07/20/2009 12:13 pm ET | Updated May 25, 2011

Health Care Costs vs. Coverage: Part II

My National Journal column for this week expands on my post from last week that reviewed the inconsistent results from polls that push Americans to choose between reduced cost and expanded coverage as the most important goal of health care reform.

My reading of the data yields a theory about the most powerful message for health care reform. To quote the column:

[These results imply that the most enticing aspect of health care reform exists at the intersection of cost and coverage. True, the February Kaiser survey found relatively less anxiety about "losing your health insurance coverage" [than about rising increasing costs] -- 34 percent were "very worried," another 20 percent "somewhat worried" -- but Americans also understand that a loss of coverage means a catastrophic increase in personal cost, especially in the event of a major illness.

Slate's Mickey Kaus puts it more simply: The aspect of reform that "most voters might desperately crave" is "not having to worry about where their health insurance will come from anymore.

While we are not seeing much in the way of pro-reform "message testing" survey results in the public domain, it is interesting that the pro-reform advertising featuring, ironically, the same "Harry and Louise" characters that helped defeat reform sixteen years ago (this time sponsored by the odd alliance of pro-reform Families USA and PhRMA) hits this message as clearly as I have seen anywhere. The describe "reform" as "good coverage people can afford, coverage people can get even if they have a pre-existing condition, coverage they can keep if they change jobs or lose their job." (My National Journal colleague Marilyn Werber Serafini has more details on the return of Harry and Louise).

Notice also the way President Obama's remarks from last Friday (as quoted by Kaus) hits a similar message blending concerns about cost and coverage:

So this is what health insurance reform will mean for the average American. It will mean lower costs, more choices and coverage you can count on. It will save you and your family money.

You won't have to worry about being priced out of the market. You won't have to worry about one illness leading to your family going into financial ruin.

Americans will have coverage that finally has stability and security, and Americans who don't have health insurance will finally have affordable quality options.

See the column for details on the public attitudes that support these messages.

For further reading: Some of the advocacy organizations on different sides of the reform battle are starting to release memoranda based on their own internal surveys. The pro-reform organization Third Way, for example, argues for a message, much like that articulated by Obama above, of "stability--stable coverage, stable costs, and stable quality." The memo is based on a survey conducted by the Benenson Strategy Group, one of the firms that also conducts internal polls for the Democratic National Committee on behalf of the Obama administration.

A memorandum from an alliance of labor unions and business interests known as America's Agenda (and referenced in David Broder's column yesterday) offers a different perspective. The memo, from Democratic pollster Celinda Lake, Republican pollster Bill McInturff and their associates finds support "across the political spectrum" for reforms focused on "changes to improve quality and control costs" without explicit measures to expand coverage.

PS:  And you can make some inferences about what the message testing surveys say about how to defeat health care reform from this advertisement produced by the Republican National Committee (via Hotline On-Call