Govrnment reform - Health Reform: Slippery Slope of Public Opinion

Philosophically, many Americans are suspicious of direct, massive government intervention.

Lawrence R. Jacobs, PhD, “1994 All Over Again? Public Opinion and Health Care, “New England Journal of Medicine, May 1, 2008

Finding how Americans feel about health care reform depends on how you ask the question.

Between 1991 and 2007, 90% of Americans in polls said the health system should be “completely rebuilt,” and another 70% felt the system was “in crisis.”

Yet seven polls between 1998 and 2007, found 41% to 58% of Americans opposed a single payer system, and 51% to 63% of Gallup polls conducted since 2001, indicate Americans prefer to maintain the current system. In essence, Americans like their doctors and hospitals but hate “the system.”

Finally, though 56% of Americans in an ABC News, the Kaiser Foundation, and USA Today favored government insurance over the current system, respondents quickly reversed course when asked specific questions: 64% became opponents when told a government system might reduce access), 49% when informed a government plan might limit choice of doctors, 36% to 40% when they learned government care might increase waiting or involve cost sharing.

Americans are clearly uneasy about the unintended consequences of government takeover. Yet, according to Gallup, many are dissatisfied with current coverage (20%), cost (40%), and quality (15%).

The polls have yet to address how many Americans would favor the Republican approach – removing tax subsidies for employer health benefits, giving $5000 tax breaks for all individuals to spend as they please, HSAs and high deductibles, increased consumer information with transparency, and heightened market competition. My bet is Americans will resist this market-based approach too, just as they show hesitancy over single payer.

As a conservative people, critical of both big business and big government, we distrust sweeping change, whether it come from the left or the right. In the coming presidential election, neither Democrats nor Republicans will be able to mobilize enough support for overreaching change for the incoming administration.

Conclusion? We’re likely to see 1994 all over again – with a slight shift to the left if Democrats win big, and a few marketplace tilts if McCain wins. Meanwhile Americans will still want to have their cake (access to superb critical care) and to eat it too (comprehensive coverage with little direct, personal cost).