A November 4 article in the New England Journal of Medicine compared U.S. public opinion about the health care overhaul effort during the Clinton Administration and the current one that the Obama Administration has championed. The results are that the pattern of public opinion is similiar today to what it was in the early ’90s, probably not a good sign for advocates of the current bill, but not necessarily the end of the world.

The study by Robert J. Blendon, and John M. Benson looks at a galaxy of polls taken during both periods, and it found that while overwhelming majorities of Americans say now and said then that they want health care reform, support for the specific proposals working their ways through the legislative process was (and is) weak. They like the idea of reform but not necessarily the reality of it.

In 1994:

• “85% of the public believed that the U.S. health care system needed to be fundamentally changed or completely rebuilt
• “Nearly two thirds (63%) knew that the Clinton plan provided health insurance coverage for all Americans,¹ a goal considered very important by 82% of Americans at the time.
• “…major elements of the Clinton plan had widespread support, including a requirement that health insurance be made available for those with preexisting conditions (81%)  and that all employers provide health insurance for their full-time employees (73%).
• ^” At the same time, only 39 to 43% of Americans supported the Clinton health plan, and 40 to 43% approved of Clinton’s handling of health care policy (see Table 2).
• “…among those who expected to be affected, more respondents thought they would be worse off than thought they would be better off.”

Today:

• “84% believe that the health care system needs to be fundamentally changed or completely rebuilt.
• “…a majority (53%) believes that the country would be better off if the legislation being discussed were enacted.
• “The public also favors several of the policy elements being discussed for inclusion in the final bill, including requiring insurers to cover people with preexisting conditions (80 to 89% support) and requiring employers to offer and contribute to their employees’ health insurance plans (59 to 67%).
• “…a public option — a government health insurance plan offered as a competitor to private plans — had widespread support in 8 of 10 polls, but support varies depending on how the option is described.”
• Still, “In six recent polls, support for enacting these initiatives ranged from 34 to 49% .
• “41% of Americans were undecided about the plan in April, and as the proportion of those who were undecided fell to 20%, opposition more than doubled, from 20% to 42%.”

Maybe this disparity has to do with how the Obama Administration and Congressional Democrats have communicated about their plan. Maybe it has to do with the sheer complexity of the reform effort. It’s hard for even those who try to follow it closely to understand what the stakes and outcomes will be. And maybe there are many people who see how imperfect the final product could be, and they’re saying that half a loaf is not good enough (but I seriously doubt these represent a significant part of the survey population — see the second maybe above).

Maybe, too, it’s a result of how much mud opponents have put in the water — scaring people into thinking, for example, that so-called “death panels” will decide who dies and who lives and equating the “public option” to Bolshevism. Call it another political victory for intellectual dishonesty.

But, Blendon, and Benson say, the story about this year’s reform effort is not yet over. They write:

We believe that public opinion is still fluid on the key question about the impact of the legislation. When asked whether they thought they would support or oppose a final health care bill or whether it would depend on decisions that still have not been made about the bill, 25% said they would support it, 33% said they would oppose it, 39% said it would depend on the bill’s final form, and 3% were unsure (Gallup, October).

In other words, stay tuned.

November 6th, 2009 by Jeff Weintraub | No Comments
Tags: Clinton Administration · health care reform · New England Journal of Medicine · public opinion