The idea of a public option in healthcare reform is not dead yet. A lot of Democrats believe you need it to hold down costs. A lot also see it as a first stride towards Medicare-for-all, which is where they want the system to end up. Obama has signalled he is ready to drop the idea, but has given no strong steer one way or the other. The party, especially in the House, is not willing to give up on it just yet.
One of the things keeping the notion afloat is the belief that voters, too, are pretty keen. I've blogged before about this (here and here), noting that the polling results are actually all over the place. The answer depends on the way the question is framed. The variation also suggests confusion--which is warranted, given the complexity of these proposals, with or without the option.
The excellent Jay Cost at Real Clear Politics has taken a much more careful look at the question. Framing is everything, he finds, and questions which draw attention to possible consequences of the option elicit less support.
Cost draws attention to some Rasmussen polling. When asked,
"Would you favor or oppose the creation of a government-sponsored non-profit health insurance option that people could choose instead of a private health insurance plan?"
the answer is strong approval. Then comes a follow-up question.
"Suppose that the creation of a government-sponsored non-profit health insurance option encouraged companies to drop private health insurance coverage for their workers. Workers would then be covered by the government option. Would you favor or oppose the creation of a government-sponsored non-profit health insurance option if it encouraged companies to drop private health insurance coverage for their workers?"
A clear majority is now opposed.
Sounds right to me.So, does this mean that the public is actually against the public option? I'd say no. Instead, I would suggest that the public lacks sufficient information about that specific item to deliver a firm opinion. Accordingly, its opinion varies depending upon question wording, priming effects, the ebbs and flows of the news cycle, and so on.
I wish they'd poll a question like: "Do you think access to the health care system and health care insurance should be dependent on your employment status or linked to an individual job?"
I'd be interested in the responses to these follow-up questions:
"Suppose that double-digit health insurance inflation continues, and employers continue to drop or reduce health-care coverage in order to make ends meet, leaving workers uncovered or with inadequate insurance. Would you support the creation of a government-sponsored non-profit health insurance option if it created an affordable health insurance alternative for these workers?"
"Suppose that double-digit heath insurance inflation continues, and companies decide to hold wage compensation steady in order to be able to continue to afford health insurance, albeit with higher co-payments, so that in effect real wages actually decline over a period of years. [Note from commenter: as has happened to everyone where my husband works for the past six years]. Would you support the creation of a government-sponsored non-profit health insurance option if it solved this problem of wage stagnation?"
Note that the fact that my husband, at the beginning of his career, is making exactly the same amount as when he was hired six years ago (though effectively less because our coverage is poorer), all because of double-digit health care inflation, can be expected to impact his lifetime earnings,retirement savings,our ability to help our children with college, our ability to maintain our home, etc.
I'd say a lot depends on the follow-up question.
I wish someone would ask the President what happened to the idea he talked about during the campaign, that people could buy into the plans for federal employees. Another thing that I have seen no more on since he said it in the speech to Congress was that they would take something like 4 years to draw up the new plan because they wanted to get it right. So, what exactly are they voting on now? He also said that people with preexisting conditions would be able to buy insurance through the federal government immediately once the bill was signed. Thinking practically, once people have the ability to buy that insurance, how does the federal government take it away and replace it with something inferior or more complicated?
How much of the healthcare problem is simply solved if the federal government provides insurance accessibility to people with preexisting conditions? I do have a bias because my daughter will need insurance on her own in a few years and she has a serious preexisting condition, but it seems to me that theres a logic to the federal government providing that accessibility, certainly more logic than providing flood insurance to people who build houses on Galveston Island, among other very vulnerable places. Its a fact of life that some percentage of people will have serious illnesses and many illnesses are random occurence.
Finally, the polls we really need to see would contrast spending money on healthcare with continuing the wars in Iraq and Afghanistan. The cost of the healthcare plans that are in Congress now are less over the 10 year period than we've spent in just Iraq in 6 years. I have yet to see a Republican politician - like, say, John McCain - get the question put to him about opposing a healthcare bill and still saying that invading Iraq was the right thing to do. Both of those wars were big mistakes. Its stunning that our politicians and our military got us into such messes and we will have to spend hundreds of billions more to get out of them.
Well, actually, the second question is highly misleading. Since the public option as currently proposed is exclusively available to the uninsured, only one in ten Americans will be able to choose it -- generally only Americans who cannot get private health insurance through an employer. A better criticism of both questions is that they assume that everyone actually does have that option (here a better criticism of public option polling). It's incredibly negligent for you, Rasmussen, and Jay Cost not to point this basic fact out.
Nonetheless, these polls show two things. The first is that the public is uninformed about the public option (as it is uninformed about most policy questions); the second is that their view of the public option as they understand it is favorable. The latter point is undoubtedly favorable to the Democrats politically. From a political standpoint doesn't matter, currently, if the public is actually opposed to what the Democrats are proposing as long as they think it's something they'd like. Of course, this is tragic from the perspective of someone who thinks truth is important in political debate; but this is the way Congress has always passed legislation. Try telling someone what BAPCPA actually does!