Third Way Dispatch

Two weeks after hitting theaters, Michael Moore’s new movie on the American health care system, Sicko, stands among the country’s top 10 box office releases (way behind the Transformers but ahead of Shrek III). Not bad for a summer flick with no explosions or Bruce Willis.

For advocates of major health care reform, this uptick in public interest is yet more evidence that times are ripe for a new discussion about the way we do health care in this country.

After Iraq, health care is once again the number one topic of concern for potential voters. Polls show growing public discontent with the current system and a seeming eagerness for change. A March 2007 CBS/New York Times poll, for example, found 59% of Americans to be “very dissatisfied” with health care costs in general, and 52% to be “very concerned” about future costs. Numerous other polls show strong majorities in favor of more government involvement in regulating health care costs.

Optimists for major reform may say the only big question left is this: Canada or Britain?

Or maybe not.

A closer look at public opinion on health care shows continuing deep ambivalence about major reform and a reluctance to make big tradeoffs—or even smaller ones—to guarantee universal coverage.

As progressives, we believe that the nation’s health care system is overdue for a change. Rising health care costs are a burden on business and a drain on middle-class paychecks. No one in this country should be without some sort of basic coverage.

But we also think progressives should be mindful of the lingering anxieties of a public that is skeptical of government’s ability to effect truly meaningful change. Our reading of current public opinion distills down to three observations:

• Americans with insurance don’t want to give up what they’ve got.

According to a 2006 CBS/Kaiser Family Foundation poll, only 5% of insured Americans (and that’s the vast majority) are “very dissatisfied” with their current coverage. Large majorities are satisfied both with their current coverage and the quality of their care.

While small majorities say they favor “national health insurance,” these majorities dry up quickly in the face of specific tradeoffs. The same 2006 CBS/Kaiser poll found, for example, that while 56% of Americans say they would support a “universal health insurance program… like Medicare,” that support dropped to 35% if it meant higher taxes or premiums, 26% if it meant limiting the choice of doctors, and only 18% if it meant losing coverage for some treatments.

What this means for progressives is that any idea for major reform can’t threaten quality or choice—the two things Americans like about the current system. And progressives should probably avoid terms such as “shared sacrifice” when talking about implementing reform.

• Americans might want more government involvement, but they are skeptical of a government takeover.

A February 2007 CBS/NY Times poll found that only 47% of Americans believe government would be better than the private sector at holding down health care costs—hardly a ringing vote of confidence. Similar polls dating back to 2000 find government and the private sector either neck-in-neck or the private sector slightly ahead on the question of who is trusted more on health care.

The lesson here is that progressives should not assume that the public is ready to embrace a government solution without clear and convincing evidence that it can truly do a better job. With public confidence in government at all-time lows, progressives have a significant hill to climb in convincing the public that a government-based solution is the answer.

• Americans misperceive the nature of rising health care costs and are looking for a “bad guy” to blame.

Health care wonks know that the real reasons for medical inflation are manifold—demographic changes such as the increasing number of elderly patients and the growing prevalence of chronic diseases, expensive new treatments based on the latest technologies, cross-subsidization of the uninsured, and so on.

The public has a much simpler explanation: “high profits” enjoyed by insurance companies, doctors and hospitals who “charge too much.” Who’s NOT responsible? Seniors, patients in general, the uninsured and the poor.

What’s happening here is that in the face of an immensely complex problem that is difficult for even experts to understand, laypeople revert to value judgments about whom to blame. Thus, while the growing number of elderly patients may indeed contribute to rising costs, the public is reluctant to hold “deserving” seniors responsible. This also explains why cost-cutting solutions cast in morally neutral terms—take health IT or chronic disease management as examples—never seem to catch fire with the public; they don’t address what the public believes is the “real” problem with the system.

This doesn’t mean progressives should start bashing the health care industry. But it does mean that progressives should consider recasting sensible solutions such as health IT or chronic disease management in the context of a more emotional or value-laden message. Health IT, for example, is not only more efficient; it can help root out waste, poor management and the occasional bad actor in the system. It also means progressives have a long way to go in educating the public about what’s really wrong with health care.

Major health reform is and should be a critical goal for progressives. But for any significant proposal to succeed, progressives must understand what the public wants as much as what the system needs.

Research for this posting was also conducted by Senior Policy Advisor Scott Winship.