A new poll by Kaiser and Harvard shows the problem the Republicans have: the only thing as unpopular as the Affordable Care Act (ACA) would be to repeal the Affordable Care Act. 28% of Americans want to expand the ACA; 19% want to keep the ACA as-is; 23% want to repeal it and replace it with a Republican-sponsored alternative; and 20% want to repeal it.
Put another way, 47% of Americans want to keep or expand the ACA, and 43% want it either repealed or replaced.
Republican’s plan B — sabotaging the law by defunding it — is even less popular:
Most Americans—62 percent—disapprove of the idea of lawmakers using the appropriations process to slow down implementation of the law. The majority view switches here because, although most Republicans (57 percent) are in favor of the idea of defunding the bill, most independents are opposed (62 percent) along with the large majority of Democrats (84 percent). Even among those with an unfavorable view of the law and those who want to see it repealed, substantial shares of about four in ten say they disapprove of cutting off funding as a way to stop some or all of health reform from being put into place.
I note that when the Democrats were favoring a policy that considerably less than 62% of Americans opposed, Republicans and conservatives found that quite immoral; “how dare the Democrats shove this down our throats!,” they cried! I’m certain that their passionate belief that Congress shouldn’t oppose the will of the people won’t suddenly evaporate now that public opinion is less aligned with their policy preference.
The rest of the poll (pdf link) has the results you’d expect; majorities of Americans favor nearly all the provisions of the ACA when asked about them one by one; everyone wants to do something about the deficit but there aren’t majorities in favor of cutting any specific programs (other than foreign aid, which we spend practically nothing on anyway).
There was a pretty interesting result on the individual mandate:
The individual mandate remains unpopular; 76 percent have an unfavorable view of this provision. However, some malleability in opinion exists. When those who initially oppose the mandate are read the argument that “without such a requirement, insurance companies would still be allowed to deny coverage to people who are sick,” opinion on the mandate becomes more split (46 percent favorable, 47 percent unfavorable). And when those who initially favor the mandate are told that such a mandate “could mean that some people would be required to buy health insurance that they find too expensive or did not want,” opposition rises to 85 percent.
There’s one thing about the design of the poll that bothers me; although respondents were asked if they’d rather address the deficit by cutting programs or raising taxes, they weren’t offered the option of saying “both.” Despite that, 5% of those polled volunteered that they’d prefer a combination of program cuts and increased taxes. How much higher would that 5% have been had the poll offered “both” as an option?
You’d think nearly 100% would answer they’d like to see spending cuts. Everyone may disagree on what needs to be cut, but we can pretty much all think of something we think should be cut. You’d also think we could agree that since there’s very little we can all agree on cutting, and very little we’re going to be willing to budge on taxes should probably go up to pay for the stuff none of us are willing to give up.
Edited to add: Though the stuff we can all agree should be cut should probably be cut, but it won’t be. Corporate welfare ain’t going anywhere. Neither are no-bid contracts for utterly useless projects that create little to nothing, bailouts for people that should have been perpwalked (Or perpdrug), or “Consumer Protections” that amount to little more than protectionism for insiders to prevent competition. Pretty much everyone is against the absurd amount of overseas military bases now too. Even people that don’t want to see cuts to the military think wasting the money on overseas bases that serve no purpose when it could be used to equip troops is kind of stupid.
There’s probably enough that the left and right agree on cutting that we could make serious strides toward balancing the budget if we got rid of it. (By left and right I mean actual liberal and conservative voters. Not Democrats and Republicans, who mostly don’t give a damn what anyone wants.)
I’m afraid that the results of the poll do not support the opinions expressed in this post very effectually.
Firstly, that only 47% of the public approves of a law which was supposedly introduced to solve a huge problem which the public faces suggests either that it is a very bad law or has been very badly publicised, or most probably both.
Actually, however, only 19% of those polled like the law. 71% want it changed in some way.
Only 32% of Democrats (whose party sponsored the law) approve of it. A massive 51% want it changed
Independents are even less sympathetic; only 16% like it. Indeed, among independents, 47% prefer some kind of Republican option; only 40% support the Democratic law. That is quite surprising.
What is weird about all this is that, as far as I have been able to understand, universal healthcare commands much more than 60% support across the board. Therefore, a large chunk of that grouping doesn’t think that this law represents what they understood by universal healthcare.
In other words, although the post is intended to show that health care reform of this current variety is popular, the reality is that it is surprisingly unpopular. Possibly some of this is due to powerful propaganda against health care reform, but a great deal is surely due to the extraordinary ineptitude with which health care reform has been promoted, and the extent to which people do not trust it to be implemented in their interests.
Creator, the post says “the only thing as unpopular as the Affordable Care Act (ACA) would be to repeal the Affordable Care Act.”
You seem to think that the premise of my post was that the ACA, as it stands, is currently very popular. That’s not what I said — in fact, it’s just the opposite of what I said.
But there’s a big difference between disliking a bill because you think it doesn’t go far enough, and disliking it because it goes too far. Conflating those two views, as you do, makes no sense.
“Far enough” / “too far” isn’t the right dichotomy; that implies that the bill is going in the right direction but over or undershot the mark.
The bill goes in the wrong direction. We’re not likely to reach agreement on what the right direction is, but I’ll throw out that any health care reform ought to:
a) associate costs with beneficiaries to the degree that is humanely possible (not a typo)
b) follow a model whereby the wealthy subsidize the poor but not the middle; if the median person cannot pay their own expenses (through whatever funding mechanisms) then the system is not sustainable
c) move away from the insurance model, which is an inherently and fundamentally broken way to pay for health care costs; insurance is a good model for unpredictable costs that come at random times, but a bad model for predictable costs that come at predictable times, and most healthcare expenses are of the latter sort
The current reform is a fail on A and a HUGE fail on C. Maybe it succeeds on B, it’s impossible to tell at the present time.
Robert, what country’s working system in the world today would you say meets requirements A, B and C?
That said, I’d add D: Any health care reform should be plausible politically in the current US Congress (give or take an election cycle).
* * *
A) is pointless. Someone who’s been told they have cancer isn’t going to be a careful consumer; someone in mind-numbering, constant agony because their arm has flared up and they need a hundred-dollar shot of cortisone isn’t going to be a careful consumer; someone being rushed to the hospital with mysterious systems that might be a heart attack but also might be indigestion isn’t going to be a careful consumer; someone told that they need an MRI to rule out a deadly disease isn’t going to be a careful consumer. The vast majority of people will listen to their doctors; targeting consumers instead of targeting care providers is guaranteed failure.
B) sounds so authoritative, but think about it for two seconds and it falls apart. Let’s say median income is $40,000. So if everyone with an income above $45,000 is giving more to the system than they take, but everyone with an income below $45,000 is getting more from the system than they give, is that really enough information for to say the system isn’t sustainable? Of course not.
Most of us need expensive medical care (for ourselves or our dependents) at some point in our lives; few of us need it all of our lives. I think in a better system, at some point, most median-income people will be subsidized (perhaps quite a lot for a brief period), and at most points, most median-income people will be subsidizing (not very much but all of the time).
c) Insurance works pretty well in some other countries — they spend less per capita than the US and get better results. I understand your theory, but the evidence is pretty overwhelming that a well-regulated insurance system can work.
That said, I don’t have any attachment to insurance. Bring on single-payer and burn all the insurance companies down, and I’m happy.
But that brings us to D). You can’t make any major reforms in the current US political system, because major changes to the medical system will be attacked by the opposing party (whichever party that is) as “they’re going to take your health care away! CHANGE IS SCARY!” That’s why the Affordable Care Act made such small changes (and they were small, compared to every other universal coverage scheme that’s ever been proposed) — it’s because to make it politically plausible, Obama had to promise that people could keep the insurance they have, assure the insurance companies they weren’t about to be eliminated, etc.
The only way that we could have legislation that openly moves us away from the insurance model is if we had major bipartisan consensus for doing that. And every incentive in our current political system pushes legislators away from making major bipartisan change. (Not to mention the millions insurance companies spend on lobbying and political donations to make sure that there will never be such a change).
This is a slightly tangential but really interesting read from Atul Gawande at the New Yorker about lowering health care costs by identifying the “top spenders” and creating ways to intensively intervene in their health care. It’s not by making them pay for more of their own care. In fact, in some cases, that backfired by causing people to avoid routine care that led to them getting sicker and spending longer in ICU.
Anyway, read it. (Of course, I think just about everything he does is fascinating.)
Warning: photo illustration is pretty anti-fat.
Between “health care reform” and my state’s “gender neutrality” law, I lost my coverage b/c the health insurance companies saw both as perfect excuses (as if it needed) to raise my premium costs 66% in a single year.
So I signed up with another plan with a huge deductible which means it’s insurance which offers all these great bells and whistles but since the deductible is so high (plus a higher copayment), nothing but smoke and mirrors.
But I do give thanks on a daily basis that two of my sisters have families in countries with national coverage. They get better coverage in the U.S. when visiting than most citizens.