What Do Americans Want?

A new survey says they still want health care reform, with one troubling caveat.

Click here for a guide to following the health care reform story online.

Health reform is now sufficiently stalled in the House energy and commerce committee that Rep. John Larson of Connecticut, chairman of the Democratic caucus, is threatening to bypass it and bring the bill directly to the floor. The Senate has officially given up on passing health reform before the Aug. 7 recess, mainly because the Senate finance committee still hasn’t produced a bill. Washington Post blogger Ezra Klein insists that “this isn’t, as some are suggesting, because Baucus is a schmuck.” I think it more accurate to say that at this tense moment, no good will likely be served by calling Baucus a schmuck. Anyway, Baucus is now saying privately that the committee will produce a bill by Aug. 7.

Time for a poll!

The Kaiser Family Foundation’s latest tracking poll shows “some softening of support” for health reform as Republicans and Blue Dog Democrats whack away at it. But it remains true that the public is significantly more supportive of health care reform than the Washington commentariat. A majority of respondents continues to believe “it is more important than ever to take on health reform now.” Strong majorities continue to favor expanding coverage through a variety of means, including (by 59 percent) creation of a “public option” government insurance plan.

Fifty-four percent of respondents said they probably would “look into purchasing” public-option insurance if it were made available (though only a tiny fraction would be eligible, at least initially, under the House and Senate health-committee bills). When public-option supporters were told that creating a public option would “give the government an unfair advantage over private insurance companies” and “be the first step toward single-payer, government-run health care,” both of which are likely true, support dropped to 35 percent and 39 percent, respectively. But when public-option opponents were told that creating a public option would “give people more choice among health insurance plans” and “help drive down costs because private insurers would be competing with the public plan,” both of which are likely also true, opposition dropped to 20 percent. Sen. Baucus, take note: It is easier to persuade public-option opponents to favor it than it is to persuade public-option supporters to oppose it.

Two findings are surprising. One of these is encouraging and one discouraging.

The encouraging finding is that the narrow (51 percent) majority of respondents who said they are willing to pay more in insurance premiums or taxes to increase the number of Americans who have health insurance represents a 10 percent increase over the percentage willing to make this sacrifice in the foundation’s June survey. Perhaps this is a statistical quirk. Or perhaps the public is absorbing the health-reform opponents’ message that such reform will take money out of their pockets while rejecting these same opponents’ message that such a sacrifice would be intolerable.

The discouraging finding concerns a question that the foundation doesn’t appear to have asked in previous polls. In his July 22 press conference on health reform, President Obama parried a question about the prospect that the government would ration health care by saying:

[T]he government already is making some of these decisions. More importantly, insurance companies right now are making those decisions. And part of what we want to do is to make sure that those decisions are being made by doctors and medical experts based on evidence, based on what works. Because that’s not how it’s working right now.

It’s a powerful point: Wouldn’t you rather decisions about your medical treatment were made by government-paid medical experts, focused on which treatment may help you get better, than by private insurance companies focused on maximizing corporate profits? Granted, once a treatment is approved, the government would probably pay less for it than a private insurer would. But, ultimately, government is answerable to the public. Insurance companies are answerable to their stockholders.

It’s a no-brainer for me and, I presume, for our president. But it is not a no-brainer for respondents to the Kaiser Family Foundation’s poll, as the accompanying pie chart demonstrates. A 45 percent plurality worries more that under health reform, “government agencies would play too big a role in deciding which medical procedures people can or can’t get,” while a 36 percent minority worries more that under the status quo, “insurance companies play too big a role in deciding what medical procedures people can or can’t get.” Twelve percent worry about both equally, while 7 percent worry about neither, don’t know, or don’t feel like answering the question.

These findings may demonstrate a (nonmajority) preference for the devil you know. Or they may indicate that the conviction that “government is not the solution to our problem; government is the problem” did not die with Ronald Reagan, as a Rasmussen survey suggested at the height of September’s financial crisis. In that survey, 59 percent of voters—including 49 percent of Democrats and 44 percent of those who intended to vote for Barack Obama—supported the famous assertion in Reagan’s 1981 inaugural speech. It’s worth remembering that this poll was taken while an extremely unpopular president was presiding over the federal government.

The larger point, though, is that evidence is growing that even the seemingly bumbling intervention by President George W. Bush’s treasury secretary, Henry Paulson, helped the United States avert the onset of a second Great Depression. President Obama’s maladroit stimulus probably helped, too. The same may be assumed of legislation that would increase government control over medical decisions. If it doesn’t help, voters can make their legislators change it. What their legislators can’t do is protect them from the rapacity of private health insurers should no health reform be enacted.