I'm borrowing the headline for this entry -- "once more, with feeling" -- from an editorial in this week's New Republic partly because of some observations it makes quoted below and partly because new survey results out in the last 24 hours revisit themes I have covered recently: First, that the satisfaction that Americans with health insurance often express to pollsters about their coverage masks deep anxiety about its costs and stability (here and here) and second, that the emphasis in Washington on "bending the cost curve" does little to convince Americans that health care reform offers them tangible benefits (here and here).
A month ago, an ABC News analysis reported the following results from a June ABC/Washington Post poll: "About eight in 10 [adults], are concerned that reform may reduce their quality, coverage and choice of care, and increase their costs, government bureaucracy and the federal deficit, with anywhere from 51 to 62 percent 'very' worried about each of these." At the time, I passed along the conclusions of the "Democracy Corps" pollster Stan Greenberg and his colleagues that Americans are "nervous about change, but they want it," because of anxiety about "having traded off wages or gotten locked into a job because of health care or about the fate of a child with a chronic ailment who may not be able to get insurance in the future." I pointed to some data from a Kaiser Family Foundation and the Pew Research Center showing reports of putting off needed care because of costs or widespread reports of "problems" with paying the costs of health insurance or a major illness.
Yesterday, John Russonello of the left-leaning firm Belden, Russonello and Stewart released findings from a national survey it conducted last week that clearly demonstrate the anxiety that Greenberg talked about (the survey had no sponsor, although as Ben Smith notes, Russonello's client list includes health reform advocates Families USA and AARP):
- 72% of adults are worried that if someone in their family becomes seriously ill their health insurance might not cover enough of their medical bills. Nearly half the country -- 47 % -- is very worried about inadequate health coverage.
- 65% worry that if they lose or change jobs they might lose their health insurance and not be able to afford new health insurance. Again, close to one out of every two Americans -- 46% -- is very worried about losing health care.
- 60% say they worry that if someone in their family becomes seriously ill their health insurance might drop their coverage. 41% worry very much.
- 56% worry that if they lose or change jobs they might not be able to get new health insurance because of a pre-existing condition. Nearly four in ten -38% -- worry about this very much.
For those following the debate, the benefits you perceive in health care reform (or the lack thereof) may depend on your politics. So, as reported in this morning's Washington Post, while Republican pollster Ed Goeas may see only a "focus on the uninsured" packaged to "convince people that's not the case," I find the new data from Russonello tends to support a contrary argument from Democrat Greenberg in the same article: "There's a real power in telling people, 'We're going to do something to make sure you don't lose your insurance if you lose your job.' "
But are Americans hearing that potentially powerful argument? New data from Gallup implies that they are not. Gallup finds that while 48% of Americans say that they personally have a "good understanding of the issues involved in the national debate over healthcare reform," only 27% say they same for members of Congress.
Before leaping to conclusions about those results, it is worth starting with Frank Newport's caveat:
Americans have quite negative attitudes about Congress in general, making it less than surprising to find that the significant majority of the public believes that Congress does not have a good grasp on the issues involved in the current debate over healthcare reform. It is possible that if Gallup were to ask this "good understanding" question about any type of pending congressional legislation, we would find the same level of distrust that representatives fully understand the issues involved.
That said, I think these results tend to confirm that the Washington debate over health care reform remains distant from the rich, personal experiences that Americans have with the health care system and health insurance. On this score, that TNR editorial gets it exactly right:
[S]omething strange, and not entirely welcome, has happened in the last few weeks: The focus on policy minutiae has crowded out part of the big picture. Health care has become almost entirely a technical discussion, rather than a personal one. It's all about deficit neutrality and bending the curve, instead of making sure every American can get affordable medical care.
Or as Brian Williams put it more succinctly as he introduced a report on yesterday's NBC NIghtly News, "there's the health care debate going on in Washington, almost impossible to follow, and then there's real life."
In real life, the debate about cost containment and the costs of the plan are not likely to translate into a belief that it will reduce every-day, out-of-pocket costs of health care and health insurance any time soon. To sell this plan, the Obama administration needs to move the focus of its message from what TNR calls the "technical gobbledygook" about cost containment to "a clean, simple message" about the benefits of reform.