Health Affairs

On September 30, 2009, the Harvard School of Public Health, NPR, and the Kaiser Family Foundation released the findings of some new polling on how the public perceives the current debate about health care or health insurance reform.  NPR discussed how most of the public feels that they are not represented in the debate, although at the same time they don’t seem to mind that interest groups do participate in the debate and engage in lobbying. 

Robert Blendon, one of the authors of the polling report, and professor of Health Policy and Political Analysis at the Harvard School of Public Health and Harvard’s John F. Kennedy School of Government, took a somewhat different approach in discussing “Understand the Health Reform Debate from the Public’s Perspective” at a September 30 event that was sponsored by the Joan Shorenstein Center on the Press, Politics, and Public Policy and the  Kennedy School and held at the Newseum, in Washington. The title of the event was “The Press and Politics of Health Care Reform.”

Blendon discussed the public’s frustration with the debate because the key questions for the public are not being answered by either the politicians or the mainstream press.  He noted that, historically, polling on health care reform has centered on two key questions: first, does the public believe that the reform will be better for the country, and second, and perhaps more important, does the respondent believe that the reform will be better for the respondent and his or her family. Oftentimes, polling on these questions at the start of health care reform efforts starts out in positive territory, but by the end of the efforts to pass legislation, the polling is in negative territory. He noted that the current trend is negative, but it is also very “soft” or variable and can change easily.

Other participants in the briefing at the Newseum included David Broder of the Washington Post, Linda Douglass of the Office of Health Reform at the White House and the U.S. Department of Health and Human Services, and Dr. Timothy Johnson of ABC News, who discussed the news coverage of the health care reform debates. The second panel included Blendon; Theda Skocpol, Victor S. Thomas Professor of Government and Sociology at Harvard University; and Kathleen Hall Jamieson, director of the Annenberg Public Policy Center at the University of Pennsylvania. Both panels were chaired by Alex Jones, director of the Joan Shorenstein Center.

From Clinton To Obama 

While all the discussants noted some of the similarities to health care reform efforts during the Clinton administration, they also noted that much is different now. On the strategy side, the Clinton administration put out one bill and left it out there for many different interest groups to attack. The Obama administration does not have “a” bill, but five bills, created in Congress, rather than in the executive branch, and they are moving through the legislative sausage-making machine. The existence of multiple bills makes it somewhat more difficult to attack specifics or explain them to the public, which may also explain why members of the public feel left out and why their questions are unanswered. On the strategic side, the Obama administration also has the support of some crucial interest groups like the Pharmaceutical Research and Manufacturers of America (PhARMA), and so far the insurance industry has been sitting on the sidelines rather than funding “Harry and Louise” attack ads.  

Perhaps the crucial differences from the Clinton era, for the media, are economic conditions for them in 2009. Traditional mainline media, particularly newspapers, are in free fall with fewer readers and shrinking numbers of knowledgeable health and science reporters.  The traditional television networks’ news programs attract smaller and older audiences. The growth of cable news networks and Internet sources have given, to those on the right and the left of the political divide, sources not only for getting news but getting it contextualized, even if it’s not always factual or correct.

The other specter haunting health care reform in 2009 is the economic downturn. All of the discussants at the Newseum cautioned that in a period of economic uncertainty, fear about the future, fear about costs, and fear about change have to be taken seriously and addressed. They also noted that this is even more crucial for the Medicare demographic. Medicare beneficiaries vote in high percentages and vote in off-year elections. And, while talk of death panels and other coverage of the town hall meetings might not have much of an impact, discussions about using savings from Medicare or changing aspects of Medicare to fund access to insurance for the uninsured potentially impact this crucial group of voters.

Blendon’s rousing call was that most of the public does get it. They do know generally what health care reform is about, but they want to hear what it means for them, their pocketbook, and their families, and they want to hear about it in plain English. “Bending the Cost Curve” works for policy wonks, but it does not resonate in public polling. The mandate for the media, at least, is clear. Explain, what will health reform do? What is the cost of not changing the health care system? If we do pass health reform, how will I get health care, and how much more is it going to cost? Only afterward can we get to the question, how will it improve my health?

This entry was posted on Friday, October 2nd, 2009 at 12:14 pm and is filed under All Categories, Health Reform, Politics, Public Opinion. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.