Public Opinion Still Important in Healthcare Debate

Overheard at a gathering of pollsters Thursday night in New York City: "The healthcare debate has moved beyond public opinion at this point." The debate, it was opined, is now all about politics. With the public cast aside, waiting docilely on the sidelines to see what happens.

Of course, that's not totally true.

Politics ultimately comes down to elections. Through elections, people make their voices heard. Elected representatives stay tethered to the public because they stand for election. At least, in theory. Representatives and senators always, always have elections in the back of their minds.

Case in point. A piece in The New York Times Wednesday reports on the the tough decisions facing Arkansas Sen. Blanche Lincoln re the healthcare bill. Lincoln is a Democrat who faces a tough re-election battle next year in a generally Republican state. The views of the voters of the state of Arkansas are very much on her mind as she contemplates the implications of her vote on this volatile issue.

Notwithstanding elections, public opinion should help guide the healthcare debate in other ways. That's because public opinion is an appropriate and effective input into decision-making. Collectively, there is wisdom in the views of the public. Wise leaders take advantage of that wisdom.

Speaking of that wisdom. Americans still fail to see the benefits from a new healthcare bill. This has been a consistent finding in our Gallup polling. In a new Washington Post/ABC News poll, just 19% of Americans say that "if the health care system is changed" the quality of their healthcare will get better. Thirteen percent of those who are insured say that their health insurance coverage will get better. (Forty-seven percent of the small percent in the Washington Post/ABC News sample who do not have health insurance say that their ability to get health insurance will get better.) More than half of poll respondents say their costs will go up, while just 11% say they will decrease. Even more say the overall costs of healthcare in this country will increase under new healthcare legislation.

Lawmakers can profitably ask "why don't people see the benefits?" Particularly because the stated goal of healthcare reform is explicitly to make things better. ("President Obama is committed to working with Congress to pass comprehensive health reform in his first year in order to control rising health care costs, guarantee choice of doctor, and assure high-quality, affordable health care for all Americans.")

[Read this comprehensive list of benefits from the White House Web site. Most Americans would agree that these are admirable goals.]

Yet, our Gallup data, and many other polls, simply don't show that the public has come to the point where they agree that these benefits will be forthcoming if a new bill is passed. There is an apparent disconnect between the well-meaning efforts of the administration/Congress and the perception of those efforts by the average American.

So. A set of questions for senators and representatives to ponder as the debate moves forward:

1. Why do almost all polls show that less than half of the public supports passing new healthcare legislation?

2. Why do most Americans believe that the bill will not help them personally?

3. Why do less than half of Americans believe that the bill will help the nation as a whole?

To get at this in more detail, we recently asked Americans to tell us their concerns about a new bill -- in their own words. (See here for my detailed analysis).

These concerns coalesce into four categories:

(1) Costs. Americans have specific worries about the impact of a new bill on their personal costs of healthcare (despite the fact that the bill as passed by the House has the word"affordable" prominently in the title).

(2) Government involvement and bureaucracy. There are basic concerns about the implications of the federal government taking up an expanded role in this sector of the U.S. economy.

(3) Worries that the specific legislation could make things worse rather than better for many Americans' healthcare.

(4) Worries that the bill won't go far enough in expanding access to healthcare.

These concerns actually provide a pretty good guideline for Congress. One would think that -- knowing the concerns -- Senators and representatives should be able to provide specific responses. If they can do so, perhaps the percentage of Americans who believe a new bill would benefit them (and the nation) would go up, and support for the bill would rise concomitantly.