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Should Democrats Fight for the Public Plan?

The Washington Post put a poll into the field last week with a substantial health-care portion. Here's the part that will interest all of you:


I don't think there's anything surprising in there. A solid majority support the public plan in theory. If you say it'll drive their other insurance options out of business, they turn against it. But imagine you had asked that question the opposite way. The reason private insurers would have been driven out of business, after all, is because the public plan would offer much lower premiums. If you asked poll respondents, "What if having the public plan lowered your insurance premiums by 20 to 30 percent," my hunch is you'd see a sharp shift toward support of the policy.

And that's not, it should be said, an idle thought about polling. In the long term, the fortunes of Democrats will be decided by whether people like health reform after it passes. If the program is a huge success, if costs go down and coverage shoots up, then that will do much to bind voters to Democrats. (This was the argument that Newt Gingrich and Bill Kristol made in 1994, and they were probably right about it.) If it's considered a flop, or simply an uneven success, there will be little long-term gain from passing the policy and potentially even some long-term harm.

At yesterday's press conference, Obama made a telling remark in reply to Chuck Todd's questioning on Iran. "I know everybody here is on a 24-hour news cycle," he said. "I'm not." Some policies that might be controversial now are likely to prove popular later. Some policies that are popular now are likely to be a failure later (see the Iraq war for an example of political coup turning to an electoral embarrassment). The question asked in the poll above has to do with the short-term politics of health care. In the long run, however, it's assuming a situation in which the public plan makes health coverage so much cheaper for individuals that they abandon private insurers in droves. It's hard to imagine that outcome being unpopular, as it's an outcome that Americans would have to choose.

Conversely, you could imagine an outcome more pursuant to the poll above but much more problematic for Democrats in the long run. Health reform is enacted, and it promptly drives up the deficit. But now Democrats have ownership of the health-care system. They, after all, passed a major reform in 2010 that they promised would lower costs. It didn't. People begin to blame them for problems in the system. A charismatic Republican with a working knowledge of the issues -- Bobby Jindal, say? -- runs on a conservative health reform platform and begins to recapture the issue from the Democrats.

Which is all to say that passing health reform is different from passing a successful health reform. And certain policies which may be controversial in the legislative period might be extremely important to the implementation period.

By Ezra Klein  |  June 24, 2009; 10:21 AM ET
Categories:  Health Reform , Polls  
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As always, failure to ask the right questions prejudices the results. Perhaps you might offer some suggestions to your polling group at the Post?

Posted by: wvng | June 24, 2009 10:28 AM | Report abuse

in the world of people who fight for things and then are never quite content when they receive them.....
a word of good advice.

be careful what you wish for.

Posted by: jkaren | June 24, 2009 10:45 AM | Report abuse

Well, let's be careful to remember that the public option is for the currently uninsured and 20%-30% cheaper premiums than what they'd pay for individual or small group policies is STILL MORE THAN what the 250 million of us with employer-based or other public insurance pay.

I think some of the public plan proponents are phrasing some of their questions in a maybe falsely inclusive way. I support the public plan - though maybe more for the sake of architecture than ideology - but it'll probably be more expensive than what I have and probably have fewer benefits. It'll be a bit of a 'tallest short guy' at best, I'm guessing. Again, I support it, but it's not going to be some magical panacea of Medicare/Kaiser/Mayo greatness. Certainly not at first.

If things go south, following your scenario, I'd guess the plans in the insurance exchange and the public plan become more and more like catastrophic coverage with fewer benefits. That's the actuarial risk the Democrats are taking. And, honestly, Bobby Jindal can put up some ads of people complaining about the lack of benefits in their plans from the reform but hey, catastrophic coverage versus the zero coverage they had before isn't a super ad.

Posted by: ThomasEN | June 24, 2009 10:53 AM | Report abuse

As you point out, it's a very odd polling question, because it basically posits a specific future possibility without any other context. AND that future is objectively bad ("go out of business" is generally not something anyone's in favor of, no matter what the industry).

"What if electing Barack Obama made the stock prices of many oil companies fall? In that case would you support or oppose electing Barack Obama?" Possible, bad, out of context, and very likely to change the response. I wonder what Nate Silver has to say about this?

Posted by: AronB | June 24, 2009 11:25 AM | Report abuse

Oops - Nate Silver has a lot to say about this.

Posted by: AronB | June 24, 2009 11:52 AM | Report abuse

(Taken from Jonathan Zasloff at The Reality Based Community

Email every "swing/centrist" Dem Senator, Senate leadership, and especially the DSCC/Menendez with something like this:

"I have been a contributor to the DSCC for years, but until and unless the Democratic Caucus strongly endorses an effective public option in health care reform, the DSCC will never again see a penny of my money....I hope very much that I shall be able to contribute to the DSCC in the future, and am waiting for the Caucus' actions in this regard."

And: "Every single fundraising e-mail and call...should be given this response. No money unless there is a strong public option. Period. This is particularly important now, since the second quarter reporting period is coming to a close on June 30th.

Every single call. Every single time."

Posted by: sblaisdell | June 24, 2009 1:39 PM | Report abuse

Your reporter need to learn to read the poll before they write about it. They claimed, " "In the new Post-ABC poll, 62 percent support the general concept [of a public option], but when respondents were told that meant SOME insurers would go out of business, support dropped sharply, to 37 percent."

Too bad the poll did not ask that. It asked if MANY isnsurers wound go out of business"

Posted by: JonWa | June 24, 2009 7:02 PM | Report abuse

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