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Fear and Loathing in Health Care Reform

The public has mixed feelings.

12:00 AM, Jul 2, 2009 • By GARY ANDRES
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Health care reform moves into high gear this month in Congress, as lawmakers move beyond slogans to concrete ideas. Accompanying the heightened legislative activity is a chorus of new surveys, studies and think tank analyses--all intended to underscore one point or another.

The avalanche of polls is particularly disorienting, particularly when media organizations report seemingly contradictory results. Do voters want reform or not? Are they willing to pay higher taxes to get it? How much of a role should the government play? Rasmussen's most recent poll shows voters closely divided when asked about President Obama's health care plan (50 percent support- 44 percent oppose). A new CNN poll released on July 1 shows nearly identical results (51 percent support-45 percent oppose). But just a week earlier, the New York Times wrote: "Americans overwhelmingly support substantial changes to the health care system and are strongly behind one of the most contentious proposals Congress is considering, a government-run insurance plan to compete with private insurers." Other surveys over the last year have found eight out of ten Americans believe the health care system is in need of major overhaul.

Why do the fingers in the wind on this subject point in so many directions? Turns out it depends a lot on how you ask the questions and what kind of new information is presented--as is always the case with polls--makes a huge difference.

Mark Blumenthal, founder of, writes a column about survey research for National Journal where he underscored this point recently saying the public's unfamiliarity with "details about pending legislation can wreak some polling havoc." Thus variations in question wording can produce different findings.

But despite the contradictory findings, two simple themes explain a lot about citizen views of health care reform: fear and loathing. Fear refers to the significant number of Americans who like their health care and don't want it changed. Loathing is the attitude that government might do something to screw things up. Writing earlier this week, Rasmussen cautions, "Support for reform falls dramatically when people fear they would have to change their own coverage."

These two connected beliefs explain why Americans seem to say they can't live with health care reform--and can't live without it.

Many polls reveal Americans like their coverage--which might suggest more tepid support for reform. Why risk changing what you like? Democratic presidential candidates understood this public sentiment in 2008. "If you like the health care you have, you can keep it," then-candidate Hillary Clinton used to say. Barack Obama adopted the same rhetoric after he became the nomine and now as president.

Blumenthal also indentified this pattern in a recent column. Surveys also show citizens concerned about costs, especially projecting down the road, he says. They "worry a lot about being able to afford the health care services they might need in the future," Blumenthal writes. "Those are the attitudes that fuel the desire for reform." He's right, and that's why some polls show strong support for doing something about health care, even though 85 percent of Americans already have health insurance and say they're pretty happy with it.

The relatively new field of behavioral economics--a blending of psychology and economics--helps makes sense of these clashing views. One major tenets of this sub-discipline is that people value a "loss" about twice as much as they value a "gain." And as a result, people are more risk averse than might be suggested by traditional, rational economic theory. In other words, instead of "rationally" weighing risks and rewards equally and then forming a judgment, behavioral economics has found risk and pain count more than benefits and rewards.

People might see some gains in reforming the overall system, but fear of changing what they have counts more. And while open to promises of health reform, they're concerned the government might mess things up.

Blumenthal quotes the Kaiser Foundation's pollster, Mollyann Brody, who argues, "it is really easy to scare people into thinking that reform will make their own situations worse off." But at the same time, as Blumenthal noted in a post last week, "people are also very anxious about their costs and future coverage under the status quo. It is that latter anxiety--much less than any altruistic desire to help out Americans without health care coverage--that drives the huge general desire for change and reform."