What those polls really mean

One of the seemingly intractable problems in healthcare polling is deciphering exactly what voters are responding to when asked whether they favor or oppose “reform.”

Most polls fail to divulge any substantive content of reform plans. Voters are simply asked whether they favor or oppose “healthcare proposals being discussed in Congress.” What’s in those proposals? What will they do and how will they work? A meaningful response to the favor/oppose question requires voters to have answers to those questions.


Focus groups suggest that most do not. Voters know the plan is the subject of intense controversy and know they don’t like the “Congress” crafting it, but are importantly unfamiliar with its substance. A Gallup poll in July found fewer than half claiming “a good understanding of the issues involved in the current debate over national healthcare reform,” and understanding the issues is a far cry from understanding the contents of the bill itself.

In a December Kaiser survey, just 34 percent purported to be following the “discussion in Washington” very closely. More telling, though, only 30 percent understood a basic fact about eligibility for the public option incorporated in the House bill. A greater number were convinced of a factually incorrect statement. It seems unlikely that Americans are more familiar with even less widely discussed aspects of the legislation.

However, while voters narrowly oppose a controversial “reform,” the content of which is opaque, the individual elements are popular.

The most popular provisions protect against insurance company abuses, expand coverage and make it more affordable. Requiring large and mid-sized businesses to provide health insurance to their employees is supported by a 73 percent-25 percent margin in a CNN poll. Expanding Medicaid for the poor generates similar levels of support. Providing subsidies to families earning up to $88,000 a year is favored by 67 percent-32. Banning rescissions and denial of coverage to those with pre-existing conditions is also extremely popular.

In truth, voters can find lots of specifics to love in this bill. Some who know the bill enables adult children up to 26 to be covered on their parents’ policies tell me that alone would make it all worthwhile. Others identify the long-term-care insurance for the disabled and elderly as their favorite, while many seniors cannot wait to see the doughnut hole in prescription drug coverage closed tight. Few, if any, polls have focused on these features of the plan (about which hardly any voter knows), or a myriad others guaranteed to create enthusiasm among some sector of the electorate.

Because these reforms are so significant, it is difficult to compress an adequate description of the plan into a single question, and few public polls have even tried. A December NBC/Wall Street Journal poll describing both the insurance exchanges and the Medicare buy-in found 58 percent in favor of the plan, 32 percent opposed.

Our own surveys in several states offered a richer description focusing on the individual and large employer mandates, protections against insurance company abuses, incentives for preventive care and subsidies for uninsured citizens to purchase insurance — and found widespread support.

As reassuring as these findings may be to supporters, though, they point out the significant educational challenges awaiting Democrats if we are to reap political benefits from reform.

After January, the legislative process will move on, and the natural tendency is to refocus communication efforts to deal with the battle of the moment. Democrats cannot afford to let that happen. A healthcare reform that is left vague and uncertain in the public mind works to our detriment. It is incumbent on Democrats to keep the big-message guns trained on healthcare, even as efforts to create jobs and make us energy-independent move to center stage on the floor of Congress.

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.