Bob Shapiro, author of two important books on public opinion (The Rational Public, 1992, with Benjamin Page, and Politicians Don’t Pander, 2000, with Lawrence Jacobs) sent me this report he just wrote with Sara Arrow, comparing public opinion for Obama’s health care initiative with opinion in 1993-94, when Bill Clinton’s health plan crashed and burned. They write:
The increasingly favorable climate of public opinion for health care reform that Clinton had in 1993 eroded enough by 1994 to dissipate any strong push on the public’s part for reform . . . All signs on the surface were that Obama took office in January 2009 with the same–or an even greater–impetus for health care reform. . . . It would therefore not be surprising to find–and there was every reason to expect–that Obama would have behind him even a more favorably disposed public than Clinton had to help move reform legislation forward. But has this been the case? Our best estimate is, overall, probably not, and this explains the battle that Obama has faced in getting public support to help the reform effort along through Congress or to offer approval later of any landmark legislation that is passed and implemented.
Shapiro and Arrow look at 18 survey questions on health policy, comparing average responses in 2009 to those in 1994. They define change in opinion as a shift of six percentage points in the balance of opinion in one direction or another. This is what they found:
* 5 questions where opinion was more favorable to health care reform in 2009 than in 1994: Does the health care system need to be rebuilt? Do you think the president’s reforms will decrease the amount you’ll pay for medical care? Do you think the Democratic party is more likely than the Republicans to improve the health care system? Do you approve of the way the president is handling health care policy? Do you favor the president’s plan?
* 4 questions where opinion was less favorable in 2009 than in 1994: Do you favor national health insurance, which would be financed by tax money? Would you be willing to pay higher taxes so that everyone can have health insurance? Would you be willing to pay more–either in higher health insurance premiums or higher taxes–in order to guarantee health insurance coverage for all Americans? Do you think the federal government should guarantee health care for all Americans?
* 1 question with a change whose direction is ambiguous: More people think that the country spends too much on health care, which is either in favor of Obama’s plan (national health care as a cost-saving move) or against it (if national health care is viewed as an extra public expenditure).
* 8 questions where public opinion is essentially unchanged.
In balance, then, Obama has faced a public opinion climate similar to Clinton’s in 1994.
As we’re all aware, opinion is volatile on these issues: support of health care reform does not necessarily translate to support for any particular policy. And a lot depends on Congress, where the Democratic majorities have a strong interest in seeing their party succeed. When translating opinion to policy, though, Shapiro and Arrow seem to have a good point when they write,
While the reports in the press of public support for major changes have been accurate (though varying from opinion poll to opinion poll, depending on how the survey questions were asked), they did not examine fully how current public opinion compares to what Bill Clinton faced in 1993-1994.
16 responses so far
1 ottovbvs // Jul 30, 2009 at 8:31 am
………..This “non change” in attitude would explain why the pharmaceutical industry is running millions of dollars worth of advertising urging universal healthcare,
2 barker13 // Jul 30, 2009 at 9:17 am
OK. Let’s see if we can ALL agree on one point:
American’s aren’t reading “the Plan.”
Our House Members and Senators aren’t reading the legislation… does anyone seriously believe the average American is?
Nor does the average American even expose himself/herself to blog discussions such as we have on this site where at least to an extent the nuts and bolts of policy options are discussed and examples of past failures/successes are provided.
Remember when you were a little kid watching football with dad? I mean REAL LITTLE! Now I won’t speak for the rest of you, but at four, five, six years old I tended to root from my dad’s favored team, OR… if it was a game he didn’t particularly care about… I chose “my” team based upon which team wore the most appealing uniforms – my favorite colors – the most appealing “mascots” on their helmets.
While public opinion plays a part – indeed a key part – in issues such as this, bottom line, the vast, vast, vast majority of the public is more or less ignorant concerning any but the broadest “details.” Americans are reacting partly on “team” identification, partly on ideology, and partly on instinct – hope vs. fear. (*SHRUG*)
These “horserace” threads kinda depress me.
BILL
3 sinz54 // Jul 30, 2009 at 10:02 am
“WASHINGTON (MarketWatch) — New polls released Thursday showed dwindling support for President Barack Obama’s drive to overhaul the U.S. health-care system. A Wall Street Journal/NBC News poll found 42% of respondents think the president’s plan is a bad idea vs. 36% who said it was a good idea. In June respondents were evenly divided. In a New York Times/CBS News poll, 69% of respondents said they were concerned that the quality of their health care would decline if the government put universal health insurance in place.”
“Those numbers aren’t too far off from what former President Bill Clinton faced when he made an unsuccessful attempt to overhaul health care in his first term. In July 1994, 52% disapproved of Clinton’s plan while 40% approved. ”
Furthermore, the trend has been running against ObamaCare. By the time Congress reconvenes in September, ObamaCare may be even less popular.
Obama and his fellow liberals cared about universal coverage as an entitlement, more than about projected cost or effects on those already insured. (When do liberals ever care about controlling the cost of a domestic program?)
They assumed, incorrectly, that universal coverage would be a major selling point for the rest of the voters, as it has been for themselves. In fact, the polls all show that most Americans care more about the cost of health care reform, and whether it would negatively impact the care they already are accustomed to.
And right now, ObamaCare is 90% about universal coverage, maybe 10% about cost containment, and ZERO about guaranteeing Americans who already have coverage that they would not be negatively impacted by ObamaCare.
That’s why it’s a tough sell. Its priorities are inverted from the non-liberal majority of the nation.
4 sinz54 // Jul 30, 2009 at 10:11 am
ottovbvs: To date, the insurance industry has not run “Harry and Louise” ads attacking ObamaCare–if anything, they’ve been supportive of some kind of reform. And the pharma industry have run very few attack ads to date. The main opposition to ObamaCare (which is now a plurality of Americans) is not coming from industry advertising this time.
It’s coming from the Blue Dog Dems, who have been on every cable TV news program, telling Americans that the plan as originally constituted costs too much and might crowd out private insurers. And their willingness to form a coalition with moderate Repubs who share their concerns. These Dems were elected in relatively conservative states and districts, and their political futures depend on them not having to sell Obama’s doctrinaire liberalism to their constituents.
The Dems own this mess. They can’t blame it on anybody but themselves.
5 SFTor1 // Jul 30, 2009 at 4:08 pm
If there is no successful reform of health care it will not be the Democrats who own the mess. It will be all of us. We can watch together as we continue to feed an insatiable health insurance industry that basically performs no discernible service except to themselves, while more families go bankrupt, more communities are weakened, and American businesses see an ever larger part of their precious capital wasted on this uniquely American idiocy.
Health care ALREADY IS an entitlement in the United States. Everything we do around treating the sick affirms it, although the uninsured have to wait until conditions become serious and chronic before the emergency room will see them. The sooner we admit that needy people eventually get care in some form the sooner we can begin doing it sensibly and cost-effectively.
That, in all its simplicity, is the heart of the matter.
6 barker13 // Jul 30, 2009 at 4:19 pm
Re: Sftor1 // Jul 30, 2009 at 4:08 pm –
“The sooner we admit that needy people eventually get care in some form…”
Seriously. Sftor1. Where in heaven’s name do you get the idea that ANYONE is failing to “admit” that the uninsured (or if you’d rather, “the needy) DO get care right now under existing circumstances…???
(*SHRUG*)
BILL
7 ottovbvs // Jul 30, 2009 at 6:32 pm
Sinz you might want to read these numbers from a CBS/NYT poll out today on the healthcare issue. In summary you aint’ winning the debate buddy. I can’t show the exact answer breakdown but here’s a summary
Americans trust Obama over congressional GOPers on health care by a 55%-26% margin.
72% think Congress is moving either too slowly or at the right pace.
59% think Obama is moving either too slowly or at the right pace.
76% think health care costs pose a serious threat to the nation’s economy.
66% support a Medicare-style public option for all Americans.
8 ottovbvs // Jul 30, 2009 at 6:34 pm
6 barker13 // Jul 30, 2009 at 4:19 pm
DO get care right now under existing circumstances…???
(*SHRUG*)
………….There’s emergency rooms aint there?..GWB……Barking favors the Bush solution to our healthcare problems
9 SFTor1 // Jul 30, 2009 at 11:40 pm
barker, we are pretending that covering the uninsured is an added cost. What I am saying is that it is a matter not of whether, but of how we pay for this care. The emergency room approach is a particularly expensive and inefficient way to go about it.
Apart from that, my latest reading has nudged me towards the Sinz camp. It really does seem that the payer is not the prominent issue. The bigger problem seems to be the fee-for-service system, service over-utilization, and medicine as a profit center. To get the efficiencies of other countries I suppose it means medicine run as a cost center, and a strong public alternative.
10 barker13 // Jul 31, 2009 at 8:34 am
Sftor1 // Jul 30, 2009 at 11:40 pm –
“Barker, we are pretending that covering the uninsured is an added cost.”
(*SIGH*)
Sftor1. There’s no “pretending” about it.
Again… separate the concepts: 1) INSURANCE; 2) Care.
Now… parse “care.” (Minimum up to maximum.)
Anyway, I’ve proposed my solutions. (*SHRUG*) No need to reiterate. We just go round and round and round and round and round…
(*SHRUG*)
BILL
11 barker13 // Jul 31, 2009 at 12:38 pm
File under… point to ponder:
http://online.wsj.com/article/SB10001424052970204886304574306693989102298.html
BILL
12 Cforchange // Jul 31, 2009 at 4:35 pm
I just wonder, whoooooo do they poll?
My opinion is that we haven’t heard enough. Details should be provided. Let’s see the math. This is one of many things that needs completely but quickly audited.
It would be nice to learn that our leaders are doing this.
13 sinz54 // Aug 1, 2009 at 10:50 am
ottovbvs sez: “76% think health care costs pose a serious threat to the nation’s economy.”
Of course we’re winning the debate.
Because ObamaCare is all about about covering the uninsured (which is all liberals ever cared about), not about cost containment. So the more that 76% finds out about it, the less they like it.
Americans don’t have to have doctorates in economic theory to understand that you can’t reduce health care costs by spending a trillion dollars more on it, while keeping 80% of the current health care system just the way it is.
Liberals were sure that the lure of universal coverage would be so alluring that Americans wouldn’t care about the cost, anymore than they do. (When have liberals EVER cared about the soaring cost of ANY entitlement program?)
But polls show that the insured care more about rising costs for THEMSELVES than they do about covering the uninsured. That’s the antithesis of ObamaCare’s priorities, which is why ObamaCare has run into such opposition.
As for the public option, it’s impaled on the horns of a dilemma: Reduce reimbursement rates low enough (say to Medicare rates or lower), and it will drive out the private insurers, resulting in single-payer, which Americans don’t want. Keep reimbursement rates high enough (say to within 10% of private rates, which is what the CBO assumed), and it can’t compete effectively with private insurers, making it irrelevant.
The Dems are caught in a contradiction. On the one hand, they claim we need a public option to compete effectively with private insurers. But on the other hand, they keep reassuring us that the public option won’t lead to a massive defection of Americans from private insurers. Not only are they lying through their teeth about this (thanks to YouTube., they’re caught lying), but it’s an obvious contradiction. If the vast majority of Americans will stick with private insurance, than the public option isn’t providing effective competition. So what good is it? In what way does the U.S. Postal Service “help keep UPS and FedEx honest”?
It won’t be hard to explain that to the public.
One more thing. The low approval numbers for the GOP mean nothing. In a two-party system, if the public gets turned off to Obama, they have nowhere else to go than the GOP, and all of a sudden it will start to look pretty good–if the GOP can present a reasonably positive sounding program.
That was true in 1966, just two years after the 1964 Dem landslide; and it was true in 1994, just two years after the public kicked out Bush 41 in disgust. In both cases, the GOP made great gains NOT because the public fell in love with them, but because the public had fallen out of love with the Dem President.
14 sinz54 // Aug 1, 2009 at 10:59 am
sftor1 sez: ‘barker, we are pretending that covering the uninsured is an added cost. What I am saying is that it is a matter not of whether, but of how we pay for this care. The emergency room approach is a particularly expensive and inefficient way to go about it.”
I explained to you once before why you are WRONG.
E.R. care is much less care.
In Emergency Rooms, patients don’t get care for their chronic illnesses. They get urgent care that keeps them alive, no more than that. E.R. care is less care than the rest of us get paid from our insurers.
A patient who presents with angina may get drugs to temporarily relieve it. But they’re not going to get a quadruple bypass operation (like the one Bill Clinton got) in an E.R. A child with an asthma attack will get inhaler medication to stop it, so the kid can go home again. But they’re not going to give the child allergy tests to find out the cause of the asthma attack.
And as for myself, I can tell you from personal experience that I cannot get dialyzed three times a week in an E.R. In fact, hospitals often don’t have dialysis equipment of their own at all. If a patient with renal failure is admitted there for surgery, they will pay an outside contractor (such as DaVita) to come in and dialyze that patient.
In this country, we’ve been rationing care by ability to pay. Those who are forced to go to Emergency Rooms get less care–only urgent care for medical crises.
So the idea that insuring those who currently go to Emergency Rooms will save money is absurd. It’s moving them out of Emergency Rooms into the health care system the rest of us enjoy, with all of its fantastic benefits for managing chronic illness. You’re taking a patient who could never afford a quadruple bypass, and could never get one at an Emergency Room, and moving him into the regular system where he’s going to get that operation. And that costs a lot of money. More money.
15 barker13 // Aug 1, 2009 at 12:56 pm
Re: Sinz54 // Aug 1, 2009 at 10:50 am –
(*CLAP-CLAP-CLAP*)
Excellent analysis, Sinz. (*THUMBS UP*)
Re: Sinz54 // Aug 1, 2009 at 10:59 am –
“I explained to you once before why you are WRONG [Sftor1].”
(*GRIN*) Sinz… I’ve gotta hand it to you… coming in right behind me, you’ve got the “silver” won for judgmental condescension. Congratulations! I’m proud of you…!!!
(*WIPING A TEAR OF PRIDE FROM MY EYE*)
* Sftor1 – Seriously… Sinz is right. (*SHRUG*) He really is. (*SHRUG*)
BILL
16 DailyInstigator // Aug 1, 2009 at 1:04 pm
If you were even slightly objective you would realize you’re asking the wrong question. The real question is “Does America like Obamacare more than the private insurance system we have now?” The answer is a big fat NO! America rejected Hillarycare and they are rejecting Obamacare. Although it might come as a surprise to you Americans are kinda big on that free choice stuff. http://thedailyinstigator.com
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