Health Care: The Politics of Reform

At the same time, as on other issues, Obama retains a strong upper hand over the Republicans in Congress: Asked whom they trust more to handle health care reform, 55 percent pick Obama, just 27 percent the Republicans. The question is whether the president can turn that advantage into positive persuasion on an issue on which so many Americans are so conflicted.

PARTISANSHIP -- One thing that's unlikely is broad consensus, given the very sharp partisan, ideological and philosophical lines that define attitudes on health care reform. Republicans, conservatives and advocates of smaller government -- all related groups, with the latter the largest -- are far more skeptical; Democrats, liberals and backers of larger government, more supportive.

The differences are striking. Among the majority of Americans who prefer smaller government, 62 percent think health care reform will bring more harm than good; among those who prefer larger government, just 13 percent agree. Similarly, the "more harm than good" range goes from 67 percent of Republicans (peaking at 79 percent of conservative Republicans) to 40 percent of independents and on to just 19 percent of Democrats (bottoming out at 6 percent of liberal Democrats).

In another metric, 55 percent of Republicans think reform would worsen their own health care; that drops to three in 10 independents and just 14 percent of Democrats. And while 61 percent of Democrats support requiring health care for all (without specifying the terms); that drops to 48 percent of independents and 39 percent of Republicans.

Three-quarters of Democrats and about two-thirds of independents support creating a government-run plan, compared with 40 percent of Republicans. But there's a similar effect of pushback: Support falls almost equally across these groups, by 23 to 26 points, if it meant private insurers couldn't compete.

OTHER GROUPS -- There are differences among other groups. For example seniors, protective of Medicare, are much more satisfied with their current care and costs (indeed, 71 percent are "very" satisfied with their quality of care, compared with 44 percent of adults under age 65) and are more skeptical of reform.

Women are more worried than men about their future health care costs. But women also are more apt than men to express concern that reform will reduce the quality of their health care. And women are particularly responsive to pushback on a government-financed plan; if it would kill off private insurers their support for the idea drops by 30 points, vs. a 19-point drop among men.

Naturally, uninsured adults are three times as apt as those with insurance to think reform will improve their quality of care -- but still just 37 percent of uninsureds think so, vs. 12 percent of insureds.

In the end, though, the biggest barrier to change remains the fact that so many Americans are satisfied with their current care and coverage. Support for reform is lower among people who think it will require coverage changes they don't want to make. And, most strikingly, people who are satisfied with their current care and coverage -- especially those who are "very" satisfied -- are far more resistant to reform. Therein lies the challenge in the debate ahead.

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