Obama’s Health Care Address: Have We Seen This Movie?

As President Obama prepares for tomorrow night’s address on health care reform, there’s a cautionary note from the last go ’round: With Bill Clinton as a guide, the evidence suggests that a good speech, in and of itself, won’t do it.

Clinton’s health care pitch – the last attempt at wholesale reform – came Sept. 22, 1993, in an address, like Obama’s, to a joint session of Congress. On one level it worked: The effort was well received, with a spike in support for Clinton’s proposals in immediate post-speech polls. But it didn’t last. Concerns about his plan quickly regained their footing; support quickly ebbed.

One reason cuts to the challenge of presidential speechifying. These addresses to some extent represent an exercise in preaching to the choir, or at best to choir applicants; people who tune in tend to be favorably inclined, or at least willing to lend an ear. Those who are movable may move, yet stay open to further debate. And outright opponents are hard to reach and hardest to turn; it’s a challenge for Obama that in our latest data half the public opposed the reform plan he and the Congress are developing, with four in 10 “strongly” opposed.

Addresses also, naturally, accentuate the positive; rebuttals and debate follow, all part of the mix of substantive evaluation. As we’ve reported previously, the chief lesson from the Clinton effort is that pushback to health care reform resonates powerfully – did then, does now.

Reviewing our polling from the 1993-94 debate, never did more than half of Americans think Clinton’s proposals would improve the quality of care for most Americans, and never did more than about a quarter think it would improve their own care. Half or more, meanwhile, thought it would raise their cost; majorities steadily thought it would raise costs for most Americans.

Health care is a public issue but also a uniquely personal one; cost is important, but concerns about care are essential. In a poll we completed Sept. 19, 1993, 31 percent of Americans thought Clinton’s plan would worsen their own health care, substantially more than the 19 percent who foresaw improvements. The night of the speech he moved that to par – a 27-27 percent better-worse split (the rest thought their care would stay the same). But that reverted to form in a Washington Post poll completed Oct. 10, just over two weeks later – 34 percent worse, 19 percent better. And it stayed there for the duration.

Similarly, before Clinton’s speech just 36 percent though his plan would improve care for most Americans. Immediately after he spoke that hit 50 percent – but two weeks later it was back down to 39 percent. And it was similar on costs – right after the speech, a 7-point drop in Americans’ views that the plan would raise their health care expenses. Oct. 10, back where it was. (Another measure, views on costs for most people, barely budged even briefly.)

Clinton is not the only worrying precedent for Obama. Gallup data recently presented by Mollyann Brodie of the Kaiser Family Foundation showed opposition to Harry Truman’s health reform efforts rising from 38 percent in March 1949 to 60 percent in November 1950 (among those who’d heard about it). Truman had proposed creating a government-run health insurance program; critics, including the American Medical Association, characterized it as "socialized medicine." (Sound familiar?)

Obama’s position today particularly echoes Clinton’s in September 1993. In our last poll Americans by 33 percent to 19 percent thought their quality of care would be worsened rather than improved under the plan being developed by Obama and Congress. Respondents by 41-19 percent thought their costs would worsen, and by 40-14 percent thought their coverage would get worse.

Obama may be blessed by not having Harry and Louise enunciate these concerns; yet they are concerns nonetheless. He’ll likely try to address them, as Clinton did. It’s clearly worth the shot; he may move the dial, as Clinton did. But whether it stays moved is another question entirely.

There are, of course, arguments in support of reform that also resonate. The current system is hardly popular. While most people are satisfied with their current care, coverage and even costs, most also are unhappy with waste in the system overall, concerned about the uninsured and worried about their future costs and coverage alike.

These conditions, too, held some sway in the Clinton days; for most of the period of debate more than half called his plan “better than the present system” – peaking, again, immediately after his speech, and tailing off to 49 percent only in the plan’s death throes nine months later. But better than the present was not good enough; overall support for Clinton’s plan drew a clear majority of Americans just once in nearly a dozen ABC/Post polls – the one done on the night of his address to the nation.

  Views on Clinton’s Health Plan – 1993

              Pre-  Post-  2 weeks

             speech speech  later

Clinton plan:

  Approve      43%    56     51

  Disapprove   41     24     39

Own care:

  Better       19     27     19

  Worse        31     27     34

  Same         46     42     44

Care for most:

  Better       36     50     39

  Worse        29     19     29

  Same         31     25     30

Own cost:

  More         56     49     56

  Less         10     10      7

  Same         29     33     29

Cost for most:

  More         61     57     63

  Less         13     16     11

  Same         21     20     20

Source: ABC/Post and Washington Post polls