Health Care, Public Opinion, and Congress

Andrew Gelman, Nate Silver, and Daniel Lee bring the political science to try to understand senators’ behavior on the health reform debate. One interesting finding is that, at least as measured by answers to the question of whether the federal government should spend more money on covering the uninsured, geographic variation is real but much smaller than variation by age or income:

Another finding is that the state-by-state variation that does exist in terms of people’s level of support for health reform has very little to do with the stances taken by senators. Instead, the controlling concern of senators seems to be Barack Obama’s popularity rather than health care’s popularity:

For instance, Senator Blanche Lincoln, a Democrat who has been a less-than-strong supporter of the present health care bill, recently told The Times, “I am responsible to the people of Arkansas, and that is where I will take my direction.” But where does she look for her cue? Hers is a poor state whose voters support health care subsidies six percentage points more than the national average. On the other hand, Mr. Obama got just 40 percent of the vote there.

Likewise, in Louisiana, where the Annenberg surveys showed health care reform to be popular but where Mr. Obama is not, the Democrats are not assured of Mary Landrieu’s vote.

There are two kinds of ways you can think about the relationship between voters, public opinion, issues, and politicians. One, a hyper-rational way, is to say that voters will like politicians who champion popular causes. Another is to say that voters will like causes that are championed by popular politicians. My sense is that the press tends to implicitly assume the rational model, whereas the truth is mostly the irrational model. Senators, according to Gelman, Silver, and Lee seem to think that the irrational model is the key one in health reform.

This underscores the fact that the toughest “gets” are people over whom the White House has little practical leverage. Overt White House pressure on Lincoln might make her less likely to vote for reform, since an image of standing up to an unpopular-in-Arkansas president would be helpful to her.