Parsing the Polls: The Health Care Dilemma

All eyes were on Iowa yesterday where Sen. Barack Obama (Ill.) became the latest Democratic presidential candidate to unveil a proposal to reform the healthcare system.

The campaigns are already battling over the relative merits of the competitions' proposals -- a spokesman for former Sen. John Edwards (D-N.C.) released a statement Tuesday afternoon deriding "any plan that does not cover all Americans" as "simply inadequate."

While Iraq continues to dominate the issue landscape, concerns about the rising costs and limited availability of health care are also front of the mind for many voters. Although a majority of voters believe the health care system is broken and want to fix it, there are real questions about how much change is needed and what that change should look like.

So if health care will be front and center in the fight for the Democratic nomination and, in all likelihood, for the presidency in 2008, what exactly do voters want to hear from the candidates?

Let's Parse the Polls!

First, a scan of a series of recent polls shows health care to be among the most important issues to the American electorate. An NBC/Wall Street Journal poll in early March had 18 percent naming health care as a "top priority" for the federal government to address, behind only Iraq (30 percent). A Diageo/Hotline survey in early April had the war in Iraq out front with 26 percent, while health care placed second with 13 percent. Later that month, Gallup asked people what priorities were most important for the president and Congress to address (multiple responses were accepted); 66 percent named the war, while 20 percent chose "poor health care/cost of health care."

(Post polling expert Jon Cohen notes that the wording of the question can affect where health care shows up on voters' priority lists. For example, a CBS-New York Times poll asked an open-ended question last week and got 31 percent of respondents saying the war is their top issue, compared with just 5 percent mentioning health care. Listing health care as an option in the question -- as in the case of the NBC-WSJ and Hotline polls, results in somewhat higher numbers.)

When it comes to how health care should be reformed, opinion is more divided.

ABC News, the Kaiser Family Foundation and USA Today did a detailed health care survey in September 2006 that gets at some of the political realities of the reform issue.

Asked whether they would prefer the current health care system or universal health insurance, 40 percent of respondents chose the current system, while 56 opted for the universal care option. But within those numbers there are significant deviations by age, socioeconomic status and race.

For example, respondents who were 65 years of age and older (people who qualify for Medicare) favor sticking with the current system by a 51 percent to 43 percent margin. Not surprisingly, those on the other end of the age spectrum (18-29) are the most gung ho about universal health care -- favoring it by 29 points over the current system.

Similarly, the country is somewhat divided when it comes to whether cutting health care costs or increasing the number of people covered should take priority. Fifty percent said reducing costs should be the focus; 42 percent favored growing the number of insured.

Those most supportive of cutting current costs are those with a high school education or less (55%) and those with annual household incomes under $50,000 (56%). The other end of the education and income spectrum feels differently. Just 32 percent of those with postgraduate degrees want to focus more on reducing costs than covering more people, and 43 percent of
those with annual household incomes of $50,000 or more would prefer cutting costs.

Although differences of opinion clearly exist when it comes to how much change is enough and what should take priority when it comes to overhauling the system, the American public seems to have made up its mind that taxes can and should be raised to pay for the changes.

In the September 2006 ABC/Kaiser/USA Today poll, a whopping 68 percent said that "providing health care coverage for all Americans" was more important than "holding down taxes." The wording of that question doesn't directly equate broader coverage with tax increases, but it does seem to indicate that people are willing to pony up a bit more each year if it means better and broader coverage.

A new CNN/Opinion Research Corporation poll, which was in the field May 4-6, finds similar results. Asked whether the "government should provide a national health insurance program for all Americans even if this would require higher taxes," 64 percent of the sample said yes, while just 35 percent said no. When CNN asked that same question in January 1995, 55 percent answered yes and 37 percent said no; in April 1991 it was an even wider margin than today, with 67 percent favoring higher taxes to pay for national health insurance while just 28 percent opposed the idea.

And yet, despite that apparent long time support for raising taxes to fund a national health care plan to cover all Americans, nothing large-scale has been done. Why? Because Democrats live in fear of being labeled tax raisers -- fretting that Republicans have successfully turned "tax" into a dirty word. Thus, this line of thinking goes, any proposal that asks people to pay more -- even if it means an increase in services -- is a political death sentence.

Could that political calculus be changing as we head into 2008? Perhaps. The plans offered by Obama and Edwards call for rolling back tax breaks for the wealthiest Americans to pay for expanded coverage -- a tactic that Republicans have already sought to paint as a tax hike.

The 2008 election should provide a crucial test of whether voters really are willing to put their money where their mouths are when it comes to health care.

By Chris Cillizza  |  May 30, 2007; 10:06 AM ET
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