The ACP Advocate Blog
by Bob Doherty
Friday, August 28, 2009
What should Obama do about the drop in public support for health reform?
There no longer is any question that public support for health care reform is faltering. But the battle for the public's hearts and minds can still be won, but only if reformers understand the reasons and adjust their plans accordingly.
Many health reform advocates blame the drop in public support on the "lies" being spread about health care reform by "special interests" and on the endless reporting of angry voters at town hall meetings. It is true, as I wrote on Tuesday, that the public seems to be buying into many of the untruths being spread by reform opponents, despite the efforts of the mainstream media, and organizations like ACP, to set the record straight. It would be a mistake, though, for health reformers to ascribe their problems to uninformed voters being misled; calling voters "stupid" is not exactly a recipe to win popular support.
A new public opinion tracking poll by the Kaiser Family Foundation provides a more nuanced view. It shows that "a slim majority of Americans continues to favor moving forward on health care reform now despite an intensifying ad war and a political climate of contentious town hall meetings that coincide with rising concerns about the reform effort." But voters increasingly doubt that health reform will be good for them: 51% of voters are more worried "that Congress and the president will pass a reform bill that won't be good for [them] and [their] family" compared to the 39% who are more worried "that Congress and the president won't be able to pass health care reform this year."
Almost half (48%) are more worried that "under a new health reform bill, government agencies would play too big a role in deciding what medical procedures people can or can't get" compared to 38% are more worried that "currently, insurance companies play too big a role in deciding what medical procedures people can or can't get." A solid plurality of voters are concerned that health reform will reduce their choices of doctors and hospitals and increase wait times for non-emergency treatments.
The critics of health reform, though, should think again before concluding that they have won the public opinion battle. 63% of the respondents described themselves as "hopeful" about the health reform plans being discussed in Washington; only 41% described themselves as "afraid" of the plans.
Moreover, voters generally favor many of the specific ideas in the pending bills, with majorities favoring or strongly favoring expanding state programs for the poor, offering tax credits to help people buy coverage, requiring that all persons have coverage; requiring employers to offer coverage or pay into a health insurance pool; and creating a government-administered option similar to Medicare to compete with private insurers.
These data suggest several things to me. One is that a "hopeful" public still wants health reform and are inclined to support most of the key elements of the pending bills, but they are anxious that the result will be to limit their choice of doctor and give the government too much authority over patient care decisions. To put it differently, it seems to me that the public's opposition really isn't to expanding coverage, but to effect of cost controls on their own access to care.
Writing in the Washington Post conservative columnist (and physician) Charles Krauthammer sees a way out for the Democrats: drop the cost controls, the public plan, end of life counseling, and the idea of the government funding research on "best practices" and instead "promise nothing but pleasure - for now. Make health insurance universal and permanently protected. Tear up the existing bills and write a clean one - Obamacare 2.0 - promulgating draconian health-insurance regulation that prohibits (a) denying coverage for preexisting conditions, (b) dropping coverage if the client gets sick and (c) capping insurance company reimbursement. What's not to like? If you have insurance, you'll never lose it. Nor will your children ever be denied coverage for preexisting conditions."
Krauthammer predicts cost control and rationing will come later on.
President Obama has been insistent that health care reform must deal directly with costs, and putting aside tough cost controls - instead focusing on guaranteeing insurance coverage that can't be taken away - would be a huge shift for him and likely make the nation's long-term fiscal outlook worse. But the polls suggest that this might be the best way for him to salvage support for health care reform from voters who want better health insurance coverage, but not if it limits their health care choices.
Today's question: Do you think Obama and the Democrats should shift the debate from controlling costs to expanding coverage?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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