Dan Balz's Take
The Health Care Divide
There are few divides larger this year between Republican and Democratic presidential candidates than on the issue of health care -- and at this point, according to a Washington Post-ABC News poll, public opinion is on the side of the Democrats.
With 47 million Americans lacking health insurance and many millions more worried about rising costs and potential disruption to their coverage, the issue occupies a central place in the presidential debate.
Republicans favor a combination of tax cuts and market forces to ensure that most Americans have affordable health care coverage. Democrats say government needs to take a more direct role in assuring that all Americans are covered and would raise taxes to pay for it.
The Democrats' advocacy for universal coverage represents an important shift to the left for the party. After the defeat they suffered over health care during Bill Clinton's presidency, Democratic presidential candidates in 2000 and 2004 offered more cautious reforms aimed at covering most, but not all, Americans.
This year they all support universal coverage and most have offered plans to achieve it. Hillary Clinton is the most notable, given her role as the architect of the proposal and the strategy that crashed in 1993-94, but others like John Edwards have acknowledged how much they've moved in just four years. "So has America," he said in the New Hampshire Democratic debate a week ago.
The Post-ABC News poll sought to gauge public impressions of the health care system, as well as possible approaches for changing it. What we found was that three-quarters of all Americans said they are generally dissatisfied with the overall system -- 49 percent of them say they are very dissatisfied.
Americans are far more likely to say they are satisfied with the qualify of the care they receive. Eighty-three percent of them -- and 88 percent of those with some kind of coverage -- said they were generally satisfied. More than four in 10 -- and almost half with insurance -- said they were very satisfied.
But that represents a modest decline in confidence over the past few years, when generally half or more said they were very satisfied. And the percentage who said they were dissatisfied, while still low, is as high as it was in the beginning of 1994, when Congress was plunging into what would become a defining battle of Bill Clinton's first term.
Americans are far less happy with the cost of care, which has been escalating rapidly in recent years. In the latest poll, barely half (53 percent) of all Americans said they were generally satisfied. That's the lowest level of satisfaction since the question was first asked in 1994. Those who were very dissatisfied with the cost exceeded those who said they were very satisfied (26 percent to 22 percent).
And two-thirds of Americans worry about they might not be able to afford coverage in the future.
At this early stage in what will be an intensifying debate over health care, Americans overwhelmingly favor the idea of finding a way to cover everyone, even if that means raising taxes. The poll found that 70 percent said they would support higher taxes in return for universal coverage, compared to 27 percent who said holding down taxes is more important than covering everyone.
No matter how we sliced the country, there were majorities in nearly all demographic, regional, political and ideological groupings who said they favored raising taxes to provide universal coverage. One notable exception is among conservative Republicans, 53 percent of whom prioritize minimizing taxes.
Republicans have denounced Clinton's plan in strong terms. Mitt Romney said it would lead to "European-style socialized medicine." Rudy Giuliani and John McCain also have warned that Clinton and other Democrats favor big government or government-run health care.
The public, as of now, does not see it that way. When the outlines of Clinton's and some other Democrats' plans are described to people -- including requirements that business offer insurance or pay a fee and that individuals buy insurance or face some penalty -- there is broad support. In the Post-ABC poll, two-thirds said they supported such a proposal, including majorities of Republicans and conservatives.
Americans also trust government rather than the insurance industry to help set the parameters for quality and affordability of care and coverage. Asked whether the federal government must make rules or whether private health insurance companies and providers can achieve quality and cost goals without government intervention, two-thirds said government needed to be involved. Most groups offered majority support for government's role in setting rules, but support is lowest among Republican women (46 percent) and among conservative Republicans (39 percent).
Public opinion alone will not determine the outcome of the legislative battle over health care that could begin in 2009 if a Democrat wins the White House. The record of 1993-94 shows what can happen when a powerful lobby and a determined opposition sets out to block an idea that Americans seem to favor in the abstract.
But in the context of the presidential campaign debate, Republicans begin on the defensive. They have been far less willing to push health care reform as part of their basic message, and the ideas they have embraced lack support from the public.
Many Republicans argue health care can become a winning issue for the party -- or at least one on which they are closer to parity with the Democrats. But the Post-ABC News poll underscores the advantage Democrats enjoy as the campaign debate is joined.
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