-of-pocket expenses, subsidize premiums of those making less than 4 times the poverty level, expand Medicaid, and reform medical malpractice laws.

In contrast to our surveys last summer and fall, lower priority was given to increasing efforts to fight fraud, further restricting federal funding for elective abortions, wellness incentives for doctors and patients, and efforts to reduce waste and errors. Least popular of all: requiring individuals to purchase health insurance, or cutting Medicare.

As to paying for it, 43% want no increase in their own taxes, but 46% would tolerate increased taxes of $50 (19%) to more than $1,000 (6%). (In previous surveys we found the favored approach to be an increase in cigarette taxes, which was not asked this time.)

In short, while the public now ranks health care reform behind jobs and government spending as one of America's top problems, they are not in favor of abandoning health reform, and indeed assign it a higher priority than homeland security, education reform, and the environment. They do not support the recent health reform bills, but want a fresh, bipartisan start, step-by-step, starting with health insurance reforms that expand coverage but do not cut Medicare or require large tax increases. They also support tort reform and efforts to reduce waste, fraud, and errors, and to incentivize prevention and wellness.

Reform leaders in Congress and Administration will object that many of these provisions are already in the bills that have passed the House and Senate. True, and many were advocated by Republican presidents going back to Nixon. If ever there were an opportunity for both sides to meet in the middle, with just a half-step by both, this is it. President Obama's visit to House Republicans on January 29 was such a step.

Republicans who think the country opposes health care reform and will punish its advocates at the polls should think twice. The public wants practical, step-wise, bipartisan health care reform. This will only increase as a priority once unemployment begins to fall. Americans could not possibly speak more clearly, and they will support whoever listens.

S. Ward Casscells, MD, the Tyson Distinguished Professor of Medicine and Public Health at the University of Texas at Houston, was Assistant Secretary of Defense (Health Affairs) from 2007-9.

John Zogby, Chairman of the Board of Zogby International, is the author of "The Way We'll Be: The Zogby Report on the Transformation of the American Dream."

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