Gaps in the healthcare debate

One of them has persisted for at least the 18 years we have been working on healthcare reform — the gap between the number who are dissatisfied with the system generally and those who may feel the same but are satisfied with their own coverage. In 1992, nearly seven in 10 Americans were satisfied with their own healthcare arrangements, but eight in ten were dissatisfied with the health insurance system generally. This “I’m OK but you’re not” attitude bedeviled previous attempts to reform healthcare and is reflected in almost identical responses to these questions today.


This satisfaction gap sets up a fundamental conundrum: How can policymakers change “the system” without changing individuals’ own healthcare arrangements? President Barack ObamaBarack Hussein ObamaFord taps Obama, Clinton alum to navigate Senate hearing McCaskill to oppose Kavanaugh nomination Presidential approval: It's the economy; except when it's not MORE has been making a strong case that if you like what you have, you can keep it. Nonetheless, in June, 58 percent believed that reform would alter their coverage and care; following the president’s joint-session speech, however, voters were evenly divided. Nearly half still expect to have their personal arrangements altered by systemic reform, though — and even larger numbers expect to pay higher taxes and find the system more complicated.

A second, and perhaps even more important gap, has emerged as the debate intensified — the gap between the majorities who favor the specific elements of the president’s plan and the minority who say they support the plan when it is not explained, but merely identified as the president’s plan.

Our own polling found over 60 percent in favor of a reform plan that required everyone to buy insurance, provided subsidies to low- and moderate-income Americans and created a national insurance exchange to enable people to keep the plan they have, purchase another private policy or choose a public option. A different, even longer description of the plan’s elements won support by a 10-point margin in an NBC poll.

While the public option has been controversial with politicians, it does not stir up significant opposition from voters. Dozens of polls have asked about it, and while support ranges from 43 percent to 83 (depending on how the question is asked), only two polls out of the dozens — both questionable — have found more people opposed to a public option than for it. This week’s ABC/Washington Post poll found support for “having the government create a new health insurance plan to compete with private health insurance plans” inching up to 55 percent from 52 in August. In its poll, CBS found 68 percent supporting the public option.

Support for other aspects of the president’s plan is even greater — 73 percent favor “increased regulation on private health insurance companies, such as limiting the amount insurance companies can charge patients for out-of-pocket costs and limiting the ability of insurance companies to deny people coverage.” Fifty-four percent favor an individual mandate with subsidies for low-income people.

Yet, when asked generally about the president’s plan without a description of the elements, at least until very recently, more voters have opposed rather than favored it.’s weighted moving average of these polls reveals a four-point margin for opponents. Indeed, some recent polls were finding the president’s plan behind by up to 15 points.

It’s worth noting, though, that two of the most recent polls found the margins flipping from earlier surveys and both gave supporters a five-point advantage.

Passing reform requires bridging both of these gaps. Voters need to believe that they can keep their own healthcare arrangements, even as the system is reformed, and voters need to know enough about the content of the president’s plan to support it.

The most recent evidence suggests that may be just what is happening in the wake of President Obama’s full-court communications press.

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.