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What People Believe About Health Care Reform What People Believe About Health Care Reform

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What People Believe About Health Care Reform

Is It Time For Democrats To Take A New Approach?

Some time after the 2006 midterm elections, I heard Republican pollster Dave Sackett recall advising his clients that in the realm of politics, "truth is what people believe." While many Republican lawmakers saw a disconnect between the performance of the economy and the way voters evaluated their handling of it, Sackett said, perceptions ruled. A longstanding Republican advantage on economic issues crumbled.

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Now the roles have reversed. Democratic insiders are scratching their heads at the apparent gap between the reality of health care reform legislation and the public's perception of it. Most recent national surveys show at least plurality opposition to health care reform legislation, yet the January tracking survey by the nonpartisan Kaiser Family Foundation finds as many as half of Americans "unfamiliar with key elements of the major bills passed by the House and Senate." Moreover, when the Kaiser poll informed respondents of "key elements" of the legislation, "majorities reported feeling more favorable."


So should Democrats heed Sackett's advice and accept what people believe about health care reform?

To begin to answer that question, let's consider the process that led Americans to their current beliefs about health reform. It is tempting to see opportunity in the disconnect between perception and reality, but much of that gap is about Americans' distance from the detail of legislative politics.


Consider the results of the Pew Research Center "News IQ Quiz" survey released just this week. It shows relatively small numbers of Americans who know that 60 votes are needed to break a filibuster (26 percent), that not a single Republican senator voted for health care reform (32 percent) and that Harry Reid is the Senate majority leader (39 percent).

Those results may seem out of sync with the strong interest that Americans have been expressing in the health care debate. Since July, the weekly news interest surveys conducted by Pew Research show between 40 and 50 percent of Americans report they are "very closely" following news stories about "the debate over health care reform."

The chart above shows that since the summer, interest in health care reform has roughly matched interest in news about the economy, a pattern that closely parallels actual news coverage. Yet a separate Pew survey shows that while 83 percent of Americans rate "strengthening the economy" as a "top priority," fewer give the same rating to "reducing health care costs" (57 percent) or "providing health insurance to the uninsured" (49 percent). The prominence of the health reform debate helps explain why so many Americans, as measured by the latest NBC/Wall Street Journal poll, think President Obama has paid too much attention to health care reform and not enough to the economy.

With so many saying they have followed the debate closely, why so much ignorance of the details? The answer is partly that few Americans focus on the specifics of the legislation and focus instead on a few bigger stories that break through the noise.


Consider the three stories that generated the most attention on the Pew news interest tracking (other than health care and the economy) during 2009:

• "Congress passing Barack Obama's economic stimulus plan" (50 percent closely following, Feb. 13-16)

• "News about millions of dollars in bonuses paid to AIG employees" (50 percent closely following, March 20-23)

• "Barack Obama's budget proposal for next year that raises taxes on wealthy Americans and increases spending on health care, education and other programs" (47 percent closely following, Feb. 27-March 2)

So prior to the health care debate, the Washington stories that Americans heard most clearly were about massive new government spending on a bank bailout abused by Wall Street; a near-trillion-dollar economic stimulus plan; a budget that included tax increases; and (to a lesser extent) a multibillion-dollar auto industry bailout (33 percent closely following in February; 40 percent in December 2008).

Then came the health care debate. News coverage focused, as it often does, on the horse-race aspects of the legislative process, and that helped spawn a "holistic" view of reform that a Democratic pollster friend of mine heard repeatedly in focus groups of independent voters: "One, Republicans all hate it, and the Democrats cannot agree what to do, so how good can this proposal be? Two, it's going to cost a trillion dollars? We're spending too much already. Three, my insurance is pretty good right now; I really don't want to lose what I have."

Looking forward, some Democrats share the hope expressed by White House communications director Dan Pfeiffer last week. If health reform is passed, he said, people will realize that "death panels aren't coming to your door" and "no one's yanking your doctor away," so they will "automatically see that it's much different than they have come to believe." In contrast, conservative voices like RealClearPolitics' Sean Trende see "little political upside for Democrats in passing this bill, and much, much downside."

So there is much disagreement about the potential fallout of quickly passing the current bill. What should be obvious from the 2009 experience, however, is the futility of starting the legislative process over again in hopes of mobilizing opinion to pass a "scaled-down" bill. Months of process coverage in 2009 helped sour Americans on reform. How would more months of process coverage in 2010 be any different?

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