The President Comes Out Swinging (Sort of) on Health Reform

In his State of the Union speech Wednesday night, President Obama strongly reaffirmed his campaign and presidential promise to support "comprehensive" health reform. "I will not walk away from these Americans. And neither should the people in this chamber." And he continued, "Here's what I ask of Congress, though: Do not walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people."

One reason for this reaffirmation may be a more careful reading of the polls, indicating that, in fact, a majority of Americans do want reform. They just don't know what comprehensive reform means, do not understand what is actually in the bills that passed the Senate and the House, and have been led to believe a number of distortions of the proposed reforms.

A recent Kaiser Tracking Poll, conducted after the Massachusetts special election, revealed that when asked if they supported the current reforms, the public was split on the general question: 41 percent said they did not and 42 percent said they did. However, when asked about specific elements of reform and whether or not if these elements were included in the reform packages they would be more likely to support reform, the public had a very different answer. About two-thirds supported 18 of the key elements in the reform legislation that has already passed the House or the Senate (see 8 of those elements below). So, when details were pointed out about what was actually in the reform legislation, more people supported reform than when they were simply asked a general question about support or opposition.

CHART 11
Most Popular Elements
Percent who say hearing the proposed legislation would do each of the following makes them MORE likely to support it:

Tax credits to small businesses - 73%
Health insurance exchange - 67%
Won't change most people's existing arrangements - 66 %
Guaranteed issue - 63%
Medicaid expansion - 62%
Extend dependent coverage through age 25 - 60%
Help close the Medicare doughnut hole - 60%
and....
Public option - 53%

Note: Question wording abbreviated. Other than the public option response, only items with responses 60% and over shown here. Source: Kaiser Family Foundation Health Tracking Poll (conducted January 7-12, 2010)

In another analysis of support for reform vs. awareness of it, only a little over half of the respondents could estimate correctly if the element they liked was actually in the reform plans.

And a NBC poll in August, in the heat of the summer Town Halls, found that approval for health reform went up significantly when people learned more about what was actually in the reform packages.

In the last few days, we have all been whiplashed by contradictory messages coming out of the House, the Senate, the White House, and cable news about the prospects for health reform. One minute health reform is dead. The next it's on life support. Some polls have declared that Americans do not want any health reform. Other polls have declared exactly the opposite. Thankfully, the President seems to have listened to more than the "top lines" of the polls but has dug deeper into what those responses really mean in terms of specifics.

If you believed that Americans had really done their homework, studied the bills in detail and come to the conclusion that they opposed the whole package, then there would be reason to listen to doom and gloom predictions. But so few members of the public have done that homework on their own, as evidenced by the Kaiser poll, that the results of the polls seem misleading if not completely wrong.

It is clear that the President still believes that the only way to bring down the deficit is to bring down health care costs, so he was compelled to reaffirm his support for comprehensive reform (as against piecemeal insurance-only reform). And since the House and the Senate have voted for these bills, it always seemed astonishing to me to think they would back down now as a result of one election and a few negative polls. If the objective situation with health care has not changed because of Massachusetts, the solutions should not change either.

We thought we elected leaders who would lead, not by poll numbers, but by what they believed was right. While the House and the Senate have yet to show the extent of their mettle, at least the President has had the guts to do so.