Health Care: The Politics of Reform

Current Satisfaction vs. Future Worry Defines the Battle on Health Reform

Americans are at once supportive of health care reform yet broadly suspicious of its impact -- keeping the issue as much a political challenge as it was in the last attempt at wholesale change 16 years ago.

The chief obstacle to reform is that large majorities are satisfied with their current care and coverage; most, albeit fewer, also call their costs tolerable. Dissatisfaction with the system overall, and worry about future costs, are countered by broad concerns that change could worsen the quality, choice and coverage most Americans enjoy now.

The result: pushback works.

Click here for a PDF with charts and questionnaire.

Sixty-two percent in this new ABC News/Washington Post poll, for example, support creating a government-funded entity to offer health insurance to those who don't get it elsewhere, a cornerstone of the plans now under discussion. But if that caused many private insurers to go out of business because they couldn't compete -- as critics charge -- support plummets to 37 percent.

Among others:

- An overwhelming 70 percent oppose taxing benefits worth over $17,000 a year, a funding mechanism under discussion. (Raising income taxes on the wealthy, as usual, is far more popular.)

- Fifty-eight percent don't buy President Obama's pledge that reform can occur without forcing people to make undesired changes in their current coverage.

- The public splits about evenly, 49-47 percent, on another basic element, requiring all Americans to have health insurance. That varies widely, though -- as high as 70 percent support, as low as 44 percent -- depending on the terms of such a requirement.

- About eight in 10 are concerned that reform may reduce their quality, coverage and choice of care, and increase their costs, government bureaucracy and the federal deficit, with anywhere from 51 to 62 percent "very" worried about each of these.

While such views aren't fatal to reform, they underscore its challenges: Critical mass for change generally occurs when Americans are unhappy with current conditions, not only worried about the future. And in this poll 83 percent are very or somewhat satisfied with the quality of their care, 81 percent of insured adults are satisfied with their coverage, and 55 percent of Americans (61 percent of the insured) rate their costs positively.

This poll supports the upcoming ABC News special on health care reform, "Questions for the President: Prescription for America," anchored from the White House by Diane Sawyer and Charles Gibson, airing at 10 p.m. Eastern on Wednesday, June 24.

CHANGE -- There is countervailing impetus for change. Far fewer Americans, 43 percent, are satisfied with "the overall health care system in this country," with a mere 10 percent "very" satisfied. A whopping 85 percent are concerned about their future costs, with 59 percent "very" concerned.

Pre-Existing Conditions and Government Mandates

And there are specific measures of reform -- an employer mandate and required coverage of pre-existing conditions, for instance -- that earn broad support.

Perhaps most persuasively, the public by 58 percent to 39 percent says health care reform is "necessary to control costs and expand coverage" rather than believing it "will do more harm than good." But fewer feel "strongly" that it's necessary -- 34 percent.

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