Healthcare's Big Moment

As most of you are probably aware, President Obama will be addressing both houses of Congress tomorrow evening about health care reform. 56% of Americans, and 52% of Independents, say that they plan on watching the President’s speech, so when we look back on this debate, regardless of the outcome, this will, in all probability, be a big night. So, here are some thoughts on where the debate stands, what President Obama might say (based on public polling data,) and, most importantly, what to look for (in terms of polling data) after Wednesday.

The Current Environment: In the latest CBS poll on healthcare, 67% of respondents say that they are confused by the healthcare debate and plan, and a full 60% claim that President Obama has not explained his healthcare plan well enough (65% among independent voters.) Though confused, the public finds healthcare ‘important’ by a margin of 93-6% and 73% believe that healthcare reform will affect them personally, according a Pew Report. And, Americans recognize that a minor change will not create the change they think is necessary in healthcare, with 60% stating that a ‘complete overhaul’ or ‘major reform’ is needed, according to an NBC poll.

While the majority of Americans may not understand the healthcare plan and view major reform as important in general and to their families, they are split on whether they would advise their Congressperson to vote for or against the bill, with 37% voting for and 39% voting against, leaving a full 24% unsure of, at this point, what to do with healthcare reform, according to a Gallup poll. However, of those people who are unsure about healthcare reform, only 36% say it will be a ‘major factor’ in how they vote for Congress come 2010. Though Gallup does not release their crosstabs, I would wager that the ‘unsure’ group is disproportionately made up of moderates, independents, and ‘leaners,’ which means while healthcare might be an important partisan issue in 2010, it might not influence those in the middle as much as we think (in fact, if the economy rebounds or falls further, that will be a bigger issue, as it is, right now, to most Americans.)

As it stands right now, Americans are unsure about healthcare, though they are interested and will tune into the President’s speech. 28% of Independents (19% of Republicans and 23% of Democrats) are unsure of how their Congressperson should vote – though partisan, this issue needs clarification before the public really makes a decision on the issue. With President Obama’s approval hovering around 50%, his ability to take these unsure voters and create supporters will help him pass healthcare, which, in turn, would help his stalled approval numbers.

What we might hear from The President: On September 3^rd, Joel Benenson (President Obama’s pollster) sent a memo to Congress with the basic premise that, when people hear about the President’s plan for healthcare, support increases. Specifically, he points to an NBC poll that, initially, puts public support for the President’s plan at 36%, with opposition at 42% (17% have no opinion initially.) However, after hearing that his plan

1. Will require insurance companies to cover people with pre-existing conditions
2. Mandate that most employers provide healthcare to their employees
3. Provide tax-credits for lower- and middle- income families to pay for healthcare, which is offset by increased taxes on the wealthiest

Support jumps to 53% (with 43% in opposition and 4% still undecided.) If this proves nothing else, it shows that when confused Americans are told about the President’s plan, they become substantially more supportive of his program.

During the President’s address tomorrow evening, he is sure to bring up all three points, especially mandating insurance companies cover people with pre-existing conditions. Another point he will, probably, stress is an increased focus on prevention programs to catch disease early. In the most recent Kaiser poll, 63% of Americans said that such a piece of the plan was ‘very important;’ however, 32% said that the most important part is helping Americans afford healthcare insurance – stressing both should increase support for his plan.

The public option (which polls at 59% support in the Kaiser poll) will come up – it has been at the center of the recent debate and President Obama must address this point. He can do one of two things – write it off as just a piece of his plan to placate Blue Dog Democrats and moderate Republicans into passing a healthcare bill or come out fighting for it in order to build up more public approval for the plan, forcing Blue Dog’s to realize that their constituents, once they understand the offering, want a public option. There is no doubt that President Obama will address the public option, the question, which even polling data can’t address, is whether he will come out fighting for it (attempting to turn public opinion in his favor) or drop it as just a piece in order to accomplish the other parts of his healthcare agenda. Right now, it is anyone’s guess.

Lastly, he must address the fact that 48% of Americans are worried that the government might play ‘too big’ a role in deciding their care, under the President’s reform efforts. Americans’ want a system where everyone is covered and insurers cannot drop them, but they are terrified of the consequences of such a plan. In his address, Obama must say that he understands the public’s fear, but reassure them (and explain to them) that his plan will increase their choice, NOT decrease it.

Overall, tomorrow President Obama will lay out the plan he has tried to disseminate from the start, to an audience that has heard mixed things about what he truly wants his healthcare reform to look like. He should talk about requiring insurance companies (who are never popular with the American public) to cover everyone, regardless of their conditions, mandating, through various mechanisms, coverage for everyone, the public option (though the jury is out on what he will say about that), and, finally, that his plan is about putting the decisions back in the public’s hands – that with more preventative care, American’s will be healthier, but, when they have to make a decision, it will be up to them and their doctor, not a bureaucrat in Washington or administrator in New York. If he can do that, as the NBC poll shows, he can convince the undecideds (and maybe some of the decideds) to give his reform a second thought, making reform and the 2010 election much easier for him and his Democrat’s in Congress.

What to look for: After his speech, pundits and prognosticators will convene on network and cable news to proclaim success or failure – half will be correct, the other half will look awfully foolish in retrospect. But, we won’t know until Americans’ tell us. After tomorrow, look for changes in the number of undecideds in the polls regarding healthcare, especially when asked if they support President Obama’s plan. Also, look for what happens to Obama’s approval on the healthcare issue – this will be important to see if people have come around to his plan, which will affect his overall approval ratings. Lastly, look at the number of people who say they are confused about the plan. If the number remains around 65%, the President didn’t do a good job selling his plan to the public – actually, he’ll have wasted a great opportunity.

This being said, there are three potential outcomes from this speech:

1. Support for Obama’s healthcare plan increases across the board and the number of undecideds decreases as the move into the support column
2. Obama’s speech decreases support as more people become aware of what healthcare reform will actually mean, which will cause Obama’s approval rate to drop below 50% and, probably, stay there for some time
3. The worst case scenario is that there is little or no movement on the debate, and a sizeable portion of Americans remain confused about the plan. Here, Obama will have wasted crucial resources getting little from the public (at least if they hate it after Obama talks to them, we will know that they know about it and have an opinion on it.)

The outcome of the President’s speech tomorrow will be seen by the public’s support for his plan, his approval on the healthcare issue, and how many Americans remain confused and undecided on the issue of healthcare in America. A successful speech could dramatically change public opinion; pushing Obama’s plan through Congress with the support of Americans and lead the charge to the 2010 elections. A bad speech could doom the initiative and slow Obama’s progress as a President for a while. There could be a lot hanging on tomorrow night – for now, we’ll just have to wait and see.

Poll Helps RNC Look to Defeat Obamacare

For the Huffington Post article and the RNC poll, click here

Cynics are often leery of polls and pollsters – believing they are mechanisms used by politicians to create inoffensive sound bites and policy that will get them and keep them elected. Usually this is not the case – polls are used to inform politicians where they are with the public and what aspects of their plan/policy needs to be emphasized, whether the electorate is informed about them and their ideas and, subsequently, the best message to use to inform them. They are not entirely evil.

However, the Huffington Post reports about an RNC poll that is just that – evil. Democratic polls on healthcare (click here for Democracy Corps’ poll) concentrate on the President’s plan and what aspects of that plan Americans support and which they might need more explanation on before they are convinced will create a better healthcare plan. The RNC poll, on the other hand, concerns itself with one focus – defeating Obamacare.

One line of the recommendations based on the polling data is especially stunning. As Sam Stein reports, the strategist at the RNC concluded, “If Obama is allowed to sell this…he wins.” Winning and losing might be appropriate terms when dealing with elections, but not with proposed reforms of the healthcare system. Here, it should not be about winning but about enacting the best reforms in order to insure that Americans have access to the best healthcare in the world while not breaking the budget. Michael Steele, apparently, is only concerned with beating the President – shameful!

All of this aside, let’s take a look at what the RNC poll says about healthcare and what it means for the Democrats moving forward.

(Note: the poll was conducted between June 15-17, 2009, thus the results are somewhat outdated; however, the messaging aspects of the poll are still somewhat relevant as we move into August without a healthcare bill. Another note, the poll segments the population into Democrats, Independents, Republicans, and ‘Ticketsplitters.’ While I have some idea what they might be referring to, without the full data, I will not discuss this segment.)

Findings and Insights: Disregarding approval ratings, favorability, and generic congressional ballot numbers (they are now over a month old) there is still some interesting gems hidden in this poll. First off, when asked if people would prefer a Congressional candidate that is a ‘check and balance’ on the President versus one that will help Obama with his agenda, 50% prefer the former (61% among independents.) With more than a year to go before the midterms, positioning candidates as checks on a popular President might be a successful strategy, especially if the President’s popularity keeps supporters home from the polls.

Turning to the healthcare debate, 51% of respondents say their biggest concern, when it comes to healthcare, is costs while only 20% say access and 6% say quality. Further, 59% (62% among independents) support the government having an active role in lowering the cost of healthcare, but not a government-run system (only 32% support this notion.) While Americans are split 56-44 on whether America has the best healthcare in the world, an overwhelming majority (70%) believe the system is in need of reform. And, when it comes to that reform 49% say they trust the Democrats to fix the system, whereas only 29% of respondents trust the Republicans to fix it.

Americans yearn for reform to healthcare, but want the costs to be controlled and do not want the government to run it. As House Democrats and the President look for ways to offset the costs of their healthcare plan, the faster they can show the public that it will be budget neutral, the faster they will gain support. Additionally, if they can emphasis that the public plan is not government-run healthcare but, instead, a system that keeps health insurance companies honest, they will win support on that side of the debate as well.

Public Opinion on Obamacare Specifics: 88% of Americans support making ‘quality healthcare coverage affordable and accessible to every America.’ Further, 71% support forcing insurance companies to cover Americans regardless of pre-existing conditions. And, when it comes to helping small businesses provide healthcare to their employees, an impressive 79% of Americans is in support of this aspect of Obamacare.

When it comes to what Obama is proposing, Americans are if full support; however, the devil is in the details here. If the President can get this accomplished without increasing the deficient, then he will, in the words of the RNC, ‘win.’

Messaging: Especially because Obamacare will not get through the House or Senate until after the August recess, messaging will be especially important – President Obama and his ‘opponents’ will have a month to move public opinion in their corner. The RNC’s poll focuses on messaging we have seen them using in the recent debates and, probably, will continue to use. One of the most powerful messages, that over half of Americans ‘strong agree’ with, is that Americans should not be forced into a government-run system where they will loose their current coverage and choice of doctor. An even more powerful message, which 77% of Americans agree with (57% strongly agreeing), concerns turning healthcare into a bureaucracy similar to the IRS and the DMV. Lastly, the most unfavorable message for Obamacare concerns the costs, which, when quoted at ‘over a trillion dollars’ makes 65% of Americans less favorable towards Obama’s plan. Summing up, Republicans are telling Americans Obamacare will drop them from their current coverage with their current flexible choices, create a system as loathed as the DMV (which isn’t even a federal agency), and will cost each taxpayer over $7,000.

These are powerful messages that score very well. If Democrats want to sway public opinion, they must overcome these messages by emphasizing that reform will mean getting to keep your current coverage (if you want to), decreased health insurance costs because the government will create more competition and more competition drives prices down, and that the plan will be budget neutral or save money in the long run (this, of course, still needs to be worked out in the final bills in the House and Senate, unfortunately.)

Democratic counter messaging: From a messaging basis, it is possible to confront the Republican attacks. The RNC poll has people split within the margin of error (2.9%) over support of Obamacare after they hear a description. This means there is much work to be done if public opinion will turn in the President’s favor; however, it is possible. Taken apart, 58% of Americans support creating a government plan that will compete with private insurers. Democrats have to stress the competition and the healthcare exchange that will provide people with ample information about all available plans – a market, which creates competition and will drive prices down. On universality, 57% of Americans support this notion of Obamacare – this works to counter Republican attacks of dropping people from their plan. Democrats can confidently say that in order to insure everyone (which has majority support) government needs to assist in creating a system and helping those who need the support (whether it be the poor or small business.)

63% of Americans do not support the government ‘setting prices for services and deciding what treatments it will and will not cover.’ This, of course, is not the case – if Democrats can stress quality medicine where doctors are compensated based on merit and not the number of tests they perform, this bleak figure can be overcome. If Democrats can frame this situation in a ‘merit pay’ argument (compensation for better care and not more care) then Americans will get behind Obamacare.

When it comes to ‘fining’ companies that do not provide health insurance or raising taxes and cutting Medicare to pay for this reform, 54% and 71%, respectfully, oppose this portion of the President’s plan. However, while these aspects of the plan have not yet been set in stone, Democrats need to do all that is necessary to cut costs – even if some taxes need to be raised to pay for healthcare, Democrats must stress creating budget neutrality and the reform paying for itself in reduced costs (both in Medicare and in general.) While Democrats do not have the strongest position here, especially in light of recent CBO scores, they can and must confront the increased tax argument Republicans are bound to throw them – tiny tax increases are a small price to pay to keep healthcare reform from increasing the deficit.

Lastly, 59% of respondents do not believe President Obama when he says that health care reform will be budget neutral. This, thus, makes it an even bigger priority and, once established, needs to be emphasized not only by Democrats but also by touting out experts to reassure the American public of the reform’s budget neutrality. Having this message come from people that appear non-partisan will go a long way in convincing the public that reform will fulfill the President’s budget pledge.

Conclusion: In any reform battle, the status quo usually has the better position; however, Democrats can successfully counter the Republican attack machine. By emphasizing that a government plan will compete with private insurance to reduce cost, create competition, and produce transparency will counter attacks about the government-run system. Stressing ‘merit pay’ for quality care over the quantity and complexity of care will counter the RNC’s attempts to paint Obamacare as having bureaucrats dictate care. And, lastly, budget neutrality must be achieved in policy and repeated over and over again to the American public by experts that appear non-partisan. If the Democrats can successfully do this, the RNC will not beat Obama and the real winners will be the millions of Americans who live in fear of being dropped from their healthcare plan or slipping into bankruptcy because of one illness. If they don’t, Americans will be the real losers in this debate – stuck with an inadequate healthcare system for the greatest nation in the world.

Looking at Healthcare

For the full polling data from Democracy Corps, please click here

To read Stan Greenberg's article in The New Republic, please click here

About a week ago, I posted Stan Greenberg’s piece in The New Republic. Now, let’s take a look at Mr. Greenberg’s numbers and the New York Times numbers to get a sense of where the healthcare debate is and where it should be heading.

Just as Stan Greenberg wrote, the numbers from 1993 to 2009 haven’t changed much. But, instead of concentrating on the similarities to the past (if you want that, please see Mr. Greenberg’s piece), let’s look at the present and, more importantly, what should be done moving forward.

Current Situation: While only 7% of Americans believe that Healthcare is the most important issue facing America right now, according to a recent NY Times poll, the Obama administration seems to be concentrating what little energy they have, while wrangling this beast of an economy back to ‘normalcy’, on healthcare.

A plurality of Americans, 48%, feel that ‘major changes’ are needed to the insurance healthcare system in America. Further, 58% say they are dissatisfied with the current healthcare system (43% say they are very dissatisfied and every group, except seniors, are either dissatisfied or split.) However, while Americans are dissatisfied with the current system generally, 72% are satisfied with their health insurance. This fact, not too unusual in American Public Opinion, will make this issue difficult for the administration – any change they propose may be seen by 72% of Americans as a break away from the satisfied service they are already getting from their insurance company. And, generally, people are willing to except the beast they have, as opposed to the beast they don’t know, so the administration has a tough sell ahead.

When it comes to the ‘nuts and bolts’ of reform, the nation is split over their concerns. 48% say they are more concerned that the current system will increase costs too much and become out of control than with the government taking over healthcare and reducing quality. Meanwhile, 46% of respondents believe the opposite is true. So while Americans are split, Independent voters are more concerned with the government taking over healthcare by a 13% margin.

Americans feel that the healthcare system in this country needs to be reformed, while leaving their own insurance plan alone. What’s more, while they feel the situation needs to be fixed, they are split over the government taking over and controlling the system and the current system becoming too unwieldy for proper management.

Goals and Concerns: American’s are conflicted over the process of reform, but are somewhat more clear on the goals they hope such reform will achieve. 39% (the largest percent of respondents) says that reducing costs should be the goal of any reform. And, while that ranks the highest, expanding coverage to children (33%), preventing insurance companies from denying coverage because of a pre-existing condition (31%), guaranteeing no one will lose coverage if they are sick, move, et cetera (29%), and expanding coverage to those without insurance (28%) are also on the priority list. Overall, Americans want reform to reduce cost, protect their current coverage, and expand coverage to more Americans.

When it comes to Americans concerns, they are most concerned with a Government run system restricting choice and becoming costly. 30% of respondents say their largest concern is that healthcare decisions will no longer be made by them, but by the government and 27% say that they are concerned that they will no longer be able to choose their own doctor. Meanwhile, 24% are concerned with an increase in taxes because of the reform.

Americans want costs to be reduced, coverage expanded and protected while not creating a Government run system that limits their choice and does not increases taxes – simply put, they want their current insurance expanded to everyone and guaranteed to them all at no additional charge.

Messaging and Moving Forward: 44% of likely voters favor President Obama’s healthcare proposal, while 18% do not have an opinion – a huge constituency. In a recent NY Times poll, 44% say they approve of the way the President is handling healthcare, but 22% don’t have enough information to make an opinion. With such large numbers of American’s without an opinion on what will continue to dominant the political arena, there is much room to change public opinion.

After a ‘critical argument’ is presented to voters under 65, the number in favor of the President’s plan increases from 47% to 55% while the number opposed increases to 40% from 36%. In the ratio, the President is winning when the argument takes place 2 to 1. However, to make sure that this ratio remains strong and splits the 18% without an opinion on the President’s plan to being in favor of the President, the right elements and messages must be used.

With over 84% support, Americans want to be given of choice between keeping their own health insurance or switching to a public plan, which is front and center in the President’s plan (he just has to spread the word.) 77 to 74% (depending on how the question is worded) support employers being required to either cover their employees or contribute to a fund to help them pay for coverage, with small business being given tax credits for such participation. Third on the list of highest supported initiatives is a potential plan is the requirement that insurance companies cover everyone at the same rate, regardless of pre-existing conditions, with 68% of respondents supporting it.

When it comes to positive messages that convince respondents to support the President’s plan, stressing the security and ‘peace of mind’ the plan offers scores at 72% convincing, while creating more choices for people comes in at 70%. No surprises there. These messages emphasis the goals Americans want out of healthcare reform. Further, when asked what ‘stood out’ about the positive aspects of the arguments respondents heard, universal coverage, affordability, and choice garnered 34, 22, and 15%, respectively.

On the negative side, “will force Americans to wait in line for care” and “puts Washington bureaucrats in charge of healthcare” scored 61 and 57%, respectively. And, when it comes to the worries people have the Obama health plan, the government’s involvement and increased costs are, by far, the largest with 52 and 38%, respectively.

So far, we have seen the Republican attack machine come out and say, over and over and over again, that the President’s plan will put Washington in charge of which doctor you see and what care you receive. If President Obama and his team are to be successful, they will have to emphasize increased coverage, choice, and how their plan will lower costs. Most importantly, they need to rebuke the myth that a man in Washington will pick the care a woman in California receives. If Democrats can successfully stress their strengths while negating the largest Republican attack (government control will be inefficient and reduce choice), than public opinion, at least, will be on the President’s side. If not, than Stan Greenberg might be right in thinking 1993 might repeat itself.

Note: All polling numbers are from the Democracy Corps poll cited above, except where the New York Times is cited. For the complete poll from The New York Times, please click here.

Two Interesting Articles on Public Opinion

Obama's Issues Crumbling by Dick Morris: Here, Morris shows us [Democrats] that while Obama's approval rating and favorability numbers are high in the sky, when it comes to issues, the tide is turning on the Democrats. While the numbers are correct, I don't buy into everything Mr. Morris says; however, there is some cause for concern. Democrats (in the House, Senate, and President Obama himself) must make sure that what happened to President Clinton in 1994 does not repeat itself in 2010. I will, hopefully, have some rebuttal and further comment on Mr. Morris' piece in the coming days.

Repeat the Question by Stan Greenberg: Greenberg, a former pollster and adviser to President Bill Clinton, prophesizes on the healthcare debate through the lens of the 1993 healthcare debate. He does a very impressive job showing the similarities and why Democrats need to worry about this debate (see piece above, as well.) I wish Democracy Corps (who did the polling) would release the entire poll with crosstabs; however, they do provide a pretty impressive presentation (click here to access.) In the coming days, I will, hopefully, be sorting through the data to see if there is anything interesting that Greenberg didn't note in his very through piece. But, I am sure that this is an issue that will not go away, and one that will say a lot about the 2010 midterms.

PS - More polling data/analysis to come in the next few days. I promise.