Health-Care Reform's Public Support Problem
"If you can't reform the employer tax exclusion," a well-connected health-care reform advocate told me a few months ago, "you can't find the money to reform the health-care system." Harry Reid is now saying that there will be no reform of the employer tax exclusion. So can we still reform health care?
Probably. By this point in the process, Max Baucus had backed so far down on the exclusion that it was going to raise only $300 billion or $400 billion over 10 years. That's not nothing, but it's not much more than, say, Barack Obama's idea for capping itemized deductions. The money can be found elsewhere.
But, as Jon Cohn says, it's July. August, the supposed deadline for health-care reform in the Senate, is right around the corner. Yet members of the Senate Finance Committee are perusing yet another document with yet another list of ways to raise money for health-care reform. Like the employer tax exclusion and the itemized deduction before them, those options will have their opponents, too. And the Senate doesn't seem so good at facing down opponents.
I'm gripped, however, by a more unsettling thought. Reports are that Reid dropped the employer tax exclusion because polling was so bitterly opposed (probably in part due to the successful effort Obama's people mounted during the campaign to persuade the American people that they were against taxing employer health benefits). Fair enough. But health-care reform isn't simply suffering because the public is overly opposed to some of its revenue raisers. It's suffering because the public is insufficiently supportive of its core.
Polling has shown strong opposition to the tax on benefits, strong support for policies like the public plan and some of the insurance market regulations, and an overall ambivalence on "Obama's" health-care reform bill. A recent Wall Street Journal poll found that 33 percent thought "Barack Obama's health care plan" was a "good idea," while 32 percent remained unconvinced. An even more recent Washington Post poll found that 50 percent thought their health care would be unchanged after reform and only 16 percent thought it would improve.
This isn't terribly surprising: it's not obvious what health-care reform will do for the average American. I could give you a long answer about delivery system reforms and so forth because it's my job to know these things. But it would have to be a long answer. The basic structure of health-care reform has been specifically built to avoid changing people's existing arrangements. The hope was that Americans would be convinced that their health-care coverage wouldn't change for the worse. But that's also made it hard to explain why it will get better.
One of the president's health-care reform principles is that everyone must be able to keep what he or she currently has. But that means we're not really going to change, or improve, what they have. And that means they're not getting much in the way that's new. Higher taxes aren't buying them obvious benefits. Instead, they seem to be paying the health-care bills of poorer Americans.
If support for the overall effort were more robust, the polling on the tax exclusion would matter less. People are willing to pay for things they want to buy. But though they might abstractly favor health-care reform, it doesn't seem directly related to their lives.
So now the Senate is trying to find revenue options that fall on fewer people. That's one response. If health-care reform will only directly help the few, then its fiscal impact will have to be similarly narrow. But another would be to go in the other direction and gamble on policies that would make health-care reform a more direct contributor to the lives of the many, and so potentially something they'd be willing to pay for.
Photo credit: AP Photo/Seth Wenig.
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