What do the polls on health care policy tell us? Does the public know enough about health care policy to give valid responses to analysts? Other than a handful of people in Washington, most had no clue what was in the final health care bill. How can you respond whether you like a proposal or not, if you have no idea what's in it?
I really have to dash, but I wanted to share some interesting articles.
At Gallup.com, Frank Newport reports that there is a huge variation in polling results depending on the survey question. He concludes that people are worried about the cost of healthcare, but they want to help out those without health insurance. He's doubtful that healthcare passage will have any impact on November; he thinks the status of the economy will be the deciding factor.
Like Newport, pollster Stanley Greenberg believes that voters will care more about the state of the economy than health care in November.
Most Americans fear losing their insurance because of a job loss or being denied coverage because of a pre-existing condition. Once we get past this talk of socialism and big government, I think most Americans are going to be very pleased with this program. This discussion has even reached the mommybloggers. Dooce talks about her struggles with health insurance.
The public is worried about costs. And they should be. I am worried about costs. I'm worried that this reform is a Frankenstein policy that pieces together bits of the old program with bits of a single payer program creating something horrible. The worst of both worlds. We'll get the growth, but be unable to control the costs. This is a legitimate fear, see David Brooks and Megan McArdle for more on this.
(more to come)
Apt. 11d 
Other than a handful of people in Washington, most had no clue what was in the final health care bill. How can you respond whether you like a proposal or not, if you have no idea what’s in it?
In general, if you have no idea what’s in something, you should oppose it. I know the bill was in flux because of the legislative process, but there was very little effort to get information to the public. Both sides failed there.
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“In general, if you have no idea what’s in something, you should oppose it.”
Right.
“…there was very little effort to get information to the public.”
The thing was changing so rapidly that it was hard for anybody (including probably the authors) to keep up.
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I’m worried about the unintended consequences of the sausage making aspects of the bill. For example, the compromise that resulted in a relatively low “penalty” being set for lack of insurance could have the consequences MH was describing in the previous thread. It might not, though. Ultimately it depends on whether people *want* the benefit of health insurance, if it’s made available to those who now struggle to obtain it. Will people want to buy it at the price at which it will be available?
It’ll also stop some of the egregious practices — I was horrified by the short term policies that some folks were suckered into buying, on 6 month renewals, but you can’t renew if you get sick.
I do not believe that the change in the system will have significant effects on “research innovation” (a claim I’ve always thought was very far-fetched). It’s worth keeping an eye on, but I don’t see it as one of the immediate worries.
But, what I want to talk about now is what’s in the bill, and the effects it might have (on everything). I’m not particularly interested in trying to predict the effect on the election in November (for that, I’d rather just wait, and see what happens in November, rather than spend any energy at all on trying to predict it). Predicting what will happen to health care, health insurance, physicians salaries/incentives, insurance companies, pharma companies, the economy, mortality rates, infant mortality. Those things would be an interesting exercise, useful for policy making, now and in the future, and also things that we can’t just wait to see the consequences of.
Elections are cool that way — a very clear result. And, it doesn’t really matter whether the health care bill had a significant effect on the November elections, since I don’t believe in direct democracy anyway — I think the democrats did the right thing, even if they loose the house over this (i.e. the Civil Rights bill of the 60’s). Figuring out the other stuff is harder.
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Dooce’s story is concrete and interesting — you can be denied health care coverage for hay fever? It’s a concrete example of the potentially economy skewing effects of our current system, the broken status quo. Dooce apparently went ahead and started the business anyway (well, perhaps after having gotten fired). But, I’d guess that there are a number of people who reconsider starting small businesses like this, because they’re worried about health insurance, risk takers, who aren’t quite willing to take that risk (especially with their children’s health). And, I’m guessing that assessment of that risk is skewed by whether you’ve had health insurance already (as part of your job), as compared to those who never had it (always ran a small business, for example).
It’ll be interesting to see if changing the insurance landscape as an affect on availability and interest in part time employment.
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“I think the democrats did the right thing, even if they loose the house over this (i.e. the Civil Rights bill of the 60’s).”
I think you may have fallen victim to a Krugman error.
“The Paul Krugman column on Monday, about the health care bill, quoted Newt Gingrich as saying that “Lyndon Johnson shattered the Democratic Party for 40 years” by passing civil rights legislation. The quotation originally appeared in The Washington Post, which reported after the column went to press that Mr. Gingrich said it referred to Johnson’s Great Society policies, not to the 1964 Civil Rights Act.”
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Either way, didn’t the Democratic party keep the House until 1994.
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sausage making aspects of the bill
I think they made it worse by the way they approached it. First place, the issues of health insurance and health care were conflated. In other words, if you want a plan that covers everything with low co-pays, you are looking at health care not insurance. Then, you’ve got issues that are not necessarily related. You’ve got some people who cannot get health care or health insurance because they are poor and you have some people who cannot get health insurance because of pre-existing conditions and you have some people who do not get health insurance for reasons of choice. Excepting a single-payer system, there is no reason to have made a big mush and tried to deal with all of these at once.
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1) I didn’t cite Gingrich, and, in any case, most people think (I think, and I believe Johnson did) that Johnson “shattered the democratic party” by passing the Civil Rights legislation (not the great society legislation). Johnson (who now reminds me of Pelosi), i.e. the “the machinelike toughness of the party apparatus” (according to Brooks) did a great deed when he passed that legislation, even if it had shattered the Democratic party. I hope (and believe) that the consequences of this legislation will be worth it, but even if they were significant (i.e. the democrats loose the house in 2010) it was a risk I’m proud that the Democrats were willing to take. As others have pointed out, the point of governing isn’t merely to remain in power. It is to do the things you came there to do.
2) I don’t really care that the comparison came from a discussion with Gingrich. I’m pleased to hear that Gingrich does indeed consider that it was a moral necessity to pass the Civil Rights legislation. http://voices.washingtonpost.com/44/2010/03/gingrich-like-lbj-obama-risks.html. Gingrich seems to have his own (and I think, contrary) opinions on what choices of Johnson “shattered” the Democratic party.
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“Either way, didn’t the Democratic party keep the House until 1994.”
Plus, percentage-wise, a lot more Republicans voted for the Civil Rights Act than did Democrats (although a majority of Democrats did vote for it). Republicans in Congress consistently voted 80% for the Civil Rights Act at different points in the legislative process. (Insert obligatory caveat about regional differences, changes in regional party loyalty over past half century, etc.)
http://en.wikipedia.org/wiki/Civil_Rights_Act_of_1964
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Johnson (who now reminds me of Pelosi)
My most vivid factoid of LBJ is his aides complaining (after he was safely dead) that he used to make them giving briefings while he was taking a dump.
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That’s one of those stories my wife says I should mention less often.
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MH, your wife is a sissy. It wasn’t just aides: he did this to the French ambassador, and the guy was so mortified/humiliated that USA got a lot of stuff out of France that France would have resisted otherwise, just so he could get out of the room.
Effects are going to be interesting: “Most Americans fear losing their insurance because of a job loss or being denied coverage because of a pre-existing condition.” – that goes away, now. You wait til you get breast cancer, then you sign up. So you now, as a citizen, have the insurance aspects of this, and you can choose whether to buy the health maintenance services. The fines for not buying insurance are so low, and for not providing as a small business are so low, that there will presumably be a lot of folks who make a rational choice to go bare. Then what? You will have a lot of middle-middle class people shopping health services by price, who now don’t, because they are maintaining their health maintenance plan because it is also insurance against catastrophe.
Doctor x charges $60 for a preschool physical? I will go to Doctor y for $45. There is a pretty substantial cash sector for cheaper medicine patronized by illegals already (at least here in DC), this will grow, as will doc-in-a-box.
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I heard LBJ had trouble getting the German ambassador to leave the room.
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1. It is nonsensical to think that the Democrats in the 1960s were hurt by passing Great Society Legislation.
2. If you include people who oppose the Health Care Legislation because it’s “not liberal enough,” then there is generally majority support for doing at least this much.
3. As with most things that the Democrats want and the Republicans fear-monger over, one of two things will happen: (a) (Most likely) the fearsome thing won’t happen and Republicans will support universal health care like the Conservative parties do in every other county; (b)(Occasionally) it will not work and there will be bi-partisan support to change/ fix/ eliminate it.
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“As with most things that the Democrats want and the Republicans fear-monger over, one of two things will happen: (a) (Most likely) the fearsome thing won’t happen and Republicans will support universal health care like the Conservative parties do in every other county; (b)(Occasionally) it will not work and there will be bi-partisan support to change/ fix/ eliminate it.”
I don’t think it’s that easy. Looking at places like Detroit and (perhaps California), it is possible to go beyond the point of no return. (OK, maybe “no return” is a bit too categorical, but how about “no foreseeable return.”)
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Rescission isn’t coming back, exclusions for pre-existing conditions aren’t coming back, lifetime caps aren’t coming back, annual caps are on their way out, the donut hole is on its way out, with luck medical bankruptcies are on their way to the dustbin of history; this is a good strong step forward.
The real Rubicon is that the question is no longer whether there is a national interest in the state of health care, it is what kind of national interest there is in health care. I don’t think that can be undone (ask the conservative parties in Canada or the UK, for instance), and I think it’s about darn time.
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“It is nonsensical to think that the Democrats in the 1960s were hurt by passing Great Society Legislation.”
Good to hear. I always find it a bit worrisome when I take a position on political history here, since it is certainly not my area of expertise.
And, yeah, the right thing for the Democrats who wanted to make health care happen was to take the risk that they would be punished in November, and pass this bill. The right thing for those who oppose it to do is to try to retake the House (and Senate). Then they can try to make policy.
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“It is nonsensical to think that the Democrats in the 1960s were hurt by passing Great Society Legislation.”
It’s also nonsensical to think that the Great Society legislation did not cause problems. They problems were just punted down the line a bit (as we’ll probably see with HCR).
At least when I studied political economy, it was taken as a non-controversial that the “Great Society + Vietnam = the high inflation of the 1970s” (+ oil shock = Stagflation). This did hurt the Democrats, thought Jimmy Carter took the abuse, not LBJ. I can still remember adults complaining about what I would later learn to call “bracket creep”.
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“It is nonsensical to think that the Democrats in the 1960s were hurt by passing Great Society Legislation.”
Democrats were hurt in the 1970s and 1980s by public perception of the failure of the Great Society, which is one of the reasons Reagan did so well.
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Democrats were hurt in the 1970s and 1980s by public perception of the failure of the Great Society, which is one of the reasons Reagan did so well.
Democrats were hurt in the 1970s and 1980s by public perception of the failure of the Great Society, which is one of the reasons Reagan did so well.
I don’t think the general public was operating with that level of knowledge or that people were specifically upset about most Great Society Programs in any great numbers (at least any great numbers in excess of those specifically enthused about it). They certainly weren’t by 1980. Excepting the well-informed few and people hit directly by something during some crucial formative period, these opinions just don’t cling for that long.
Polling on those types of things is not stable and never that negative unless you really slam with the question. If it won’t trigger some kind of affective response, you won’t get a very big effect. Once you get past those affect laden issues, as noted in the original post, it’s the condition of the economy that matters for elections.
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“I don’t think the general public was operating with that level of knowledge or that people were specifically upset about most Great Society Programs in any great numbers (at least any great numbers in excess of those specifically enthused about it).”
I don’t know to what extent public housing projects count as “Great Society,” but public housing did not have a good image as of the early 80s. (My family lived across the street from “the projects” in our little town for several years when I was a little kid.)
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