What the Polls Tell Us About the Health Care Battle

Republicans and other critics of health care overhaul have seized on poll numbers reflecting public opposition and unease to accuse President Obama and congressional Democratic leaders of trying to ram through a measure that Americans don't want.

But but these snapshots of public opinion aren't necessarily good indicators of how voters will feel later about the legislation and what impact it will have on next year's midterm elections, opinion experts say.

Pollsters such as Scott Keeter of the Pew Research Center say it's not surprising that public opinion has taken a negative turn. "When you have unified and vehement criticism of the legislation from one side, and division and heated debate among the other side, it's no wonder that much of the public is ambivalent or downright negative about it," he said. "I see little prospect that this will change unless and until supporters of reform agree on a bill and then promote it enthusiastically to the country."

Drew Altman, president of the Kaiser Family Foundation, has studied public opinion surveys of previous overhaul efforts and sees a pattern. "Since time immemorial we've seen in these health reform debates that when they get really contentious and hot, people just get nervous and cautious about change and a little more comfortable with the status quo. We're seeing that again now."

There has been a common theme in the polls released in the last few weeks: Americans care far more about the economy and jobs than they do about health care reform; they are getting more worried about the costs to the country; they believe it will raise the deficit and their taxes; they think if the legislation is passed it will hurt or make no difference to the quality of their own care or coverage, and they are concerned about government getting too deeply into the management of the system.

In the last two weeks, polls by Washington Post/ABC News, Wall Street Journal/NBC News, the Pew Research Center, USA Today/Gallup, CNN/Opinion Research, and Quinnipiac University have shown pluralities or majorities of Americans opposing the health care reform legislation.

And the belief that if legislation passes, Americans' own health care costs would rise and quality of care would not improve was reflected in George Washington University Battleground and Kaiser Family Foundation polls, as well as in many other surveys.

The Kaiser poll, in particular, found that while 54 percent still believed that economic problems in the U.S. make it even more important to tackle health care overhaul, that number was down from 58 percent from last month; the number of those who said the country can't afford to act now rose from 36 percent to 41 percent.

So how do polls connect to the public policy debate and what happens on Capitol Hill?

"The first thing is that the most important use of polls when you are in middle of complex policy debate like this is the ability to illuminate the problems people are having and help shed light on which solutions seem to be most amenable to people, " said Mollie Brodie, director of public opinion and survey research for the Kaiser Family Foundation. "They give policymakers a sense of the policy constraints, which is why a single-payer system isn't on the table. It never had any support."

But the way polls are interpreted and used can still leave a gap between what interest groups, politicians and the news media highlight, and what the public really cares about.

In a story on a health care poll conducted by The Washington Post and ABC News in October, the Post headline trumpeted a rebound in support for the public option, a part of the debate that many other polls had also emphasized. Polling analyst Nate Silver, on his FiveThirtyEight.com blog, wrote that leading with the public option angle was a "bizarre decision" given that "public opinion has been fairly steady on the issue for months."

"The media got swept up in the public option debate because that was where the activists and the Washington political battle were, while people were worried about other things, like costs and mandates and how it would affect them," said Robert Blendon, professor of health policy and political analysis at the Harvard Kennedy School of Public Health and director of the Harvard Opinion Research Program.

Nevertheless, Blendon said, "The polls carried by the media have a more significant impact on what members of Congress think because it has an impact on writers. It sets the tone for journalism coverage of an issue. The media attention to the polls, how the editorial writers chew off it, the fact that reporters say 'this is in trouble,' it helps set the culture."

That's why Blendon does not believe that polls showing Americans placing the importance of the economy and jobs over health care by margins approaching or exceeding two-to-one should be over-interpreted. He concedes health care is a distant number two, but given how many major issues the media can digest at one time, it is still high enough on the agenda to get the attention it needs.

There is no question that the contentious debate in Washington is taking its toll on public opinion. While Keeter of the Pew Research Center says, "Our polling throughout the year has shown that the public supports most of the key provisions in the draft legislation," that dynamic will change if the debate is drawn out too long. It's no surprise, then, that President Obama and Senate Majority Leader Harry Reid have pushed so hard to get the Senate bill done by Christmas.

But if the trend of public opinion raises the question about whether Obama and national Democratic leaders have been wise to keep the health overhaul battle front and center, it is also true that they are aware of another consistent finding of these polls: that Democrats by big majorities want them to deliver on health care reform.

"Politics in America are extremely polarized," said Blendon. "People who are elected to office pay a lot of attention to their own core group. I believe the Democratic leadership believes their core group wants this bill passed. I think for many of them this issue is really important to Democratic voters. And if they don't do it, they fail their core base."

While pundits and pollsters agree that the economy and jobs likely will be the most important dynamic in the 2010 midterms if there is not improvement, Blendon said that the failure of the Democratic leadership to show it can deliver on health care can have political consequences next year.

"I believe one of the reasons the House turned over in '94 (to the Republicans) was that (President Bill) Clinton had fired the country up on health care and they saw him failing in it. That has the effect of depressing the turnout -- union workers, liberals, your people who are active."

Pew's Keeter also said that, putting aside the economy, "the costs of failure on reform will probably be higher than costs of success, at least in terms of the public's image of the Democratic Party's ability to govern. But there could be a downside to success, largely because attacks on the legislation will not end when and if it passes" since many provisions of the bill do not take effect until well after next year's elections.

That was something clearly on the mind of former Democratic National Committee Chairman Howard Dean on Sunday when he appeared on "Meet the Press." Dean was speaking from a partisan standpoint, but he also was showing awareness of what the polls have demonstrated -- that while people may not like the plan overall, there is opportunity in the fact that they like parts of it, such as the goal of expanding coverage to the uninsured or preventing insurers from denying coverage to people with pre-existing conditions.

But given the complexity of the legislation, Dean said, "Republicans will make it a target and we'll have a hard time explaining it" because some provisions in the bill don't go into effect until 2014.