Decision Day For Democrats: Poll Shows Path to Healthcare Reform
By S. Ward Casscells, MD and John Zogby
As regular chroniclers of American opinion on health care reform, we got a shock, and then a surprise, from our Sept. 28-30 poll (for details see today's issue of the Health Affairs blog). Support for the health care reform bill that has been most discussed and praised by President Obama -- the moderate bill being debated this week and next in the Senate Finance Committee, chaired by Max Baucus (D, MT) -- is only 27%, with 59% opposed and 14% undecided.
Even among Democrats, only half support, and a third oppose. Only one in 25 Republicans, and a quarter of independents, support the bill. Support is higher among women than men, and a bit lower among seniors.
Now the surprise: We asked which of 10 proposed amendments would change people's minds: "replacement of the proposed cooperatives by a 'public option' (government-run health insurance for those without other coverage); "inclusion of a 'trigger option' that would establish a public option only if private insurers do not offer affordable coverage"; "malpractice reforms (independent medical reviews, mediation; limits on non-economic damages); "elimination of the 'individual mandate' which makes every employee buy insurance, with assistance for those who cannot afford the premiums."
And so on. Despite suggestions that Americans were either tired of the health care issue or did not consider it to be enough of a priority, we found that people would read the long description of the bill, then wade through 10 amendments. Even after months of off-putting rhetoric by an over-heated, over-publicized few on both sides, Americans do indeed care about this health care debate.
Moreover, they sent a clear message: Only one proposed amendment raises support for the bill to even: malpractice reform. The second biggest boost was from eliminating the individual mandate, and third: adding a public option. Quite a few oppose the bill only because it lacks a public option. Most supporters of the current bill can live with replacing the cooperatives with a new government-run Medicare-like option.
(Another surprise: Americans did not just vote the party ticket: Some responses were clustered, but there were many clusters and combinations. Americans are not so much polarized as arrayed in numerous camps.)
Together, the three amendments would increase support to the mid-50s, as would the combination of tort reform and a public option, while tort reform and elimination of the individual mandate yields a slim plurality of support.
We also calculated the impact of 1) just eliminating the individual mandate (ignoring the fact that this would require an employer mandate and/or inducements to purchase insurance, which would inflate the Congressional Budget Office's estimate of the bill's cost); and 2) adding the public option. This yielded a slim majority.
Earlier this week the Senate Finance Committee moved in two half-steps: easing the individual mandate (exempting those for whom the least expensive policy would exceed 8% of adjusted gross income, and delaying the penalty and cutting it in half); and allowing states to use federal subsidies to initiate public options.
If we guesstimate that these steps are half as successful in winning back public support as the two amendments we polled, we now estimate the bill is supported by only in two in five Americans.
But tort reform alone -- which would be a big concession to Republicans -- yields essentially equal numbers of supporters and opponents, and majority support could be earned by adding to tort reform either a Democratic amendment -- the public option -- or a second (largely Republican) amendment: eliminating the individual mandate (which would increase costs).
This is the fork in the road for the Senate's Democratic leaders: they must choose between the tort lawyers and a health care bill that could re-unite a country that has turned against the present bill.
It appears the President Obama got the same message from his private polling when he offered a modest test of tort reform in his address before Congress. But the biggest lesson from the long, arduous debate in Congress and town halls is this: the public is the adult in the room and are pointing the way to consensus on health care reform.
John Zogby is President and CEO of Zogby International, and most recently the author of "The Way We'll Be: The Zogby Report on the Transformation of the American Dream (Random House).
S. Ward Casscells, MD is the Tyson Distinguished Professor of Medicine and Public Health, V P for External Affairs and Public Policy at the University of Texas Health Science Center at Houston, Senior Scholar at the Texas Heart Institute, and from April 2007 to May 2009 served as Assistant Secretary of Defense for Health Affairs.
Bill Moyers and Michael Winship: In Washington, the Revolving Door Is Hazardous to Your Health
You can't tell the players without a scorecard in the old Washington shell game. Lobbyist out, lobbyist in. They've been plowing this ground for years, and the soil has never been so fertile.
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The best tort reform would be removing the reasons for tort reform--lack of cheap healthcare.
Ideological spin via polling.
Leaving out tort reform is the Democrat version of corporate subsidy for trial lawyers. It's not going ot happen. The one thing that could eliminate half the unnecessary tests and procedures in a single measure is not going to see the light of day because the Democrats are the hand puppets of the trial lawyers. It's that simple.
Tort reform,
Have hardly heard a peep about it, then Zogby does a pool with a Doctor and we have tort reform.
HMMMM.
hmmmm.
Could it be the details are being sorted through now?
Could be.
Preparing us for shifts.
Watch closely.
I agree with many who say this article is confusing.
In this case, I think what it's saying is that polls SEEM to be against reform, but in reality that's a misread. In reality, people say they're against it because what seems to be on the table is not progressive enough. I'd be one of those people. Personally, single payer is the only way to go in my estimation. And, without a public option at least, I'd vote against any reform.
At any rate, I've made this point many times on HuffPo and on a blog.
Shameless plug: (read the article about polls, and single payer, too!!)
http://qualitypublicdiscourse.blogspot.com
The thing with tort reform is that most Americans, despite Zogby's polls, don't understand the arguments for why allegedly tort reform would improve are health care but have been told often enough in colorful and frightening enough detail by propagandists for tort reform that it is something they should want and desire, that they instinctively select it. It is almost Pavlovian, like being told over and over again that conquering Iraq will make us safer. We were told enough in colorful enough terms (remember the "smoking gun in the form of a mushroom cloud" phrase, anyone?) that the Republicans were able to get the country to go to war on propaganda alone. So of course it should be no surprise that they can train the same American populace, using the same techniques, to memorize the same mantras. But ask any of these Americans that Zogby polls to explain why tort reform will make a difference for the quality or scope of health care in this country and most can't even make the argument. Sorry, Zogby. Sometimes the people polled don't even know which way is up.
Thanks for the heads up on right tactics.
How many Americans wanted us to invade Iraq? What if 70% of Americans wanted to tax Bill Gates 100% of his wealth? A majority of Americans don't support gay marriage.
Majority doesn't mean right...
So let's see, you hate Americans, Bill Gates
and gay people that want equal rights.
Your mother must be so proud.....
Having trouble with reading comprehension? The poster is stating that those things are wrong and that a majority opinion would not make them right. Try to keep up.
The writer of this article is 100% wrong.
It is decision time for the Repugs. If they all oppose health care reform and it still passes, then they are toast.
"Probably"(???), you're 90% wrong: Lawyers are unpopular--no surprise there, but Republicans have been very effective in demonizing them amongst the "Murkan" demos. Whether tort suits constitute a significant element in health care costs remains ambiguous, but the ISSUE must somehow be DEFUSED to molify PERCEPTION!
R. I have learned to never count these nasty repubs. out. They are masters at hate and fear and have been plying their trade for 200 years. I thought repubs were toast after actor Ronnie and Poppy Bush, but the little w. guy managed to get his sneering face on my TV for eight long, miserable years. Dems. are cowards, bend over and don't fight down and dirty. Fight fire with fire is a mantra they should embrace, but never do. The use of the term, "Public Option" was dumb and no one understood it, nor did O. make it clear to the American people as to what it was or what he supported. For a professor, his teaching skills need to be trimmed down to a simple 3 to 4 word declarative sentence, spewed 24/7. "Healthcare for all Americans". I'm disgusted with this dithering, while Americans are sick and dying. Where is the advocate for the American people. Michael Moore? Yes.
I'm not trying to be a smart ass, but the Republican Party has only been doing what you say, well, probably since Nixon, I would surmise.
The original "Republican" Party had Jeffersonian beliefs. That Party died out.
Then, the anti-slavery Republican Party was formed in 1854. Obviously, they were the "liberals" or "progressives" at that point. The Democrats, at that point, were largely Southern and pro-slavery.
It's funny how that has nearly flipped. (Not the slavery part; well, maybe I shouldn't speak so quickly.)
Tort reform is BS. It's people yelling "Keep me out of the courtroom! Stop me before I sue again!" If doctors would police their own ranks, a lot of lawsuits would be unnecessary, because many people just want to punish the doctor for screwing up, or make sure he can't hurt someone else. But they won't, and this being America, the place of last resort is court.
In California, pain and suffering awards are capped, and you can only sue based on damages. If a child or an old person is killed, there's no monetary damage, because they were not earning money. So you're screwed with no recourse.
The thing a lot of people are ignoring is that if people didn't have huge medical bills, there would be a decrease in lawsuits anyway. A lot of people sue because they can't afford to pay the monstrous costs associated with an illness. Take away that problem, and a lot of people won't bother, thus effectively removing the problem for the most part. It's already not much of an issue. I don't know why it keeps coming up. The statistics show that lawsuits constitute a very small percentage of overall health costs, something like 0.04%. Not worth the trouble in trying to reform, especially given it would hurt regular people who may really need compensation for malpractice.
If cost is the problem, why do we hear insurance reform?
If people could afford to pay for a lot of their own insurance bills, there wouldn't be a problem.
I think the cancer of the entire problem is that America has seen thirty years of wage stagnation, watched jobs move to foreign countries, American's tried to live on credit for far too long and now they are screwed.
American economic status is like an animal that when in a trap, will chew its own leg off, then eventually bleed to death. Health care is the focus of chewing the leg off because the public doesn't know what else to do. But they do know / feel they can't afford paying their own doctor visit.
People do not sue for malpractice because of high medical bills. They sue because of an actionable loss or damage suffered. In all 50 states, as far as I know, you have to prove damages to be granted relief.
Medicare, since 1965, a government managed Health Insurance, right here in the USA, for most Americans 65 or older. No, not perfect, but improved and adjusted over time. Not controlled by the government. Don't take my word for it, for starters here's key milestones link: http://www.cms.hhs.gov/History/Downloads/CMSProgramKeyMilestones.pdf
1945, Twenty years before Medicare, 'Two decades of debate ensue, with opponents warning of the dangers of "socialized medicine."' Two decades it took to pass Medicare. They abandoned a 'universal' care program then also, and Medicare covered the 'elderly and poor'. http://seniorjournal.com/NEWS/2000%20Files/Aug%2000/FTR-08-04-00MedCarHistry.htm
2009, 44 Years after Medicare, we're still having trouble with a 'universal' care program. Canada took less time to pass it. Hopefully we can agree to it catch up before another decade drifts by.
I am very disappointed in how this article was presented. It was confusing, the headline was misleading and the polled base was too small to make an impact no matter what the subject. And people that support national healthcare sure don't care about the Baucus version.
Sometimes I question the way the Zogby polls are done. I buy the books and I am one of the people that take the surveys but when I see the results of the surveys I wonder where these people come from that are surveyed...the Deep South?
I agree. I take the polls as well, but the questions sometimes seem trickily worded, & I do get the odd feeling that they're sometimes trying to get me to say not exactly what I'd hope to express. Sometimes the multiple choices do not include my preferred response.
Does anyone know the background of these Zogby surveys and if they are genuinely politically neutral or not? Who pays for them?
Real surveys poll people from from all over and careful efforts are taken to ensure the sample is random. If properly done, a sample of 1000 can accurately show public opinion of a population of 300 million or more.
Unfortunately, in this case the poll is a survey of a bunch of people who have signed up for Zogby's web based polling service. It is only representative of that small group of people who have signed up for that service, not the US population as a whole.
Well, I signed up for it just to try to give a more liberal response to their conservatively oriented questions. Sometimes it's tough the way they word things to do that. But maybe if more liberals did sign up, they'd get the idea that things are not as they had hoped they would be.
One point that needs to be made is that conservative states like Missouri have already tried anti-patient "tort reform". Did this result in lower health care premiums? Nope.
I have no problem with certain types of tort reform. For example, medical malpractice courts have the potential of judges who can distinguish between junk and real science. But as a cure for the rising cost of health care/insurance, it is a failed hypothesis.
In order for tort reform to lower health care premiums, a whole bunch of leaps of faith have to be made. First, you have to believe that malpractice liability insurers will pass their savings on to medical care providers in the form of lower premiums of medical malpractice liability. Then, you have to believe that health care providers will reduce the costs they charge to health insurance companies for the services they provide. Then, you have to believe that the health insurance companies will reduce the premiums they charge to insured individuals for the health insurance coverage they provide. Whether any of this happens depends on a complex web of relative price elasticities and market pressures for each transaction where money changes hands. You would have to be a fool to believe that all of these will happen just because it becomes harder for damaged health care recipients to sue their doctors when the doctors mess up.
One additional point: tort law is state law, not federal law. Tort reform should happen at the state level.
Good article....however......the CBO estimates $4 billion in revenue from individual mandates. CBO claims an $81 billion savings overall.......we could actually refrain from penalizing individuals who still cannot afford insurance and still reduce the deficit if these numbers are accurate.
Phraseturner said:
"we could actually refrain from penalizing individuals who still cannot afford insurance and still reduce the deficit if these numbers are accurate."
The problem is that if insurance companies are required to provide insurance without regard to whether you have a preexisting condition, and there is no penalty for NOT having insurance, then you are creating a strong incentive for people to only buy insurance when they get sick.
The logical consequence of this is that you will only have people with expensive conditions in the risk pool and premiums will go through the roof.
Put another way, leaving a hit and run victim (or a victim of cancer) without treatment simply because he or she doesn't have insurance is, to use a phrase, sick. Therefore we need a mechanism for paying for this care. In the plans currently on the table, this funding comes from insurance. People who opt out a taking a free lunch. Hence the mandate and therefore penalties.
Phraseturner why are you trying to bring logic to the table. It doesn't make me feel happy or good. I only want to be told what will make me happy or feel good.
Switzerland by the way, and I seemed to have omitted this point since it was the point that I wanted to make in the last post, is the most competitive country in the world.
Yes. number 1 and we do not have any natural resources or an nth of what you Americans have just because you are blessed. We have rocks and common sense. We have learned that we have to be capitalistic and democratic. A slip anywhere is doom. We know that. The balance must be sacred. This means we have to know everything including the best health care system and yes, how to progress despite the demands of health care system that is an essential feature of human life.
We know too.... A health care system must be excluded from economic choice. This should be the object. The only way to achieve this is by reform. You are on the right path. We learned most of what we know from you you know. And we love America!
A Swiss.
Would that the vast majority of Americans were as practical as the Swiss. Unfortunately, a lot of us just go with emotional responses without regard to the truth, which makes for some pretty major problems. Thanks for your support though.
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