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What Price Health Reform? What Price Health Reform?

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What Price Health Reform?

Initial Willingness To Pay For An Overhaul Usually Gives Way To Opposition As Specifics Enter The Picture

Are Americans really willing to pay higher taxes for universal health care coverage? Three surveys conducted last month show that roughly half say they are.

• A CBS News/New York Times poll finds 57 percent of adults willing and 37 percent unwilling to "pay higher taxes so that all Americans have health insurance that they can't lose, no matter what."

Read more from Mark Blumenthal on health care polling at

• A Quinnipiac University poll finds 49 percent of registered voters willing and 45 percent unwilling "to pay more in taxes for a health care overhaul plan that reduces health care costs and covers those who don't have health insurance."

• A Kaiser Family Foundation poll finds 41 percent of adults willing and 54 percent unwilling to "pay more -- either in higher health insurance premiums or higher taxes -- in order to increase the number of Americans who have health insurance."

Policymakers who support health care reform and are searching for new sources of revenue to pay for it may take some comfort in these results. But be forewarned: Genuine support for higher taxes is likely much lower than these results imply.


Not surprisingly, question wording helps explain some of the variation in the above results. Health insurance you "can't lose, no matter what" certainly sounds more appealing than simply increasing "the number of Americans who have health insurance." And the potential for increases in both taxes and premiums probably sounds more threatening than just unspecified "higher taxes."

More broadly, all of these questions may exaggerate true support for tax increases because they are unavoidably double-barreled, asking about both an appealing goal -- health care coverage for all -- and a willingness to pay for that goal. How do you answer if you want reform but do not want to your own taxes raised?

The answer, as presented in a helpful "data note" released last week by the Kaiser Family Foundation, is that an initial willingness to pay typically gives way to opposition as questions move from the abstract to the specific. Here are four tips on how to avoid being misled by questions that show relatively high willingness to pay in the abstract.

Price tags matter. When the CBS/Times pollsters asked those initially supportive of higher taxes if they would be willing "to pay as much as $500 a year more in taxes" to fund health insurance, support dropped from 57 percent to 43 percent.


Similarly, when the Quinnipiac survey asked those open to higher taxes just how much they would pay, only 20 percent of all registered voters (40 percent of the higher-taxes group) said they would pay $500 or more each year.

Who gets taxed matters. Not surprisingly, Americans respond more favorably when it sounds like someone else will foot the bill. For example, the Kaiser poll, as well as recent national surveys conducted by ABC News/Washington Post and NBC/Wall Street Journal, have all shown support at or above 60 percent for raising taxes on families earning more than $250,000 in order to pay for health care reform. The Kaiser survey finds similarly strong support for increasing taxes in cigarettes, alcohol, wine and beer.

Yet only 29 percent of Kaiser respondents expressed support for "increasing income taxes for all those who pay income taxes," while 67 percent were opposed.

Watch the "no" side. Republican pollster Neil Newhouse says he generally discounts the "yes" side of abstract questions about raising taxes in order to fund an appealing benefit. So the 37 percent of adults telling the CBS/Times poll they would oppose raising taxes even for coverage you "can't lose, no matter what" helps identify what Newhouse calls the "base of hard-core opposition."

Test the specifics. "The easiest way to change results on an abstract question," conclude the Kaiser Foundation analysts, "is to make it concrete." They advise us to "to push beyond the abstract" and test responses to more specific proposals.

The best example is the proposal to change the tax treatment of employer-sponsored health benefits. The Kaiser analysts compared questions on six different surveys that described proposals to start taxing health care benefits and found opposition varying between 46 percent and 70 percent, support between 20 percent and 40 percent.

Their own test of a proposal to tax only the "workers with the most generous health care benefits" finds the most support for taxing benefits (40 percent) yet still leaves a majority opposed (54 percent). One reason for that opposition is that on a subsequent question, 41 percent of those with employer-sponsored health insurance say they think their own plan "would be considered among the most generous and be subject to the new tax."

All of these results, combined with strong majority support for an "overhaul" of the health care system, tell us that many Americans want reform but do not want their own taxes raised.

The June Kaiser tracking survey also adds a detail that the researchers found "sobering." Americans have a ready rationalization for their arguably inconsistent views: Sixty percent of Americans say that "if policymakers made the right changes, they could reform health care without spending more money to do it." Only 34 percent believe that "real reforms" require policymakers to "spend more money."

Two weeks ago in this column, I quoted Democratic pollster Allan Rivlin saying that while the public supports health care reform, "paying for it is still an open question." Now we know why.

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