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Healthcare history lessons

President Obama recently and rightly chastised poll-waving pundits for parroting premature conclusions about the popularity of healthcare reform, based on the absence of a post-passage surge in support. Wait until the bill takes effect, then views will change, the president advised.

Just how likely is an increase in support for healthcare reform? While history is at best an imperfect guide, in this case there is precious little history, with none of the cases truly parallel.

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By the time Medicare passed in 1965, it was already quite popular. Gallup found 63 percent favoring a “compulsory medical insurance program covering hospital and nursing home care for the elderly ... financed out of increased Social Security taxes.” 

Earlier, Medicare appears to have generated less appeal. In 1962, Americans divided rather evenly, with 28 percent offering favorable views and 24 percent unfavorable. Just a month later, after Congress rejected the plan, more Americans had opinions, but their distribution was similar — 44 percent believed the plan should have passed; 37 percent endorsed its defeat. 

Support grew after President Kennedy’s assassination and following more debate — on the eve of passage, 63 percent favored Medicare. In the ensuing years, as Americans lived with it, approval increased somewhat. While the question is not comparable, by 1996, 72 percent offered a favorable view of Medicare. 

Massachusetts, which adopted a reform similar in concept to the new federal plan, provides another, more recent lens through which to examine evolving healthcare attitudes. 

In 1996, before the current law was contemplated, 59 percent of Bay Staters supported a ballot measure urging Congress to enact a national healthcare plan. Specific plans often prove far less popular than general concepts, however. 

In this case, though, after the law had been enacted, but before implementation — a period comparable to the one we are in nationally — 61 percent favored the law and 20 percent opposed it. A year after implementation, that initial 41-point margin increased to 51 points; in 2008, the Massachusetts reform was supported by 47 points; while in 2009, proponents’ advantage shrank to 31 points. 

What does this brief survey of just two semi-relevant cases suggest?

First, the plan just signed into law passed in a unique political environment. Both Medicare and the Massachusetts plan already enjoyed widespread support before being enacted. By contrast, voters actually opposed the latest reform before passage. Whether public opinion can be turned around, whether opposition can be turned into support, is outside the range of these limited experiences. 

Second, while support appears to have risen for both plans as people lived under the systems they created, those changes have been marginal and not always in a straight, upward line. Although, as noted earlier, the questions are not comparable, support for Medicare seems to have jumped by about 10 points, while in Massachusetts, where identical questions are available, support increased similarly. Moreover, support for the Massachusetts plan now appears to have declined to its lowest level yet.

If the margin of support for the current reform increased by 10 points, most polls would find the public at best divided, and more likely opposed.

Many elements of this plan remain exceptionally popular: preventing insurance companies from denying coverage based on pre-existing conditions or taking away coverage from those who get sick; offering help with prescription-drug costs for seniors; providing tax credits for small businesses; allowing parents to cover adult children on their policy — all enjoy vast support. Yet most Americans do not know they will derive these benefits from reform. 

Experience alone is unlikely to build majority support for healthcare, but active educational efforts just might. 

Mellman is president of The Mellman Group and has worked for Democratic candidates and causes since 1982. Current clients include the majority leaders of both the House and Senate.