When President Obama lays it on the line tonight with a primetime news conference pushing health care reform, part of his message may be to invoke, as politicians do, the will of the people. We got a preview yesterday; in a Rose Garden appearance, the president said, “the American people understand that the status quo is unacceptable.”
Were it that simple.
While he rightly brings up the public’s concerns about health care, the president’s challenge is that those concerns cut two ways. On the one hand, yes, most are supportive of reform in principle, given broad dissatisfaction with the current system overall and worry about future costs. But on the other, most people also are satisfied with their current care, coverage and even costs – and worried that reform could in fact worsen these.
We explored these dynamics in detail in our health care poll last month. They're in many ways the same as those that confronted President Clinton in his quest for reform 16 years ago. Barack Obama’s hoping that the politics and the economics have changed, and that may be; nonetheless public opinion by and large is where it's always been: Interested in reform, but skeptical about its impact.
Roughly eight in 10 in our June poll expressed concern that reform could reduce their quality, coverage and choice of care, and increase their costs, government bureaucracy and the deficit, with anywhere from 51 to 62 percent “very” concerned about these outcomes. Fifty-eight percent expressed doubt that people would be free to keep the coverage they have now without any changes – contrary to Obama’s repeated assurances on this point.
As an example of the compunctions, while 62 percent supported a government option, that fell to 37 percent if it put many private insurers out of business. And the public split essentially evenly on a personal mandate, but with great variation depending on the particulars.
Again, support for reform is there; when we rolled up the main pieces of the House plan in our new poll this week, 54 percent favored it. But “strong” support and “strong” opposition were even (a third each), and this was without the pushback language that so reliably resonates.
Note, moreover, the direction of Obama’s approval rating for handling health care as he’s pushed the issue forward: In April, 57 percent approved, 29 percent disapproved. In June, 53-39 percent. And today, 49-44 percent. On health care, it seems, the hurrieder he goes, the behinder he gets.
At the end of the day, two forces for change operate in public sentiment. Discontent with current conditions is the strong force; when it exists, change is demanded. (The economy is an example.) The weak force is apprehension about the future. It creates interest in change, but not demand.
Health care reform is somewhere between the two. Most people are unhappy with the current system and would like to see it improved. But eight in 10 rate their own quality of care and coverage positively, and 55 percent are even satisfied with their current costs. Those realities – and the concerns about the possible consequences of reform – are the hurdles in public opinion that Obama, like Clinton before him, has yet to clear.