Public Opinion And Health Reform
November 6th, 2009
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by
John Iglehart
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Chris Fleming
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On October 13, the day the Senate Finance Committee passed its version of health reform, the Health Affairs Blog held a roundtable on public opinion and health reform. Participants included Bob Blendon, professor of health policy and political analysis at Harvard; Chad Bohnert, director of marketing and e-commerce at Zogby International; Mollyann Brodie, vice president, public opinion and survey research, at the Kaiser Family Foundation; and Bill McInturff, partner and co-founder at Public Opinion Strategies.
Participants addressed many topics, including issues related to health reform that appear to be important to Americans. For example, Bohnert discussed a Zogby survey finding that including malpractice liability reform – defined as providing for independent medical reviews of claims, mediation, and limits on noneconomic damages – would greatly increase support for the Senate Finance Committee’s health reform bill.
Participants also discussed the importance of the wording, framing and context used by pollsters, and the influence that these factors can have on answers given by respondents. McInturff noted that a two-to-one majority of respondents in one of his surveys said that an individual mandate to purchase health coverage was acceptable; however, when a second survey pointed out to respondents that such a mandate could mean a fine for those who did not purchase coverage, the percentages for and against a mandate completely reversed. Brodie added that informing respondents of the strongest arguments for or against proposals such as an individual mandate or a “public option” could turn favorable majorities into unfavorable ones and vice versa.
Blendon emphasized the importance of looking beyond controversy over particular aspects of the Congressional heath reform bills. Middle class Americans have taken a beating in the recession, and the way the bills have been debated “Americans hear taxes out of every single bill, and they see rising premiums, and they’re worried about that,” he said.
Other participants echoed Blendon’s emphasis on worries about individual out-of-pocket costs. Americans are unwilling to make individual sacrifices for health reform, said Brodie, and they don’t understand wonkish concepts like “bending the cost curve.” However, she said, people might still be persuaded to back trade-offs through the proper framing: “When we talk to seniors about cuts to the Medicare program or Medicare providers to pay for health reform, of course they are completely against it. They don’t want to see cuts to the program. But if instead you talk to them about a way to help keep Medicare financially sound for the future, a majority favors it,” she said.
Blendon, however, suggested that the issue of Medicare cuts was substantive and not merely a matter of wording: “Republicans are repeating over and over again that the money that’s being saved is going out of the Medicare program. It’s not going to make the Medicare program more solvent. If some of the money that was being reduced went to make it more solvent, it would take Molly’s point and make it more of a reality.”
McInturff noted one potential danger for Democrats that became a reality this past Tuesday: If the Democrats lose the governors races in both New Jersey and Virginia, and “if Virginia gets ugly in terms of margin, I think that we’ll have a very chilling result … imagine the dialogue with those Blue Dog democrats if the party has just lost New Jersey and Virginia as they get to the final vote on health reform: That would be a very chilling input.”
