We Want Reform, So Long As It’s Free or Really, Really Cheap

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I could have written any number of headlines about a health care poll released this week by Zogby International and the University of Texas Health Science Center. Like most of the polls done in the past year related to health care, there are an infinite number of story lines that could be pulled out to prove an infinite number of points.

For instance, based on this poll, I could say that a majority of Americans strongly support major new federal insurance regulations and very few Americans want lawmakers to give up on health care reform. But I could also say that a majority wants Republicans involved and half of Americans oppose the House and Senate reform bills drafted and passed by Democrats. When it comes to polling, it’s all in the phrasing of the questions and I’m skeptical of polls that make broad claims about whether Americans like or dislike the generic concept of reform. For example, here’s an accurate headline about this poll. And here’s an accurate headline about a poll from last week.

The problem is that polls often ask simplistic questions and the U.S. health care system and policies that affect it are complicated. This is why there’s a split between the percentage of people who support “reform” and the percentage of people who support the specific reforms in the Democratic bills. People support the provisions in the House and Senate bills when asked about them individually, but when ask whether they support the bills themselves and they tend to answer no. People also like the bills more once individual components are explained to them. Here’s the latest Kaiser tracking poll that proves this.

But despite the inherent flaws in asking people simple questions about complex topics, I like this question in the latest Zogby-University of Texas poll:

How much would you be willing to pay in extra taxes every year so that everyone could have health insurance?

$0 – 42.5%
$1-99 – 18.9%
$100-499 – 14.4%
$500-999 – 6.5 %
$1,000 – 2,000 – 3.4%
More than $2,000 – 2.5%
Not sure – 11.8%

I think this says more about how the American public views Democratic health care reform than questions like this one from the same poll:

Some people do not like the provisions in either healthcare bill, and believe that Congress should start over. Do you agree or disagree with this opinion?

Strongly agree – 43.4%
Somewhat agree – 13.5%
Somewhat disagree – 14%
Strongly disagree – 25%
Not sure – 4%

I called up S. Ward Casscells, who commissioned the poll for the University of Texas, shortly after the results were made public. Casscells is a medical doctor, professor and former Assistant Secretary of Defense for Health Affairs. He disputes the notion that Americans don’t really understand how Democratic health reform would work. “We think the public more or less understands the bills,” he said. The public agrees on that point – more than 80% of those surveyed in the Zogby-UT poll said they were “very” or “somewhat” “familiar” with the key components of health care reform in the House and Senate bills.

But if the public is familiar with the bills, most people don’t understand how components of the Democratic health reform plan fit together. They’re not alone. Even Peggy Noonan doesn’t (or didn’t) really get it.

For example, in the new poll, about 68% support insurance reforms like an end to pre-existing conditions exclusions but only 19% support an individual mandate. As Paul Krugman (linked above) and others have explained, the entire system breaks down if insurance underwriting is eliminated and universal coverage is not enacted. And by break down, I mean cost prohibitive premiums followed by an insurance death spiral.

I asked Casscell how confident he really was that those in his poll understand things like this. He laughed and said, “We can’t quiz them. That would push the response rate right down.” This is true and this is why polls about health care reform tell us more about the efficacy of Republicans and Democratic messaging than they do about whether Americans support or oppose what’s actually being proposed.