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Two-thirds of Americans don't understand the public option

I've long wished polls did more to question how much the American people know as opposed to what they believe, or think they believe. For instance, we've had dozens, maybe hundreds, of polls assessing the public's beliefs on the public option. These polls probably began during May, or maybe even before that. It's December now, and Vanity Fair finally had the bright idea to ask, "Could you confidently explain what exactly the public option is to someone who didn’t know?" The answer:


And so far as health-care reform goes, the public option is fairly simple, and undeniably prominent. Imagine how many could explain the exchanges, or the mandate, or the benefit package ...

By Ezra Klein  |  December 7, 2009; 7:39 AM ET
Categories:  Health Reform  
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Next: The not-a-public-option compromise, and beyond


"Confidently" is the key term here. You may be getting some folks who know the basics but not enough to be sure of themselves in explaining it.

It would have been ideal of this poll had included a question asking people to identify features of the public option. Then you could see what confidence meant.

But to your point: there are clearly many millions who have strong opinions for and against the public option who have only the most superficial and distorted understanding of what it is.

Posted by: jdhalv | December 6, 2009 10:54 PM | Report abuse

Well, it's no wonder. We have wingnuts calling it a government takeover of health care, complete with whopper lies of "death Panels" and throwing granny under the bus by canceling the wingnut welfare program called "Medicare Advantage" and a media giving credence to all of it as legitimate debate. When they are not breathlessly reporting on Sarah Palin and her traveling horror show of crazy/

Not to mention tea bagging idjits sporting signs Of "get government hands off our Medicare".

Which in hindsight, may have been dems biggest mistake. They should have just said it was the medicare for all option, or something, instead of threading needles with the public option meme.

You can't have an informed public, when the media's first priority is to attract viewers by fueling the eternal food fight between the two parties. And not sorting out fact from fiction, and calling a lie a lie. Just won't work, and neither will a healthy democracy for much longer, if things don't change.

Posted by: arnold104 | December 6, 2009 11:22 PM | Report abuse

I have a slight problem with the graph in this post. You have biased this graph to over exaggerate the relative size of 'No' response by starting the graph at 20. Thus it appears as if the No's outweigh Yes's by almost a factor of 8. When in reality it's only about 2.5. (66 vs 26)

Sadly the number of Americans incapable of explaining the public option is so large that there was hardly a need to graphically exaggerate it to make your point.

Posted by: volpevl | December 6, 2009 11:29 PM | Report abuse

"They should have just said it was the medicare for all option"

Brilliant, let's take the most out of control portion of the Federal Budget (now that the bailouts are over) and the program that drives up health care costs for everyone and let everyone have as much health care as their doctor can order. I think that would have been called "stupid". Did you mean Medicare A, B, C, and D? Face facts, people like Medicare because it hides the truth, but the impending nightmare can't be avoided. The President talked about how it was a huge crisis. And now his so-called health care reform is being driven by the Congress to make the Medicare nightmare.

I wanted health care reform, not a blame the insurance companies for high prices + crazy Enron-style exchange with fake competition where plans can't compete on varying benefit levels and deductibles, so will have to revert to rejecting claims to innovate. If we can drive costs down first, or at least at the same time, then we can afford extending coverage, not before.

Instead, we have a weak-kneed congress afraid to make any cuts at all, but pulling out the credit card again to double down on the deficit. They don't even have the guts nationalize the insurance market, which would eliminate many of the monopolies that have arisen. They don't have the foresight to allow plans which really are insurance, that focusing on covering people in emergencies and on the big expenses, but they allow plans with ridiculously low benefit caps to exist.

About the only way to turn the garbage bills that we have now into real health reform is to throw out every proposed new cost, but keep the trillion in new taxes so we can pay for what we think we already have.

Posted by: staticvars | December 7, 2009 12:03 AM | Report abuse

The President talked about how it was a huge crisis. And now his so-called health care reform is being driven by the Congress to make the Medicare nightmare.

Your right wing talking points are showing. Single payer would be the best way to drive down costs, but politically impossible due to wanking fear mongering from people such as yourself.

There are only two ways to bring down costs in the system we are burdened with. One way would be for government to step in and directly regulate prices for health care delivery. The other is to create competiion for a system that does not fit into the free market model, because it is a vital service folks can't do without lest they die.

Any non profit carrier created outside of government would quickly be sabotaged by the deep pocket insurance companies, see Blue Cross.

And using tax raised money's to simply pay for future unpaid for liabilities, would quickly be eaten up in rising prices from the system we have now, from an industry voracious for more profit, that has no competition and is collectively a monopoly because their product cannot be refused by those who need it.

A single payer system that could set prices for non profit by the government would be the surest way to bring down costs, that would also make current medicare more solvent over the long haul.

But no, can't have that cause it would be socialist and tea baggers would get the vapors that government is going to mess with their Medicare, they are idiots holding back progress that every single western democracy on the planet has seen as necessary to pay for health care and not bankrupt their country, except for us, largely be people who think like you.

Posted by: arnold104 | December 7, 2009 12:55 AM | Report abuse

This is a silly discussion. People don't want to understand "health care reform" or "the public option" and they won't. They voted for politicians who would do the job that governments in rich countries do: make sure that citizens (everyone actually) have access to medical care when they need it. They don't care much how the politicians do the job -- but they think they made it clear with their votes that they wanted the job done.

If the product is unaffordable or excessively bureaucratic, they'll punish the politicians who, in their opinion, failed to do their jobs.

All the rest is fluff.

Posted by: janinsanfran | December 7, 2009 1:07 AM | Report abuse

This doesn't surprise me a bit. No prominent persistent voice including yourself, Ezra, has kept their feet moored to the ground in terms of what is real reform and what are lame attempts to compromise with people who are dead-set against reform.

I'm wishing T.R. Reid had a column like yours, because at least he really grounds his analysis in the international experience of real reform.

Posted by: michaelterra | December 7, 2009 4:39 AM | Report abuse

"And so far as health-care reform goes, the public option is fairly simple"

But the Dems inability to find an option and stick with it is part of the problem. The reality is that there is no "the public option" as there are a good 5 five flavors out there.

Posted by: wisewon | December 7, 2009 7:42 AM | Report abuse

This doesn't even account for the portion of people who THINK they know what the public option is but really don't. So many people think the public option means people will get free healthcare, that the public option would be subsidized, or that it would basically be medicare for all.

The democrats wanted to avoid having 1 plan that the republicans could pick apart which is why we are getting this byzantine process. But in reality while wonks might understand public option, community rating, and capitation the public has absolutely no idea what any of these things really mean. Even strong supporters of the bill are mistaken about some of the elements.

Posted by: spotatl | December 7, 2009 8:30 AM | Report abuse

could you define something Ezra that changes by the day? Try asking them if they understand CER or what IMAC will do? CER hasn't changed at all and IMAC just recently got weakened and I'll bet you'll get even less of a response there.

Like Janinsanfran said people want things done for them. When they realize that isn't the way it will work here because we don't want high teens unemployment and taxes enough to choke a horse they'll realize what Doug Elmendorf said. That America's problem is they want every service in the world but don't want to pay for it.

Posted by: visionbrkr | December 7, 2009 9:10 AM | Report abuse

Please advocate for polling that investigates how much people know in addition to where they stand! Polling now becomes nothing more than a popularity contest with issues instead of beauty queens.
While you're at it, advocate for polls measuring what people know about global warming, energy, and even evolution.
Make it a cause!!! It is urgent.

Posted by: EKBuddenhagen | December 7, 2009 9:14 AM | Report abuse

This survey shows how disingenuous left-wing talking points are on this subject. There's no hesitation to tout polls that ostensibly show majorities supporting the public option, even though advocated know full well the public doesn't particularly understand it or have strong feelings about it (Kaiser survey). This issue has been characterized by a lack of intellectual honesty from the left from the beginning.

Posted by: FreeMas | December 7, 2009 9:41 AM | Report abuse

"This issue has been characterized by a lack of intellectual honesty from the left from the beginning"

LOL, you mean like Death Panels coming from the Right.

Posted by: arnold104 | December 7, 2009 10:07 AM | Report abuse

" They should have just said it was the medicare for all option..."

In which case, the pollsters would have been egregiously misleading. The public option is not "Medicare for all"; that would be a single-payer plan. The "public option" being discussed is niether universal or payroll tax supported.

And that's why it is so hard for most people to understand. When they hear the details, they don't understand the point since a public insurance company to compete with private insurers doesn't do squat about addressing the primary problems with face with respect to health care financing and delivery in this country.

Posted by: Athena_news | December 7, 2009 10:27 AM | Report abuse

"In which case, the pollsters would have been egregiously misleading. The public option is not "Medicare for all";"

That's why I used the qualifier word "option"; Though I could have termed it Medicare Option for clarity sake of what I was saying.

Posted by: arnold104 | December 7, 2009 10:47 AM | Report abuse

There is can be no clarity whatsoever in any statement that seeks to equate the public option with Medicare....NONE.

That is why people are so confused about the "public option". Ezra may think it's a simple component of the non-reform but most people don't understand why so much energy is going into something that is NOT a public health plan but just another insurance program that would be optionally available to a tiny minority of citizens.

Posted by: Athena_news | December 7, 2009 10:55 AM | Report abuse

Well, it's not just another insurance plan, really. It is claimed it will pay for itself, at least after an amount of seed tax money is put up to get it started. It is also non profit with no allowance, or hopefully so, with no denial of coverage for high risk patients, only that they are low income.

I see your point that it is not medicare when comparing the nuts and bolts. But it is also like Medicare for the simple reason you pay in what you can and the government uses subsidies to help you our. Medicare is just paid in differently, but basically what you can afford via payroll taxes and the government subsidizes the rest after you reach a certain age. People who made a lot of wages pay in more that those who don't but when they become eligible both are afforded the same services.

So I don't think it's true that NO comparison can be made. The terms of payment are different, but the product will, or should be comparable and subsidized to varying degrees.

ergo government run insurance program.

Posted by: arnold104 | December 7, 2009 11:15 AM | Report abuse

Listening to the debate on CSpan, it's easy to see why people don't understand. There is no good attempt to explain coming from the far liberal side -- instead just the intoning of pieties, as when Harry Reid, in that weak voice of his, prattles on with such platitudes as "if not now, when". This does not constitute explanation or serious discussion. And Baucus! When I first heard his voice this morning I thought it was some kind of republican parody. He simply cannot speak clearly, or even articulate a large percent of his words. How is this man still a senator? He has aphasia.

Posted by: truck1 | December 7, 2009 11:50 AM | Report abuse

Does it mean I get free insurance? Because then I'll support it. Maybe I'll support it if all these Democrats that claim to have my interests in mind are for it.

This is why slogans and smiles work. This is why incompetent individuals such as Obama and Bush get elected.

Posted by: cprferry | December 7, 2009 2:03 PM | Report abuse

Ezra, I would caution you to be careful about interpreting this kind of polling data. I would be shocked if 26% of Americans could accurately explain the public option. In fact, I'd be surprised if more than half could identify the public option as a piece of health care policy without the kind of priming given in the question. You could poll "accurately explain the public option" by asking people to explain it and then scoring the answers based on some kind of rubric. If you ask for self-perception, though, you get some weird biases: people who don't want to admit to a pollster that they don't know something, people who could probably hit the major points but are never confident in their knowledge, people who are sure they know about it but don't, etc. Polling can be fairly difficult to interpret reliably, but one thing you can know for sure is that people usually don't know or have clear preferences about policy details.

There's a whole literature on this - which I know a very small piece of - and to say that 2/3 of Americans don't understand the public option is not what you learn from that question.

Posted by: NomadHomebody | December 7, 2009 4:39 PM | Report abuse

I understand that there is a proposal to replace the idea of a public option with a Medicare buy-in, perhaps for people fifty and over.

I think that is a GREAT idea. The GOP, the party many of whose members fought Medicare in the first place, now are touting themselves as trying to save it. They should be able to agree to making Medicare available to more people thus making it more financially stable, giving it a younger and more health base to draw premiums from.

Posted by: tinyjab40 | December 7, 2009 7:29 PM | Report abuse

I define this so-called health care bill like this, it is progressive liberals and their hate of this country and it's people.
It is a Diabolical Program to destroy decency, honor and principals.
Also google Boston Children's Hospital Sex Change Clinic
Also google You're Teaching My Child What?
Also google Dawn Stefanowicz Out From Under
Also MFIeForce(

Posted by: boski66 | December 8, 2009 10:54 AM | Report abuse

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