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.
Jim Jaffe: Let Insiders Make Health Deals
Each time politicians seeking to make a deal try to move the ball forward, there's a vocal reaction from those who can't tell the difference between making a deal and selling out.
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.
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
Majority doesn't mean right...
and gay people that want equal rights.
Your mother must be so proud.....
It is decision time for the Repugs. If they all oppose health care reform and it still passes, then they are toast.
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.)
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.
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.
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?
Does anyone know the background of these Zogby surveys and if they are genuinely politically neutral or not? Who pays for them?
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.
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.
"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.
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.
The essence of tort reform is: make it harder to sue for harms suffered and/or reduce the amount of damages you are entitled to if you suffer a loss. It presupposes that doing either of these will make malpractice defense insurance premiums come down, which will lower the cost of providing health care. There are two for profit entities standing between every tort lawsuit and every health care bill: the for profit insurance company and the for profit medical provider. There is no evidence that insurance companies will actually lower malpractice premiums if they get tort reform. Even if they did, there is no evidence that health care providers would actually lower their costs to consumers if they paid lower malpractice premiums.