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Public Opinion and Health Care: Fearmongering on the Right

When forced to express an opinion specifically about Obama's plan, most poll respondents will. But if permitted, they will also admit that they really don't know much about it.
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Recently, New York Times columnist David Brooks has echoed the chorus of right wing noisemakers, who claim that the public is firmly opposed to the healthcare reform efforts of President Obama and the Democrats in Congress, and that if the Democrats persist in trying to pass such legislation, they will suffer electoral disaster in 2010. Such concern for the Democratic Party by these otherwise stalwart partisan foes suggests at least a scintilla of insincerity, but the depth of that disingenuousness cannot be appreciated unless one examines more carefully the actual claims.

Brooks writes, for example, that "public opposition to health care reform is now steady and stable." He adds that according to Republican pollster, Bill McInturff, "public attitudes toward Obamacare exactly match public attitudes toward Clintoncare when that reform effort collapsed in 1994."

In fact, public support for health care reform today is substantial, even according to McInturff's own polls, and it mirrors the strong support for health care reform expressed by the public in 1994, even as the Republicans were killing President Clinton's proposals with their "no compromise" strategy.

McInturff is the Republican partner of the NBC/Wall Street Journal poll, while Peter Hart is the Democratic partner. Contrary to Brooks' claim about the public's opposition to health care reform, the McInturff/Hart mid-August poll for the media organizations found 60 percent of Americans saying that the U.S. health care system needs either a complete overhaul or major reform. These results mirror those found by several other polling organizations, such as the recent poll by CBS News, which shows 82 percent of Americans saying the U.S. health care system needs either to be completely rebuilt or fundamentally changed. It's clear that Republicans in Congress do not agree with the public on this matter.

While general public support for reform is widespread, opponents of health care reform can point to polling questions that ask specifically about Obama's health care plan. Here the results show a decline in support over the past several weeks. Pollsters know that few people genuinely understand the various proposals, so typically they ask respondents to express an opinion based on "what you've heard or read." That's what the NBC/WSJ poll did, and it found 36 percent saying Obama's plan was a "good idea," with 42 percent saying "bad idea," and another 22 percent expressing no opinion.

That apparently is the basis for Brooks' contention that public opposition is now "steady and stable." But the pollsters recognize that many respondents who express an opinion do not know what Obama's plan is. So, in this case, McInturff and Hart wrote a separate question that included a brief summary of the plan. Once respondents heard what the plan was, a 10-point majority expressed support (53 percent to 43 percent). Somehow Brooks failed to mention this finding.

A similar situation prevailed in 1994, when President Clinton's health care plan was defeated. In general, the public expressed widespread support for reform. Over the course of the public debate, people became more confused about the specifics of Clinton's plan and thus more negative. Reform legislation ultimately failed in October, but Gallup polls right beforehand showed even then that more than 60 percent of Americans wanted Congress to pass health care reform -- if not that year, then the next year.

When respondents were asked, "from everything you've heard or read about the plan so far," did they favor or oppose Clinton's health care reform plan, a majority said they opposed it (55 percent to 40 percent). But the same poll showed that a stunning 70 percent admitted they needed "more information to judge the health care plans that have been proposed." And, when read a description of Clinton's plan, 61 percent were favorable toward it and only 37 percent unfavorable.

Today, we find the same confusion. When forced to express an opinion specifically about Obama's plan, most will. But if permitted, respondents will also admit that they really don't know much about it. The CBS poll, for example, reports that only a third of respondents say they understand the health care reforms being considered by Congress, while two-thirds say the proposals are confusing. Earlier, Gallup reported half of respondents saying they don't have a good understanding of the issues involved in the current debate over health care reform. In their confusion over the plan, with conflicting media reports about what it might ultimately entail, many people are cautious and express opposition. Yet, when the NBC/WSJ poll, and earlier a poll for National Public Radio, included descriptions of Obama's plan, majorities expressed support.

Because of implacable Republican opposition to health care reform, some supporters propose that Democrats consider a legislative technique in the Senate to circumvent a likely Republican filibuster, which would require 60 votes to override. Using "reconciliation," some Senate Democrats believe they could get most of the health care reform bill passed with a simple majority vote. Brooks characterizes this strategy as ignoring the "ignorant masses" to "ram health care through reconciliation."

That the "masses" may be ignorant -- or at the very least, misled -- is attested to not just by the CBS and Gallup polls, but by McInturff's own poll (with Hart). They found majorities of Americans believing -- erroneously -- that Obama's plan would cover illegal immigrants, entail a government takeover of the health care system, and provide tax dollars to pay for abortions. Close to half also believe the lie that the government would then be authorized to make decisions about when to stop medical care for the elderly. Given these widespread misperceptions, polls showing specific opposition to Obama's health care plan need to be viewed skeptically.

Still, Brooks argues that allowing for a simple majority vote in the Senate (hardly what democratic theorists refer to as "ramming") would be "suicidal." "You can't pass the most important domestic reform in a generation when the majority of voters think you are on the wrong path." But had Brooks looked carefully at the polls, he would find that most voters don't think Obama is on the wrong track. Not only do they overwhelmingly support reform, as shown earlier, but by a two-to-one margin, the CBS poll shows they also believe Obama has better ideas about health care reform than do the Republicans in Congress.

That the Democrats might actually get a health care reform bill passed worries Republicans, who believe, as did their party colleagues in 1994, that passing no health care bill will ensure a major Republican victory in the mid-term elections. Fifteen years ago, the Republican mantra was "no bill at any cost." And it worked. They crushed President Clinton's efforts to enact any health care reform, and in the mid-term elections they won majority control of the House for the first time in four decades.

Many, but not all, Democrats in Congress have learned the lesson of 1994. They know that whatever the public opinion polls show now, the party will be much weaker in the mid-term elections if it has failed to produce health care reform than if it can enact reform, even if "only" by majority vote. Taking advice from Brooks and his cohorts about what the public wants would constitute the real disaster.

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