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Posted by on Jun 21, 2009 in Health, Politics | 93 comments

Poll Shows Most Americans Want Public Health Care

The poll is the New York Times/CBS News latest:

Americans overwhelmingly support substantial changes to the health care system and are strongly behind one of the most contentious proposals Congress is considering, a government-run insurance plan to compete with private insurers, according to the latest New York Times/CBS News poll.

The poll found that most Americans would be willing to pay higher taxes so everyone could have health insurance and that they said the government could do a better job of holding down health-care costs than the private sector.

Yet the survey also revealed considerable unease about the impact of heightened government involvement, on both the economy and the quality of the respondents’ own medical care. While 85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt, 77 percent said they were very or somewhat satisfied with the quality of their own care.

That paradox was skillfully exploited by opponents of the last failed attempt at overhauling the health system, during former President Bill Clinton’s first term. Sixteen years later, it underscores the tricky task facing lawmakers and President Obama as they try to address the health system’s substantial problems without igniting fears that people could lose what they like.

These poll results add to the evidence provided by the NBC/Wall Street Journal poll that came out a few days ago (emphasis mine):

Yesterday’s NBC/Wall Street Journal poll has both good news and bad news for health reform. Public opinion is mixed on “Barack Obama’s plan” (odd, as Barack Obama doesn’t currently have a plan). About a third think it’s a good idea. About a third think it’s a bad idea. About a third don’t know. That suggests that we’re still early enough in the process that the bulk of people with opinions are the partisans who didn’t need to actually form one. Indeed, a few questions later, the pollsters describe the plan in more detail, and support shoots to 55 percent, but opposition barely budges.

But make no mistake: There are elements of health reform that are important, but will be sharply unpopular. Almost 60 percent, for instance, oppose efforts to tax generous health care benefits. I’d guess that when people hear about penalties in the individual mandate, that policy will prove controversial too. Luckily, there are some elements of health reform that meet with overwhelming public approval. Among them is the public plan. According to the poll, 76 percent of Americans believe it’s either “extremely important” or “quite important” to “give people a choice of both a public plan administered by the federal government and a private plan for their health insurance.”

Much in health reform is unpopular. The choice of a public insurance option isn’t. And given the many hard and controversial choices that will need to be made to achieve health reform, it’s not clear to me that the Democrats can afford to lightly remove the genuinely popular aspects of the legislation.

Conservatives who are ideologically opposed to public health care are not about to come around just because it’s what most Americans want — although, to be fair to them, they don’t agree that most Americans DO want a public health care option. Those conservative bloggers who posted responses to the New York Times/CBS News poll are implying, or saying, that — to quote one — the poll was rigged. Donald Douglas implores us to think of the children. No, not this child, silly. Look at the picture again, you’ll figure it out.

Jason Arvak at Poligazette pays me the compliment of mentioning me several times in his fairly lengthy post on the Times/CBS poll and the health care debate in general. He makes a number of specific points with regard to my views:

This stridently dishonest approach has been eagerly embraced by the ideologues of the left, who prefer slogans to debate.  A characteristic example is TMV’s Kathy Kattenburg, with her no-discussion-tolerated demand “We Need Single-Payer Public Health Care — NOW“.  Kattenburg’s post does identify a legitimate problem that requires reform (the practice of “rescission” — the arbitrary denial of coverage using flimsy and even dishonest excuses), but its willingness to only consider one possible solution and its intolerance for any discussion of problems or alternatives makes it a dangerous diktat rather than a progressive proposal.  …

If single-payer health care were the nirvana its advocates claim it to be, this wouldn’t be a serious problem.  But continuing experience in Canada, for example, shows that serious problems with availability and rationing in critical care areas such as cancer treatments persist in single-payer systems.  The hostility to debate and discussion among single-payer advocates like Kattenburg is thus revealed as more than simply self-righteous arrogance — it is a serious threat to the viability of a future post-reform system.  Refusing to discuss potential problems may marginalize and disempower opposition, but it will not prevent those problems from occurring in reality.  And the economic logic that causes rationing is impervious to proclamations from high atop a moral white horse:  Providers in a single-payer system can only expect to receive whatever the government’s political process deems an “appropriate” payment.  Since those payment levels will inevitably remain fixated solely on present costs, there is no room left to invest for the future.  As a result, investment in new equipment and technology is slow and unreliable and, as a result, available capacity inevitably lags behind demand.  The outcome in the end is that cancer patients and other patients who would benefit from immediate treatment have to wait in line and, inevitably, some of them die while waiting.

But, of course, such matters are of little interest to self-righteous purists like Kattenburg.  All that matters to them is demonizing the other side enough to score an easy rhetorical “win” before blithely moving on to the next item on their infinite list of political vendettas.  Actually making the system work is Somebody Else’s Problem.  And, after all, any problems that do crop up can always be blamed on Republicans, conservatives, or “the rich”.  A big advantage of refusing to even talk to your critics is that you can continue that same practice to evade accountability later on as well.

Fortunately, not everyone embraces this vicious and irresponsible approach.  Moderate Democrats in the Senate are eschewing the temptations of the extreme purists and are trying to craft a compromise that might address some of the legitimate concerns about single-payer health care.  Whether such proposals can gain steam in spite of the dogmatism of the purists remains to be seen, but the willingness of pragmatist liberals like Justin Gardner at Donklephant to actually recognize and discuss legitimate concerns about purist approaches to health care reform is a very hopeful sign.

The bottom line is that the choice is entirely in the hands of liberals.  Partisan Democrats dominate the entire political playing field, from the Congress to the elite media to the blogosphere.  If they choose to embrace the intolerant purism of their Kathy Kattenburgs, then Americans may have little more to look forward to than a dreary march to technological stagation, rationing, and the decreased quality of care that results from decreased timeliness of care.  The fact that enlightened liberals will have “won” over evil insurance companies will be of little comfort to the breast cancer patients who see their tumors metastitize while they linger on the waiting list for radiation and chemotherapy treatments.  But if they instead adopt the willingness to compromise of Senator Kent Conrad and Donklephant’s Justin Gardner, a centrist consensus might just be possible.

As Jason knows, I cannot respond to his points in Poligazette’s Comments section. However, I can certainly do so here. Without going on at great length, here are a few of my thoughts in response to his (Jason’s comments are in italic):

If single-payer health care were the nirvana its advocates claim it to be, this wouldn’t be a serious problem.

Jason is using a very common rhetorical device here. (I have been known to use it, too, on occasion, so I cannot judge Jason too harshly on this one.)

Of course single-payer is not nirvana, and in truth, there are no advocates of single-payer who claim it to be nirvana. I think it goes without saying (but maybe not) that no system devised by human beings can ever be nirvana — by definition, since human beings are imperfect. In the countries where some form of universal public health care exists, however (which is, to my knowledge, all industrialized nations except the United States), that type of system does a better job of delivering basic health care to all citizens than does the privately administered, for-profit model that exists in this country.

Refusing to discuss potential problems may marginalize and disempower opposition, but it will not prevent those problems from occurring in reality.

I agree, but refusing to discuss potential problems is not, in my view, the sticking point — I think most people are willing to discuss potential problems with a public health care option (as well as potential problems with the for-profit model), and to figure out ways to address those problems. There is a difference, though, between discussing potential problems and possible solutions, and giving up. I cannot speak for anyone else, but for me, the inclusion of a public health care option as part of any reform package is non-negotiable. Note that a public option is already a step down from single-payer. A public option is already a compromise. I don’t know what line in the sand, if any, Democrats in Congress will decide to draw — but for me personally that line is labeled “public option.” No public option, no go.

Providers in a single-payer system can only expect to receive whatever the government’s political process deems an “appropriate” payment.  Since those payment levels will inevitably remain fixated solely on present costs, there is no room left to invest for the future.  As a result, investment in new equipment and technology is slow and unreliable and, as a result, available capacity inevitably lags behind demand.  The outcome in the end is that cancer patients and other patients who would benefit from immediate treatment have to wait in line and, inevitably, some of them die while waiting.

Check out this recent 60 Minutes segment, Jason. Cancer patients without health insurance are dying right now in our country because the low-cost or no-cost hospital-based clinics they rely on for essential care are being closed due to recession-fueled budget cuts. The rationing and waiting lists that exist in some public health care systems are bad — but not getting the health care services at all because you are uninsured and don’t have the money to pay for them is worse.