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Time to Get Back to Health Care Reform

by Ruy Teixeira

Health care costs are the number one economic worry in most polls. Health care is the number one domestic issue in most polls. And the public thinks that Bush and the GOP are doing an outstandingly bad job in addressing the issue.

How bad? In the latest Pew Research Center poll, just 28 percent approve of Bush’s handling of “health care policy”, with 57 percent disapproval. That’s the lowest job rating Pew has ever recorded on this issue, including in 1990 for Bush’s father. In the latest Gallup poll, Bush’s rating on health care policy is 31 percent with 60 percent disapproval. And in the latest LA Times poll, his rating on “the cost and availability of health care” is 27 percent, with 64 percent disapproval, including 47 percent who strongly disapprove. Among independents and moderates, his ratings are even lower (21 percent and 20 percent, respectively).

And in the LA Times poll, the Democrats in Congress have an amazing 28 point lead (53-25) over Bush on who could do a better job handling health care issues.

But is the public interested in just tinkering around the edges or do they want big change? In the latest CBS News/New York Times survey, 90 percent say we need to either implement fundamental changes in the health care system (56 percent) or completely rebuild the system (34 percent). Just 8 percent think only minor changes are needed.

How about the federal government taking a leading role? In the same poll, by 2:1 (62-31), the public says it’s the responsibility of the federal government to “guarantee health care for all”.

So what are progressives waiting for–a written invitation from the voters? I think it’s about time for progressives to put serious, large-scale health care reform back at the top of their domestic agenda and push it hard. Felicitously enough, the recent release of an excellent health care poll by Americans for Health Care and the Center for American Progress helps show progressives why to do that and how to do that.

Here are some excerpts from the executive summary accompanying the poll, which I urge you to read in full:

Americans are intensely dissatisfied and are hungry for change – not incremental or symbolic change but fundamental policy changes that challenge long-held assumptions and focus on outcomes rather than process and politics. No domestic issue stirs these passions more than health care. Health care costs are seen as the primary threat facing our country’s economy, but more importantly, by a margin of nearly 2-to-1, they are identified as the number one threat facing the economic well-being of individual Americans. With American families feeling increasingly helpless in the face of skyrocketing costs and stagnant wages, they are desperate for real reform.

Given this starting point, it is still startling that 86 percent of Americans say they support ‘reforming our current health care system to provide affordable health care for all Americans.’ We would point out that this language secures significantly higher initial support than we have historically seen for the more common phrase ‘universal health care.’ Support for the proposition is broad, including at least 80 percent of those in virtually every demographic group and every region of the country; even 76 percent of Republicans agree. The language used is critical to securing this broad support, with two key reassurances included:

'Reforming our current health care system’ – this is not a big-government takeover of the health care system

'Provide affordable health care for all Americans’ – this is about affordable health care, not a free government handout, and government working with private interests to reduce costs and ensure all Americans have access to that essential piece of economic security, in
turn making them more likely to save for retirement or education or to buy a home.

While this broad level of support is unprecedented in our research, strong support for some form of ‘universal coverage’ has been present for more than a decade, and voters have consistently indicated a strong preference for progressive policies and proposals on virtually all issues related to health care. So why have progressives failed to translate these advantages into meaningful reforms to the health care system?

Commendably, this poll was designed to directly confront exactly this issue and here is what they found:

Previous research has consistently found that doubts about efforts to extend health coverage to all Americans revolve around two primary fears – big government and higher taxes. When both of these concerns are introduced separately – in an attempt to provide the most difficult test possible – 49 percent of Americans remain solidly in support of reforming our health care system to provide affordable care for all Americans, with 37 percent withdrawing their initial support based on one or both of these concerns. This is a significant drop, which underscores the difficulty of overcoming deep-seated reservations on these issues. But the fact that nearly half of Americans remain solid in their support despite these concerns is testament to not just the profound public dissatisfaction with our current health care system but the strong popular support for extending coverage to all Americans. After hearing arguments from both sides of this debate, overall support remains at 84 percent, with the number who remain steadfast in their support even if it requires higher taxes and a much larger government role rising to a majority (52 percent).

Since the defeat of the Clinton health care plan in 1994, the health care debate in Washington has been diminished into a series of minor skirmishes over important, but relatively small, changes within the current system that have done nothing to change the underlying dynamic. But the health care debate in America remains focused on two essential issues – first, the growing gap between health care costs and the ability of most Americans to meet those costs and second, the fundamental unfairness of a system that denies the basic security of needed medical care to nearly 46 million Americans while delivering record profits for insurance and pharmaceutical companies. Americans are eager for a health care debate that goes straight to the heart of the problem.

I think that’s about right and I also agree with their assessment of the politics of this issue in the current climate:

The strategic importance of this issue for progressives cannot be overstated. With presidential and congressional job approval numbers near record lows, Americans want leaders who are willing to reject the broken status quo and offer bold new solutions to the core challenges facing our country. Health care is identified as the primary threat facing both our country’s economy and the economic well-being of individual Americans. And real health care reform, that expands affordable health coverage Americans, resonates with a majority of Americans, including those that do not self-identify as progressives.

I’ll just add this one data point to reinforce that conclusion. Remember those white working class voters who gave Bush another term in the White House? Well, 84 percent of them support the kind of health care reform explored in this poll.

If nothing else does, that one fact should have progressive politicians lining up to put their name on serious health care reform proposals.