Pollster, Heal Thyself

Trying to make sense of the public’s contradictory feelings about health care reform.

How did President Obama do in his big health care speech last week? Let’s judge using the White House’s measuring stick. Before the speech, aides pointed to a few key goals. They wanted to inform people who were confused, persuade those with insurance that they would benefit, explain that the president’s plan would not increase the deficit, and reassure seniors they wouldn’t suffer.

Sounds simple enough. Unfortunately, there’s no way to assess Obama’s performance without using polls—and three polls taken after his speech show mixed, if not contradictory, results.

Good News: A CBS poll shows that the president’s approval rating on the issue of health care increased 12 points to 52 percent. When asked whether the president had clearly explained his plans for health care reform, 42 percent said yes—an improvement of nine percentage points. So he gets good marks on clearing up the confusion.

Among those who actually watched, the results were even better: Some 58 percent said he had been clear, and 60 percent liked what they heard. Thus we have some evidence of the president’s ability to make impressions on those who actually hear his message. He’ll be talking a lot about health care in the coming weeks, and this suggests that if people hear him, he has the opportunity to win their support. Obama also rallied Democrats: 85 percent approve of his handling of the issue, according to CBS. In an ABC/Washington Post poll, 88 percent of liberal Democrats support the reform plan as is, and 81 percent still support it even if a government-run portion is not included.

Middling News: According to the ABC/Post poll, the president also seems to have made some headway in convincing people that their insurance won’t change. Half of the insured now see that it’s possible legislation would allow individuals to keep their coverage without changes, up from 37 percent in June. The president still has work to do, though: In a separate question, majorities still think changes to the health care system would hurt or not improve their insurance coverage, their costs, and their overall care.

Bad News: The president could not persuade even those who listened to his speech that there was something in health reform for them. Many analysts believe that unless people believe their lives will improve, they’ll offer only lukewarm support for the president’s plan, even though they may support the broader notion of reforming the system. In the CBS poll, 31 percent of those who watched the speech said the reform would benefit them, only a five-point increase from before the speech. Some 27 percent thought the reforms would hurt them, and 39 percent thought they’d have no effect. So about two-thirds of those who heard the president make the case weren’t convinced.

As a point of comparison: In February, after Obama gave a speech on the economy, 51 percent who listened thought his economic policies would help them personally, a 15-point jump from before the speech. (Of course, this may say less about Obama’s ability to persuade and more about the difficult nature of the health care issue. Or it may simply reflect the fact that he’s now six months into an administration rather than in a post-inaugural honeymoon glow.)

Obama also still has work to do convincing people that reform will not add to the deficit. Although he added a new promise in his speech—he would lock himself in to finding additional funds in future years of the plan if initial savings didn’t materialize—the audience hasn’t signed on yet. Almost two-thirds, 65 percent in the Washington Post poll, said Obama’s plan would increase the deficit a great deal or somewhat. According to a CNN survey, three-quarters of those polled said they think his plan will lead to an increase in the federal deficit. According to CBS, among those who listened to the speech—60 percent of whom generally approved of what they heard—reaction was mixed: Half believed the president’s claim that the deficit would not grow; half didn’t.

Seniors, another key audience Obama was talking to, are also tough to crack. The president made a direct appeal to them in the speech, emphasizing that Medicare would not be negatively affected by reforms. But after the speech, 56 percent of seniors told the Post they thought Obama’s reforms would weaken Medicare.

Finally, the Post analysis of their poll shows a deadlock with 46 percent in favor of proposed reforms and 48 percent opposed. A program without a government plan—the much-discussed “public option”—appears to increase support for reform by four points and weaken opposition by six. The improvement of support without the public option seems to contradict another of the poll’s findings in which 55 percent say they support a public option. A whopping 76 percent support a public option if it is limited only to those unable to get private insurance—which is Obama’s plan.

What accounts for the discrepancy? Nate Silver says the Post’s methodology, but one explanation may be that the split is another example of the well-documented divide between the way people think about reform in general and reform as it applies to their situation. A June CBS poll showed that 77 percent were satisfied with their own health care but only 48 percent were satisfied with health care for the country as a whole. Pollsters suggest that what may be happening in this case is that people like the public option in the abstract as something that might fix America’s larger health care problem. Or when it’s discussed as a way to pressure unpopular insurance companies (as it was in the Post’s question), they like that competition in the abstract. But when they’re asked about an overall reform package, they start thinking about themselves more and figure that a public option will disrupt the system and interfere with their care. That sentiment reminded me of a finding in a New York Times/CBS poll from June in which 72 percent said they would support a Medicare-like government option—but 68 percent also said they thought it would limit their access to tests and treatments.

The president’s aides repeatedly insisted before the president’s speech to a joint session of Congress that the health care debate would not be changed in one night. The numbers prove they were right. Now, the test will be whether public support can be changed by sheer repetition. Since the big speech, Obama has held two health-care-related events and sat for interviews with 60 Minutes, Bloomberg, and CNBC. He has another town hall on the topic this week and on Sunday will appear on five news programs. Hillary Clinton was the last politician to perform that grueling cycle of talk in her bid for the Democratic presidential nomination. Obama hopes that health care reform is not as insurmountable an obstacle as he turned out to be for Clinton.