For the first time in a long time, health care has rocketed to the top of voters' big issues in the presidential election. With the future of health care reform in the balance, several recent surveys have put health care as the No. 2 concern after the economy, a position it has rarely enjoyed in recent elections.
Perhaps that’s why Mitt Romney decided it was time to outline his positions on health care policy, which he did in a series of speeches and media appearances this week. The details weren’t new—his campaign laid out its health care platform months ago—but Romney was unusually thorough in discussing those details himself.
But those details probably won’t matter much. Data from the same pollsters who see health care scoring high also suggests that voters aren’t really talking about health care when they list it as an issue. In this election, health has become something of a proxy issue for voters’ larger views about the appropriate role of the federal government. For opponents, it’s a symbol of government overreach; for supporters, it’s a sign of how government can help solve people’s problems. Those preferences better reflect voters’ partisan preferences than they do their actual experiences with the health care system.
“The debates are becoming less practical, about people’s problems, and more about whether or not it’s the right thing for the government to do,” said Robert Blendon, a pollster and professor at the Harvard School of Public Health who studies public attitudes about the health care system.
That attitude often was expressed during the Supreme Court's arguments over the law in March. Elizabeth Mancha, a private investigator from Georgia, came to Washington for the arguments because she felt the health reform law "truly exemplifies how out-of-control the federal government has gotten. It's the big trophy on the mantle," she told the Associated Press.
The economy is still, by leaps and bounds, the top issue for voters. But health care is catching up. In recent surveys from the Kaiser Family Foundation, Reuters, and CBS, it occupies the No. 2 slot. (Other polls have it lower down, though it’s a concern that comes up in virtually all the open-ended issues questions.) That’s unusual. Health care hasn’t bubbled up to the forefront of voter concerns in several presidential cycles.
The public is strongly divided on President Obama’s 2010 health care reform law—as it has been since the bill first passed. Kaiser asks people whether they approve or disapprove of the legislation every month, and the trend has been remarkably flat—about 40 percent oppose the law and 40 percent support it nearly every month.
But the numbers behind that topline are revealing. Startlingly few people actually know what provisions are in the legislation, even though large majorities support provisions like preventive care without copayment or rules limiting insurance company overhead, when asked about them specifically. (The individual mandate at the heart of the Supreme Court case is the exception to that rule—a majority of Americans know it’s in the law and a majority oppose it.)
Large segments of the population also believe things that are simply untrue about the law. More than 40 percent of those asked in a March Kaiser poll said they thought the law had already been overturned by the Supreme Court or weren’t sure. Sixty-eight percent of Republicans told Kaiser that they thought the law creates a government-run health care system to compete with private plans. Forty-one percent said they thought it allowed a “government panel” to make decisions about end-of-life care.
“We know so much from our polling about how little people really understand about what’s in the law, it’s hard to say that it’s because they really hate what it does,” said Mollyann Brodie, Kaiser’s pollster. “It’s become a real rallying point for the opponents for what they think is wrong with government, and I think that’s very different from their views of the health care system and what’s wrong with the health care system.”
Brodie drilled down into that question in March, when she asked opponents of the law whether that opposition was more about “what you know about the health care law” or “your general feelings about the direction of the country and what’s going on in Washington right now.” More said the second than the first—38 percent to 27 percent—while 32 percent said it was some of both.
Frank Newport of Gallup, whose own polling has shown less interest in the issue, said his findings are consistent with that overall picture: People like individual provisions when asked about them specifically, but not the law itself.
“One of the things that Obama’s team probably didn’t recognize in 2010 is it was the gestalt,” he said. “The overall bundling together of these things under the aegis of the government is what people are responding to.”
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