Americans Support Health Reform, Reject Policies to Make Health Reform Workable


I think Jeff Young led with the wrong poll result in his writeup of a recent survey of public opinion on health reform. That the public thinks congress should “start over” on health care has, I think, basically no real meaning or content. The real issue is further down in the piece:

Despite their misgivings about the bills overall, the poll showed the the public is strongly in favor of some of their key components, such as forbiding insurance companies to deny coverage based on pre-existing conditions, establishing a health insurance exchange marketplace, prohibiting women from being charged higher premiums and requiring most employers to provide health benefits.

These same respondents, however, demonstrated resistance to making tradeoffs in exchange for these benefits by stating their opposition to paying more taxes, instituting cuts in Medicare spending or being required by law to obtain health coverage.

As earnest liberal pundits never tire of explaining, the insurance market reforms can’t work without a mandate because without a mandate you’d get a “death spiral” of adverse selection. And a mandate can’t work without subsidies. And it’s not responsible to put subsidies in place without offsetting taxes and spending reductions.

I do think it’s notable, however, that back during his primary campaign Barack Obama opposed an individual mandate. The overwhelming consensus among health policy observers at the time wasn’t that Obama didn’t understand the death spiral point, it was just that he thought the mandate was politically poisonous. This was generally taken as a sign that he regarded a push for comprehensive health reform too daunting and wasn’t going to try. And, frankly, even though I favor universal health care I agreed with the diagnosis that it was probably politically impossible and thought this indicated a wise caution on Obama’s part. But then Obama changed his mind, and he came agonizingly close to succeeding. Now that congressional Democrats once again seem to be flinching, this same roadblock in public opinion that Obama identified in the first place is still there.