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Posted at 9:30 AM ET, 11/24/2010

Americans favor universal health care -- until anyone tries to pass it

By Ezra Klein

Between 2001 and 2008, the public overwhelmingly believed that it was the federal government's "responsibility" to guarantee all Americans health-care insurance. Then, in 2009 and 2010, President Obama and the Democrats tried to make it the federal government's responsibility. You can guess what happened next:


Sometimes, the public gets mad at Washington because politicians never do what they say they're going to do. And other times, the public gets mad at Washington because politicians do exactly what they say they're going to do. From the perspective of the politicians, it must be quite confusing.

By Ezra Klein  | November 24, 2010; 9:30 AM ET
Categories:  Health Reform, Polls  
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Sad, isn't it? We live in an age when approximately half of what was once a freedom loving, responsibility *demanding* population is now willing to abdicate that responsibility and sell that freedom for the most ephemeral and ersatz appearance of security.

Posted by: msoja | November 24, 2010 9:48 AM | Report abuse

For your next chart I recommend:

"Americans favor deficit reduction -- until anyone tries to pass it"

Posted by: jnc4p | November 24, 2010 10:19 AM | Report abuse

I agree with jnc4p's point.

Everyone is happy to be in favor of something when there are no costs. What changed in the health care debate is that people began to realize the costs, and Congress put a lot of other things in the bill, too.

It's really not that surprising. If politicians were more straightforward from the beginning (both Democrats and Republicans promise free lunches), then you wouldn't see these kinds of switches.

Posted by: FroggyJ4 | November 24, 2010 10:26 AM | Report abuse

As usual, the problem with progressive ideology, that sounds heavenly in a college lecture hall, comes down to the details and unintended consequences.

Of course when you ask people whether they think everyone should have health insurance, most are going to say 'yes'....sort of like if you asked people whether they favor or oppose having starving children roaming the streets. (I harken back to what Reagan said decades ago about how liberals/statists will always use 'health care' as a carrot to impose more state control of our lives, because it's easy to manipulate peoples hearts and emotions with visions of sick people unable to get health care).

But most people are only saying 'yes' as long as, in their minds, you can provide health care to everyone else without screwing up their own situation. So when progressives advanced the ACA, which clearly starts threatening their own situation (via higher taxes, imposed mandates and fines, threat of having to change physicians when doctors start dropping Medicare patients because -21% pay cuts are included, etc) in exchange for providing the dreamy promise of universal care for all...well, people turn against it.

It's not that hard to figure out, but I know progressives have a really hard time believing people don't like their they will continue, as Obama has, blaming their failure to properly communicate, peoples failure to understand how wonderful it is, blaming Bush, etc.

Posted by: dbw1 | November 24, 2010 10:29 AM | Report abuse

"If politicians were more straightforward from the beginning (both Democrats and Republicans promise free lunches), then..." no one would vote for them.


Posted by: KBfromNC | November 24, 2010 10:35 AM | Report abuse

"...the dreamy promise of universal care for all..."

Indeed, it can only ever be a dreamy promise, since, as is well documented in the land of the hippie-punchers, no other country has ever achieved this lofty goal, and any country that has tried has ended up a Soviet hellscape.

Your argument against "progressive ideology" would be fantastic if only the U.S. weren't among the worst healthcare situations in the industrialized world. We pay a lot, we get very little, but the moment someone tries to change that, suddenly conservatives scream that the line between freedom and tyranny has something to do with health insurance. Which is, of course, stupid.

Posted by: KBfromNC | November 24, 2010 10:47 AM | Report abuse

People don't like how Obama sold them out!

Posted by: obrier2 | November 24, 2010 10:48 AM | Report abuse

When asked philosophically, they agree. When brainwashed and the Act is attached to Obama, they agree less.

Posted by: cinyc | November 24, 2010 10:50 AM | Report abuse

It's funny, but the wording of that question, "make sure all Americans have health care coverage", almost makes it sound like the individual mandate. (as in, "make sure all drivers have auto insurance")

Perhaps a better way to phrase the question is: "Do you think it is the responsibility of taxpayers to have their wealth forcibly transferred to pay for the unlimited health care costs of others?"

Corollary, "Do you think it is the responsibility of current and future taxpayers to cover the health care costs of current citizens who did not contribute sufficient funds while they were paying taxes to cover the benefits they now demand?"

What responsibilities do non-taxpayers have in this system? Should they not be responsible for trying to hold costs down, instead of trying figure out how they can get as much as they can from "the system"? The savvy shopper on SNAP can clip coupons and feed their family effectively on public assistance. The savvy consumer of health care is incentivized to get the most expensive care they can for a flat fee. Why not let people manage the costs themsleves, so they see some benefit from saving us all money?

Posted by: staticvars | November 24, 2010 10:59 AM | Report abuse

This shows Americans are smart. In 2001-2008, they were in favor of expanding health coverage because they assumed it would be done through something like Medicare expansion or the public option, which would also lower costs and improve quality. Once people became aware in 2009 that the politicians' actual plan was a disastrous unconstitutional mandate to simply force people to buy into the same terribly overpriced system (see Ezra's blog yesterday) they already disliked, people's opinions changed. You can piss on the American people, just don't tell them it's raining.

Posted by: michaelh81 | November 24, 2010 11:29 AM | Report abuse

--*if only the U.S. weren't among the worst healthcare situations in the industrialized world.*--

Complete disconnect from reality.

Posted by: msoja | November 24, 2010 11:37 AM | Report abuse

What is confusing about this phenomena? Universal health care is common sense; what good is 'freedom' without good health? This is why the public generally supports universal coverage. But when there is a serious push for universal coverage, the health industry wages a lobbying and advertising campaign to confuse citizens about what is being proposed. Citizens aren't against universal health care, they are against what is being sold by the opposition as 'death panels'.

Posted by: cjlbest | November 24, 2010 11:41 AM | Report abuse

He did not run on this healthcare reform. He would not have been elected if he had. Hillary was far more associated in the public mind with healthcare reform than Obama was. According to Remnick's book, it wasn't his plan to foist it on the public first. They tried cap and trade first, decided it wouldn't fly so immediately "pivoted" (favorite word!) to healthcare. If cap and trade had had better management in congress, that would have been the work of the first two years, and you would be cooing about how the planet was saved, the seas began to recede...

Posted by: truck1 | November 24, 2010 11:42 AM | Report abuse

"if only the U.S. weren't among the worst healthcare situations in the industrialized world. We pay a lot, we get very little"

We pay a lot because government intervention destroyed the pricing signal in a country where cost controls imposed by government fiat aren't going to fly.

In addition, the U.S. effectively subsidizes medical innovation for much of the rest of the world, particularly with regard to pharmaceuticals, and it subsidizes the defense of all of the various European welfare states.

It's not all that certain we "get" little for it, though admittedly at the bleeding edge there are a lot of high cost / low benefit procedures/equipment available.

If you look at age-adjusted cancer incidence/mortality ratios, the U.S. tends to be at or near the top when compared to peer countries.

To the extent our life expectancy isn't all that long, it is primarily health related, not health care related.

"scream that the line between freedom and tyranny has something to do with health insurance. Which is, of course, stupid."

There is no freedom, traditionally understood, in a nanny state. Government health care / insurance is but one of many offenses against freedom.

Freedom and tyranny run along a continuum - while the social welfare states aren't soviet hellholes, they do impose real restraints on citizen action, and redistribute the property of the citizens according to the whims of those in power. The opportunities available to the citizens are hence reduced, and they are poorer both materially (euro-area GDP per capita was 69.6% of US levels in 2009 per the IMF) and otherwise.

Posted by: justin84 | November 24, 2010 11:45 AM | Report abuse

You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price check If you have health insurance and do not care about cost just be happy about it and trust me you are not going to loose anything!

Posted by: crawiford | November 24, 2010 11:47 AM | Report abuse

And they want to stop the spending, just not on SS, Medicare, defense, or any prok in their district. The Rep. have always relied on dumb Dems willing to vote against their own best interest! Just wave the flag higher and talk about the others-Blacks, Mexicans, illegals.

Posted by: crossroadsnow | November 24, 2010 11:59 AM | Report abuse

Posted by: dbw1 | November 24, 2010 10:29 AM:

One of the best comments I've read here in a long time.

Posted by: JRM2 | November 24, 2010 12:06 PM | Report abuse

"What is confusing about this phenomena? Universal health care is common sense; what good is 'freedom' without good health?"

The obvious fallacy here is that health care guarantees good health.

Nothing guarantees good health, but if it is the government's duty to maximize our health with no concerns for freedom, you should be willing to accept:

- An outright ban on all foods and products the government declares unhealthy or insufficiently healthy (potentially including cake, cookies, soda, pie, potato chips, red meat, ice cream, spirits, cigarettes and cigars, butter, white bread, fish with high mercury levels, raw foods which may be unsafe if raw, etc)
- Laws requiring that anyone who is caught drunk or high be incarcerated for 6 months or pay a $10,000 fine
- Laws mandating proper portions enforced at restaurants and grocery stores
- The right of the state to relieve parents of obese children from parenting duty on grounds of not providing proper portion control / exercise
- Mandatory 2 hour exercise periods daily for all Americans, enforced by government officials
- All obese individuals required to stay at fat camps until no longer obese
- Banning of tanning salons
- Fines for not wearing sunscreen while at the beach
- Maximum national speed limits of 30 mph to reduce traffic fatalities
- Curfew/lights out from 10pm - 6:30am to make sure each person gets 8 hours of sleep

You can do whatever else you want, provided you follow the government's program on diet, exercise and sleep.

I can assure you that such a program would do far more for Americans' collective health and life expectancy than Obamacare or Medicare for all. It would also cost far less than the government health insurance programs and health subsidies which are currently over $1 trillion/yr and growing rapidly.

Is the massive gain in health worth the significant loss of freedom? Remember that you still have a lot of choice in how you live - where you work, where you live, what entertainment you like, where you vacation, what clothes you wear, etc. You'll also save money in taxes/insurance on lower overall health care costs!

Obamacare will do little to improve health - it will only do a little on the margins to keep the unhealthy ticking a little bit longer. It's entirely possible increased insurance coverage increases the amount of unhealthy behavior amongst the newly insured, offsetting the small effect from extra coverage. Furthermore, the health benefits of the already insured may fall under Obamacare as more dollars fall under government control and we move along down the line to Paul Krugman's death panels (or as he clarified in a blog post, a panel which decides what "society" is willing to spend on your medical care).

Posted by: justin84 | November 24, 2010 12:09 PM | Report abuse

It's not that the public is fickle, it's that once the public figured out that what the government was going to do--force people to purchase private policies from the same insurance industry corporations they despised--of course support dropped.

In the public's mind, universal healthcare, when phrased as "responsibility of the government" (as the poll is worded) means that the government provides the coverage: single payer, or public option.

People need to quit putting lipstick on the pig that is a mandate to purchase private policies. The public wanted to break up the private corporate monopoly on health insurance. INstead the government abdicated it's responsibility by foisting a mandate to rely on the private health insurance industry.

That's all that this Gallup poll discovered. Not that people were swayed by all the death panel hoopla.

Posted by: jc263field | November 24, 2010 12:10 PM | Report abuse

Unfortunately, Democrats are not good at controlling message delivery. I thought that Obama's election would bring a new era of liberal/progressive communication with the middle class. I just wish Democrats would call republicans out on their half-truths and lies.

Posted by: photek00 | November 24, 2010 12:22 PM | Report abuse

The majority of the electorate wanted health*care* reform and the number one concern was the desire to maintain ones coverage independent of employer/employement status. The major policy issue was that healthcare in this country is bankrupting individuals, companies, and the country.

Once the Democrats started talking though, care was redefined as insurance and the objective became creating another poverty program while reinforcing the dependence on employerbetween employer and coverage for the non-poor. The resulting legislation was another triumph for the finance industry that leaves most individuals no better off than they were.

No amount of work on messaging can change the fact that what was done had zero to do with the concerns of the majority. It's no wonder that the public support dropped as people realized what was happening.

Posted by: Athena_news | November 24, 2010 12:49 PM | Report abuse

And, pols are shocked when people get upset when they violate the Constitution? Just goes to show that they must have IQs<50.

Posted by: illogicbuster | November 24, 2010 1:03 PM | Report abuse

Yeah, but starting in 2008 you had massive Republican propaganda against universal health insurance, which certainly turned a lot of people against it.

Posted by: RichardHSerlin | November 24, 2010 3:37 PM | Report abuse

justin84 wrote:
"Nothing guarantees good health, but if it is the government's duty to maximize our health with no concerns for freedom, you should be willing to accept....An outright ban on all foods and products the government declares unhealthy or insufficiently healthy."

Oh, here we go....Justin84 is obviously one of those right-wing hate-mongers trying to scare people, insinuating that by turning over their individual freedoms when it comes to health insurance big government will then come in and say that since they are now paying for our health care, they have a right to tell us what to eat, what to drink, how many times we have to exercise each week....

I'm sooooo politicians would ever try assert the power of the public purse to regulate the diet of the citizenry.

Posted by: dbw1 | November 24, 2010 4:27 PM | Report abuse

" I just wish Democrats would call republicans out on their half-truths and lies."

Does it bother you at all when progressives (including Ezra) continue to regurgitate the lie that Obamacare will reduce the deficit?

Posted by: dbw1 | November 24, 2010 4:30 PM | Report abuse

"Justin84 is obviously one of those right-wing hate-mongers trying to scare people"

The funny part is that I'm not even trying to scare anyone. I don't think Obamacare will lead to the scenario I described (though as you show in your link, the more of your spending dollars that come under government control, the more strings you will likely find attached).

All I claim here is that if your premise is that government should maximize the health of the citizenry at the expense of individual freedom (as freedom is nothing without health), you should conclude that the government should regulate our behavior - it would be far more effective than health insurance for the vast majority of citizens.

In a similar vein, if you think utilitarianism and concerns about equality justifies redistributing income from the rich to the poor, then you should support a confiscatory tax on all incomes above the poverty line here, with the funds primarily shipped to the third world. The American middle class is obscenely rich compared with, say, Zimbabwe or Somalia.

Posted by: justin84 | November 24, 2010 5:01 PM | Report abuse

Why do liberals continue to falsely claim or imply that Medicare and Medicaid are the same program?

Posted by: krazen1211 | November 24, 2010 5:20 PM | Report abuse

Fabulous News!! I just printed Coupons for free. You can print coupons before you shop

Posted by: terriabreu | November 25, 2010 1:33 AM | Report abuse

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