Cognitive Dissonance: Public Opinion and Pending Healthcare Legislation

A reporter called and asked about healthcare reform legislation: "Is this the largest and most significant public policy legislation that has been passed by Congress over the wishes of the American people?"

I answered that I didn't know for sure. We don't have good survey results for every piece of legislation throughout U.S. history.

We do know that less than half of all Americans favor Congress passing a new healthcare reform bill at this point in history. This conclusion is based on every recent poll that I am aware of. That includes a couple (see here and here) just released this week.

Politicians have a curious relationship to polls. Politicians will often cite polls when the results support their position on an issue. Politicians will deride polls when they signify public opposition to their position. In this situation, public opinion as measured by polls is not highly compatible with the positive spin put on the healthcare bill by Democratic leaders and President Obama. So it is not surprising to find these -- and others on the "pro" side of the bill -- dismissing or criticizing public opinion



This is a truly interesting situation. We have senators working into the night and on Christmas Eve in order to pass what the majority of that body no doubt perceive as highly positive, historic legislation. We have President Obama postponing the start of his vacation in order to stick around for the final Senate vote on what he perceives to be -- potentially -- one of the signature victories of his first year in office. We have the public not at all convinced that the new legislation is a good thing for the country.

We gain some insights into the way the White House is handling this cognitive dissonance by analyzing recent remarks made by Obama's Senior Advisor, David Axelrod. Axelrod made the rounds of talk shows this past weekend.

Both David Gregory on Meet the Press and George Stephanopoulos on This Week asked Axelrod about the disparity between poll results and the healthcare bill. His responses can be divided into three categories:

1. The public actually likes the parts of the bill; they just don't like the overall bill.

MR. GREGORY: Let me talk about where the public is on this. This was our poll this week, Wall Street Journal/NBC News. Good idea, bad idea, the president's healthcare plan? Forty-seven percent say it's a bad idea, 44 percent say they thought it'd be better to keep the current system. Is the public really for this?

MR. AXELROD: I think that there's a big anomaly in the polls that's worth discussing. When you ask people "do you support the bill that's working through Congress, the president's bill" and so on, they give you that result. When you describe what's in the bill, when you describe the fact that there are all kinds of protections for patients and consumers within the system, a, a, a, a patient's bill of rights on steroids, as--we've had that debate for years, are we going to protect patients? When you'd say--when you explain that small businesses are going to get tax credits and assistance so they can offer health insurance, and that individuals who don't get it through work are going to be able to get health insurance at a price they can afford, when you talk about the fact that it reduces deficits, extends the life of Medicare; when you talk about all of those things, people are very strongly supportive. But that's not the picture they've gotten through this kind of narrow debate we've seen on television in Congress.


Axelrod argues here that if people were aware of the specific benefits of the bill, they would support it. And that they may not be aware of these benefits because of the way the debate has been covered by the media.

This is the basic argument advanced by Democratic pollster Mark Mellman, who argues in a memo obtained by Politico: "Focus group research makes clear that voters know little about the substance of the plan-all they know is that some on both the left and the right don't like it and that it is the subject of intense controversy. In essence then, these questions ask people whether they favor or oppose "a controversial plan that is in constant flux."

I'm not aware of current data measuring how well Americans understand what's in the healthcare bill. Mellman's assertion is based on focus groups, not random sample surveys. We did a survey in July that showed about half of Americans said they understood the issues involved in the healthcare debate. About a quarter said that members of Congress understood the issues. The bill has certainly enjoyed a great deal of visibility in recent months. More than most legislation I would say. So it's not clear empirically that we can confirm the supposition that "voters know little about the substance of the plan".

It is true that the basic "ballot" questions on the healthcare bill is quite general. We at Gallup ask: "Would you advise your member of Congress to vote for or against a healthcare bill this year, or do you not have an opinion?" If one were to instead list the benefits of the bill as Axelrod has outlined in his response to David Gregory, one by one, I have little doubt that the public would be supportive of each individually.

But. It doesn't appear that Americans' objections to the bill are based on a perceived lack of benefits. Americans' two major objections to new healthcare legislation center on government involvement and costs to the system as a whole. These objections center on the relative price that has to be paid to receive the benefits. Which makes it less than clear that Americans would suddenly move to the support side of the equation if they were appraised of the specific benefits of the bill.

2. The president does what he thinks is right, not what the public wants.

AXELROD: But here's the thing, David. If we--I guarantee you, the one thing the president's not doing is spreading the NBC or any other poll in front of him and pondering the political ramifications. What he's looking at are the, the millions and millions of people who have pre-existing conditions who can't get health care; the millions of people who--working people who can't get health coverage because they can't afford it. He's looking at the implications for our long-term budget if we don't act. He's looking at Medicare and its survivability. We'll add 10 years to Medicare through this health reform. Those are the numbers he's looking at. If the president--the president's belief is if he does his job and moves this country forward, the rest'll take care of itself. I don't think anybody wants a president who's governing according to the NBC/Wall Street Journal poll or any other.


And:


AXELROD: First of all, you say this is what people think, I think when people see what actually happens after these reforms are passed, those concerns are going to be allayed, and they're going to realize that if they have insurance, they're more secure in their relationship with their insurance company, their costs are going to go down.

If they don't have insurance, they can get it at a price they can afford. It's going to reduce our deficit. It's going to extend the life of Medicare. Medicare recipients are going to get a better deal on prescription drugs and better care. So the reality I think will trump polls numbers in the dead of winter as this debate is going on.

As I've noted previously, these are fairly standard responses by elected representatives (or their surrogate in this situation) when confronted by the fact that they are enacting policy the public doesn't support.

Axelrod is arguing that the president understands the problems besetting the people better than the people who are being beset by the problems. Or that the president understands the problems affecting a minority of Americans which the majority of Americans ignore. Or, harkening back to the initial point, that Americans don't understand the benefits that will come from the bill and won't until after it is passed and these benefits begin to roll in.

Healthcare is one issue which is not highly abstract or abstruse for Americans. It's not policy relating to Turkmenistan. It's not a decision on the relative merits of tanker replacement options and whether to use the proposal advanced by Northrop Grumman Corp/EADS versus the proposal advanced by Boeing. It is, instead, an issue that is near and dear to most Americans' daily lives. It touches most Americans very directly. It would seem that Americans would be able to understand the ramifications of proposed remedies for this particular policy issue if for no other.

In the final analysis, the public's ongoing reaction to the passage of a new healthcare bill be is an empirical question. One not answerable until time goes by in the months -- and years -- ahead.

3. The only poll that matters is the vote on Election Days.

AXELROD: And what I suggest is that you guys wait until next October to talk about polls, when they're actually germane to an election, because that's a, that's an eternity away.

This is certainly a valid argument in terms of actions that have legally binding implications. Polls do not have legal standing. Election votes do.


Still, today's public opinion is highly likely to affect tomorrow's elections -- even if they appear to be an eternity away. Axelrod may hope that American voters will shift their perspective on the bill between now and next November. But this is by no means assured. In fact, Republican leaders are arguing just the opposite. That by next October, the healthcare bill will be a major negative for those representatives who voted for it. Again, what will happen by next October is unknown at this point.

Regardless. I'm of the conviction that elected officials should pay attention to polls between elections. Saying that polls are only germane in relation to an election suggests that the views of the public are only useful to the degree that they reflect or anticipate a vote. I disagree with that premise. Our legislative process can benefit from as much enlightened input as possible. There has been no shortage of input in this particular process from lobbyists and special interests. Why not make room at the table for input from the people who are actually most likely to be affected by the legislation?