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The New Health Dialogue

A Blog from New America's Health Policy Program

HEALTH POLITICS: Forecast -- Volatility

Published:  March 29, 2010

(We've been asked to note that while Bob Blendon has done polling with Kaiser for years, they also have their own in-house team. We have quoted them in the past and linked to MollyAnn Brody and her team's work often -- here's where you can find more.)

The health policy world may have been transformed with the stroke of a pen (and a century of effort) but one thing is the same: when we have a question about public opinion and health reform, we call Bob Blendon.

Blendon, an expert on health politics and polling at both the Harvard Kennedy School of Government and its School of Public Health, sees a schism in public perception that is not likely to ease quickly.

"The vision, or difference in perception, between Republicans and Democrats over whether or not this bill was the right thing to do is so wide that it's likely to keep being a potential issue in the 2010 elections. And the preliminary public opinion after the bill signing is more mixed than people realize," he said.

As Blendon, who does polling for the Kaiser Family Foundation, noted, some recent opinion polls show significant and growing support for the new health law. And some don't.

"Why do the polls differ so wildly? People do not have a really fixed opinion yet. They are hearing on the news various people speaking [about what the legislation does or may do] and it's quite volatile. A larger share of people are unsure whether or not, overall, it's good for the country -- and good for them."

Nor is there really a clearcut historical precedent to know how this will shake out, particularly given the unique historical and political context of our times. The 2008 TARP was popular, but became unpopular. The Medicare catastrophic coverage program was popular and became really really really unpopular. (It was repealed).  The 2003 Medicare drug coverage law was mixed, and became popular.  The health legislation "is 2200 pages long and it affects everyone's life." People don't yet have a real sense of its meaning, or some may see why it's good for the country but fear that it's not good for them or their families.

The challenge for President Obama and the Democrats, Blendon noted, "is to make sure that what people learn early on is the perception that it's good for them and their family, not the perception that it could make it worse for them, that costs go up, taxes go up."

The volatility may persist because even if the "knowns" are popular -- like the provisions for covering children with pre-existing conditions or keeping young adults on their parents' plan until they are 26 -- the "unknowns," or what people perceive as the unknowns (since how many Americans can really explain exactly what a CBO score for 2019 means?) are stirring doubts. People are worried that costs and taxes will rise -- whether or not that's true, that's part of what they are being told by the critics of reform. And some are worried about the quality of care and their own access, Blendon added. "They worry that doctors' offices will be packed, that they won't be seen, that it will limit their benefits...People worry about these other things even if they do agree with those popular things. That’s what people have to sort out. What is the bottom line here."

And that could complicate the political messaging. If one side says stick with us as we work to implement this over the next four or five years, it's going to work. If the other side is promising to repeal just parts of it (keep the dessert, repeal the spinach) it may sound attractive, but it can't possibly work -- you can't do the popular items without comprehensive reform -- but it may sound yummy.

And the political context itself is quite charged given the economic stress out there. "The anger that we see sweeping through American life is driven by a number of issues that are not specifically related to health care but are showing up in the health care debate. That includes the impact of the unemployment issue on middle income people, a sense that government has not done a lot to help them through this difficult period, and anger that government, as they see it, has helped banks and very low income people and left the middle income on their own," Blendon told us.

"The second force playing a role in this is a sense that many religious conservatives feel that this government and time period is shifting away from their most fundamental religious values, they feel the direction is very threatening to their faith." These two groups, Blendon concludes, the anxious middle and the angry religious right, have found things about the health reform legislation "that reinforces their concerns about the country’s national leadership."

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