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HEALTH CARE ENDGAME

George Gallup, Health Care and the Peril of Legislating by Polls

4 years ago
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To John Boehner, the top Republican in the House, the health care bill coming up for a vote on Sunday boils down to a single question: Which party is heeding the will of the American people? "Americans want Washington to scrap this job-killing government takeover of health care," says the Ohio Republican.

Picking up on this theme, Rep. Paul Broun of Georgia asserts flatly that the American people have already "rejected" the Democrats' proposed health care legislation, citing a Wall Street Journal poll showing that 57 percent of respondents fear it would hurt the economy.

Reps. Eric Cantor of Virginia and Charles Boustany of Louisiana made the same point directly to President Barack Obama at the White House-sponsored health care summit on Feb. 25. "We don't care for this bill. I think you know that," Cantor told the president. "The American people don't care for the bill. I think that we've demonstrated in polling that they don't..."

Health Care Endgame: Full CoverageThe public opinion surveys cited by the Republican leadership do indeed report such findings. And Eric Cantor is a bright, attractive guy, and Charles Boustany was a practicing physician with first-hand knowledge of the problems in medicine. Nonetheless, this line of argumentation is all wrong. For months, Republican lawmakers and conservative commentators have brandished public opinion surveys like shillelaghs over the heads of health care reform's proponents, threatening mayhem to the Democrats and their party should they dare to ... legislate.

You will hear more of this all weekend -- and in the future after the health care debate in Washington comes to a climax. But it strikes me as bad social science, bad government, and bad history -- with a dose of hypocrisy thrown in. Using polls in this way is not only unscientific, it's not how a Republic can, or should, operate.

Personally, I do not look forward to the passage of the president's package. I would have few qualms about voting against it if I were in Congress. I'd prefer less government involvement in health care, not more, and less insurance, too. (I think Americans should pay out of pocket for routine medical care, that insurance should be for truly expensive procedures, and that the whole thing should be uncoupled from employment. My views were informed by an eye-opening Atlantic Monthly cover story last summer, "How American Health Care Killed My Father," an article that should have altered the national debate, but didn't.) My views aren't important, and I only mention them because this is not a back-door argument for the Democrats' bill. It's a front-door argument for better debate and better governance.

Let's start with the concept of governing by polls. Bill Clinton did this, to a fault many believed, the nadir coming when he tasked pollster Dick Morris to ascertain whether vacationing each summer at Martha's Vineyard sent the right re-election message for 1996. (I never saw any actual survey on this question, but after Morris reported back to Clinton, a president who neither rode horses nor fly fished ended up in Wyoming for his family's summer holiday.) Clinton's successor veered toward the other extreme: George W. Bush took obvious pride in ignoring public opinion. "I make decisions on what I think is right for the United States based upon principles," Bush told Chris Wallace of Fox News in a February 2008 interview. "I frankly don't give a damn about the polls."

Let's leave for another day a discussion of whether this was a bridge too far for a wartime president. This much is certain: Many influential Republicans and conservatives simply loved this aspect of the 43rd U.S. president 's personality. "Some call it stubbornness; I call it principled leadership," Rudy Giuliani proclaimed as Republicans met in New York to re-nominate George W. Bush in 2004. "President Bush has the courage of his convictions."

And a week before George W. Bush left office, Sen. Orrin Hatch, R-Utah, singled out this trait as perhaps Bush's most impressive attribute. "President Bush knows that it is tough to lead when you are following the polls," Hatch told his colleagues in a Jan. 14, 2009 tribute to the outgoing president on the Senate floor. "George W. Bush is not leaving the presidency with chapped fingers from holding them up to the wind."

Not to belabor the obvious, but how can it be political courage when a Republican president ignores public opinion polls and high-handed arrogance when a Democratic president does the same thing?

And what of these polls anyway? Do they deserve to be accorded the great weight Republicans are putting in them? I wouldn't think so. Polling the public on something like a 2,100-page health care bill is more akin to junk science than social science -- even though this kind of thing has been going on since the beginning of modern polling.

* * * * *

In 1936, a college journalism teacher named George H. Gallup came out of Iowa with a doctoral degree and an idealistic streak to famously embarrass Literary Digest magazine, which ran a poll predicting a huge victory by Alf Landon over Franklin Roosevelt. Literary Digest had conducted its quadrennial straw poll without mishap since 1920. And in 1936 the magazine's editors were confident that the 2.3 million post cards they'd received -- the names came from subscription lists, automobile registrations and telephone books -- were more than enough to give them an accurate picture. This proved spectacularly wrong: The Digest had Landon besting Roosevelt by 55 percent to 41 percent. It turned out that Literary Digest's cohort was probably a more affluent sample than the country as a whole in the height of the Great Depression. An even worse flaw in the Digest's methods was the response rate: The magazine had sent out 10 million cards -- and the Americans who didn't want to waste the money on a stamp were disproportionately voting Democratic that year.

George Gallup wasn't the only political scientist who'd figured out how to build a better polling mousetrap in the mid-1930s. Elmo Roper and Archibald Crossley, for example, had also learned that with a relatively small sample size of between 2,000 and 2,500 people, they could take the pulse of a nation with 128 million people. It was eye-opening, and the public followed closely as these three men engaged in a spirited competition with themselves, as well as Literary Digest. Whose methods would prove the best?

In political lore, Gallup was the victor, although in real life the competition was won by Elmo Roper. Crossley's model had FDR winning with 53.8 percent of the vote; Gallup had the Democratic ticket winning with 55.7 percent, and Roper said it would be a whopping 61.7 percent -- very close to Roosevelt's actual total of 62.5 percent. George Gallup's coup was that he also predicted that Literary Digest would be wrong, a prognostication that helped make him become a household name. It also attracted Franklin Roosevelt's attention: By 1940, the president quietly retained Roper and Gallup to poll for him on his plans for having the U.S. government help the British in their war against Germany, a plan of action that became known in headline-ese as "Lend-Lease."

It sounds so sensible in hindsight -- and God knows Roosevelt was in the right about Nazi Germany. But in George Gallup, in particular, FDR had hit on a socially conscious innovator who was less interested in horse-race polls than in plumbing the minds of the American people about the issues he cared about, education reform, criminal justice and quality of life. This turns out to be a mixed blessing. To this day the official company biography asserts that George Gallup's name is "synonymous with integrity and the democratic process," and this is true enough. But the democratic process is not as tidy as George Gallup or his public opinion polls, and the very notion of polling Americans about complex policy issues that they often know little about is problematic on its face.

In 1995, for instance, at the behest of CNN and USA Today, Gallup polled about the verdict in the O.J. Simpson murder trial. The questions ranged from the straightforward (agree or disagree with the verdict) to the absurd (would Simpson have been convicted if he were white.) OK, that kind of thing helps get a pulse on racial attitudes, but how about these questions: Did Judge Lance Ito do a good job? Did the jury reach a verdict too quickly? These are technical legal questions that were posed to non-lawyers, who typically watched little of the actual trial, and who may never have set foot in a courtroom in their lives. In other words, everyday Americans who had no basis for registering an original opinion at all. You probably see where I'm going with this. Aren't similar problems present in the health care debate -- and also when pollsters try to determine public opinion on other intricate policy questions, in which the key participants themselves cannot agree on what the legislation would accomplish -- or even on what it should be called?

Take "cap and trade," for instance. The concept itself is not easy to comprehend, but what the shorthand phrase means in policy-speak is having the government set a limit (a cap) on various types of pollutants that contribute to greenhouse gas emissions. Companies with aging plants can buy credits (that's the "trade" part) from firms with cleaner emissions. The theory is that by essentially charging companies for polluting -- and rewarding companies that build cleaner plants -- government creates market incentives to lower greenhouse emissions. I have no opinion on whether this is the right approach to global warming, but I have a definite opinion on the efficacy of polls purporting to show where the public is on this issue.

A 2009 Zogby Poll claimed that only 30 percent of Americans support cap and trade, while a CNN Poll done last fall asserted that 6 in 10 support it. Who is right? Who cares? The most enlightening, not to mention entertaining, polling done on cap and trade reveals that Americans have no earthly idea what the thing means -- or even what issue realm it belongs to. This Pew Poll shows that in an open-ended question only 23 percent of Americans correctly knew (guessed?) that cap and trade concerns energy and environmental policy. And fully 55 percent acknowledged knowing "nothing at all" about cap and trade.

Polls about both cap and trade and the health care bill made the Top 10 Dubious Polling Award. This little-known, but important annual list (it started in 2009) is compiled by George F. Bishop and David W. Moore, two veteran pollsters, authors and political scientists who display appropriate skepticism of their brethren -- and of the media outlets that promote such goofy social science.

One obvious possible lesson of the health care polls may simply be that the Republicans did a better job of criticizing the legislation than the Democrats did at promoting it. Or maybe it's just too complicated an issue, and the public doesn't trust something it doesn't understand. Or perhaps Americans even like the features of the bill well enough, it's Democrats they can't stand -- or Congress itself. (There are actually numerous polls that tend to bolster that last postulate.)

Of course, things could be worse. Ross Perot could be president. I don't mean that as a personal dig at Ross Perot -- I'm using him as a symbol here. Nearly two decades ago, Perot anticipated the interactive nature of the Internet. The phrase 2.0 wasn't in vogue -- the technology did not yet exist -- but this is what the twangy Texas tycoon was talking about in his call for governing via "Electronic Town Halls." California and two dozen other states have for nearly a century practiced a controversial form of direct democracy with their referendum systems. Perot's fantasy of governing via insta-polling would have made California look namby-pamby. In Perot-ville, America would (theoretically) have been spared the messiness and corrupting influence of lobbyists, legislators, political consultants, special interest groups and the media.

"With interactive television every other week, we could take one major issue to the American people ... have them respond, and show by congressional district what the people want," Perot explained. Or think they want. One thing is certain, however: Although the Founders of our Republic couldn't have known about the Internet, a Webocracy would have given them pause. They had enough qualms about democracy.

The Framers had fought a revolution against monarchy, so they knew they didn't want that. But unchecked democracy struck them as too close to anarchy. And so checks and balances were built in to the system. The Supreme Court: lifetime tenure. Senators serve six years, presidents four, House members two. A deliberate body (the Senate), the people's House, a chief executive with veto power. It's all there, mechanisms to be responsive to the people's whims, while being responsible to posterity -- and minority views -- at the same time. In a "pure democracy," James Madison worried in the Federalist Papers, "there is nothing to check the inducements to sacrifice the weaker party or an obnoxious individual."

In a letter to a friend named John Taylor written while Madison was in the White House, John Adams amplified on this sentiment. "Remember," he wrote, "democracy never lasts long. It soon wastes, exhausts, and murders itself. There never was a democracy yet that did not commit suicide."

John Adams was right about a lot of things, but our democracy hasn't committed suicide -- not yet -- and one reason it hasn't is that a critical mass of men and women remember that it's a democracy, yes, but wrapped inside a Republic. That shouldn't be a hard word for Republicans to remember.

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