Americans "are deathly afraid that a government takeover will lower their quality of care." So writes Republican pollster Frank Luntz in a widely circulated set of talking points on how to stop a "government takeover" of health care.
Yet in summing up recent survey results, the Washington Post's Ceci Connolly and Jon Cohen write that poll questions "that equate the public option approach with the popular, patient-friendly Medicare system tend to get high approval, as do ones that emphasize the prospect of more choices."
Indeed, the latest ABC News/Washington Post poll found 62 percent of Americans expressing support for "having the government create a new health insurance plan to compete with private health insurance plans." Other pollsters describing the public option as "government administered" and "similar to Medicare" gauged even more positive reactions: 67 percent in a Kaiser Family Foundation poll in April and 72 percent in the most recent CBS News/New York Times poll.
So if Americans live in fear of government intrusion into health care, why does likening the public option to Medicare make reform more popular?
Consider some results obtained by the same Kaiser tracking poll. When asked how much they trust various health care players "to put your interests above their own," respondents rank doctors (78 percent trust "a lot" or "some") and nurses (74 percent) at the top of the list.
Among those insured through Medicare, however, "the Medicare program" (68 percent) scores nearly as high. Among those with private insurance, "your health insurance company" earns much less trust (48 percent).
Perhaps that result is just about perceptions of corporate interests and not about patient experience?
We can test that question with data from a set of surveys known as the Consumer Assessment of Healthcare Providers and Systems. CAHPS is an initiative of the Department of Health and Human Services that developed a standardized survey questionnaire used by virtually all health insurance plans -- public and private -- to assess patient satisfaction. Most private insurers use the CAHPS questionnaire and disclose the data to the National Committee for Quality Assurance in order to receive their accreditation. So thanks to CAHPS, we have a massive collection of data comparisons of how patients experience and rate Medicare, Medicaid and private insurance.
Those comparisons show the depth of Medicare's popularity. According to a national CAHPS survey conducted by the Centers for Medicare and Medicaid Services in 2007, 56 percent of enrollees in traditional fee-for-service Medicare give their "health plan" a rating of 9 or 10 on a 0-10 scale. Similarly, 60 percent of seniors enrolled in Medicare Managed Care rated their plans a 9 or 10. But according to the CAHPS surveys compiled by HHS, only 40 percent of Americans enrolled in private health insurance gave their plans a 9 or 10 rating.
More importantly, the higher scores for Medicare are based on perceptions of better access to care. More than two thirds (70 percent) of traditional Medicare enrollees say they "always" get access to needed care (appointments with specialists or other necessary tests and treatment), compared with 63 percent in Medicare managed care plans and only 51 percent of those with private insurance.
So let's come back to recent poll results on the "public option." Both the ABC/Post and Kaiser surveys found that while Americans react favorably to the basic concept of a public option, they are easily swayed by arguments about having an unfair advantage against private plans or being the "first step toward single-payer, government-run health care." On the latter argument, the Kaiser survey moved support from a 67-to-29 percent majority favoring the public option to a 41-to-50 percent margin opposing it.
If the Medicare experience is so positive, why are people so easily talked out of expanding on it?
First, younger Americans not enrolled in Medicare do not share the enthusiasm of seniors for the program. Six years ago, the Kaiser Foundation asked a national sample of adults to rate the Medicare program. Medicare was hugely popular among those aged 65 or greater. Eighty percent rated Medicare favorably. Similarly, more than half of seniors (62 percent) considered Medicare "well run" compared to only 28 percent willing to say the same of "private health plans such as PPOs and HMOs that people get through their jobs."
Those under 65, however, had very different views. Only 45 percent rated Medicare favorably. Only 36 percent considered it well run, as compared to 47 percent who said the same about private health plans. While 73 percent of those over 65 said Medicare allowed patients to choose any doctor, only 28 percent of those under 65 agreed.
Second, the older Americans who like Medicare see little to gain from the public option since they like the coverage they have now. Democratic pollster Stanley Greenberg finds "little support among seniors" for reform. A recent survey conducted by Greenberg's Democracy Corps found a narrow plurality among all voters favoring "President Obama's plan to change the health care system" (43 percent to 38 percent), but net opposition among seniors (34 percent to 50 percent).
So, the Americans experienced with "government-run" health insurance like what they have and don't want to change it, and younger Americans enthusiastic for change don't know what they're missing.