As the epic debate over health care reform enters its final days, partisans are pointing to different polls to argue that their side is winning the battle of public opinion. Even those not using polling as a weapon of propaganda are asking a related question: When it comes to health reform, what do Americans really want?
Two weeks ago, Ipsos Public Affairs pollsters Cliff Young and Aaron Amic noted the "cherry-picking" of survey results evident on both sides of the debate. "Democrats," they wrote, "prefer to cite polls on the public option, which has consistently shown strong majority support," while Republicans "point to polls on general support for health care reform -- most showing only a plurality." Both sides "miss the mark" because "they assume that polling on health care reform is analogous to polling on presidential elections."
The problem extends far beyond partisans. For many Americans, as I noted last week, polling is the horse race -- the question that pollsters use to determine candidate preference.
But an election campaign features something tangible to forecast: Some Americans cast a ballot; others do not. Those who vote ultimately choose to support a specific candidate. The ballot has no option for "mixed" opinions.
In the health care debate, however, no one votes besides the 535 members of Congress. True, a significant number of people have followed the debate closely and formed unambiguous opinions about which side they support. Some of the decided may choose to write their member of Congress or otherwise speak out, but these are the minority. Most Americans have only a general sense of the debate and need not pick sides or resolve conflicting attitudes the way they do in an election.
Yet the question of "what Americans want" remains critical to nearly everyone involved in the health care debate. Reformers and reform opponents want to know if the public is on their side, and if not, how to win over a majority. Self-interested members of Congress want to know whether their health care votes will be punished or rewarded in 2010 or 2012.
Asking simple follow-up questions can help give a better sense of why Americans favor or oppose reform. November polls conducted by CNN/Opinion Research Corporation and Ipsos/McClatchy, for example, find that about a quarter of the opposition comes from the left, those who say they oppose reform because it is "not liberal enough" or "does not go far enough." Yet a more recent survey by Public Policy Polling finds a much smaller silver of the opposition (6 percent) coming from those who say the reform does not "involve government enough." So these questions too produce fuzzy results that are open to differing interpretation.
The most helpful approach of all comes, not surprisingly, from the tracking polls conducted by the Kaiser Family Foundation, an ongoing project to measure attitudes on health care reform.
Kaiser's November survey begins with a new three-part question that captures the ambiguity in general attitudes about reform. More than a third of respondents (35 percent) agree that "the president and Congress need to take on health care reform now, and I like what I'm hearing about the proposals currently being considered." Slightly more than a quarter (26 percent) say the government should not "take on health care reform right now." And a third have doubts but are somewhere in between -- they want the president and Congress to take on health care reform now but don't like "what they've been hearing about the proposals begin discussed."
An analysis prepared by Kaiser for this column shows the sort of consistency we would expect from the two-thirds of respondents with unambiguous opinions. They sharply polarize on whether reform will benefit their family or the country and in their reactions to specific elements of the reform, such as the public option and employer and individual mandates.
But the Americans in that middle third demonstrate a number of conflicting and unresolved opinions about health reform. They support some provisions such as individual mandates (76 percent), employer mandates (66 percent) and the public option (61 percent), but as the Kaiser analysis notes, their support is not "full throated." Strong support for these provisions is just 34 percent, 33 percent and 23 percent, respectively.
The middle third divide evenly on whether they will benefit from reform. Thirty-seven percent say it will be better for their families if reform passes, and 44 percent say it will be better if the system were left in place with no changes.
What makes these middle voters most distinct is their concern about cost. While opponents of reform worry most about busting the budget and supporters worry about the affordability of coverage, those in the middle worry about both. As the Kaiser analysts put it, "they have cost on the brain." When asked to rate the importance of eight elements of health reform, voters in the middle give their highest ratings to "not adding to the country's budget deficit" (47 percent extremely important)" and "making sure affordable health insurance plans are available to the average consumer" (42 percent).
What do Americans want? The answer is not much different than what surveys were telling us back in July. Those who favor "reform" want the security of affordable coverage that can't be denied or taken away. Those in the middle worry even more about cost.
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