August 19, 2009

Would Americans Welcome Medicare if it Were Being Proposed in 2009?

by Andrew Kohut, President, Pew Research Center

Many Americans are balking again at the prospect of health care reform. This is surprising in light of how much priority the public gave health care as an issue during the presidential campaign, and how critical it was of President Bush’s failure to act on this issue. But after a few months of hearing about it, a number of recent polls find the public divided over the health care proposals being considered on Capitol Hill.

A late July Pew Research survey found more opposition than support for the health care proposals before Congress. Recent Gallup and NBC/WSJ surveys show the public about evenly split over these proposals. And a CNN poll found a slight plurality favoring “Barack Obama’s” plan to reform health care. As the contentious town hall meetings bear out, the opponents of health care reform and those who are following the issue most closely hold more intense feelings than do backers and those who are less engaged.

The current highly divided climate of opinion about changing the health care system raises the question: If Medicare was being debated today would it be getting the same frosty reception that we are seeing now — and that we saw for health care reform in the Clinton years? To my mind, the answer is yes. Much of the opposition to health care reform today is being fueled by anti-government sentiment that did not exist during the mid-1960’s.

A look back at the polling from 1964 and 1965 shows the American public giving broad support to the idea of Medicare. In January 1965, Gallup tested reactions to a congressional plan calling for compulsory health insurance for the elderly that would be financed out of increased Social Security taxes; 63% approved of this plan while just 28% disapproved. Harris polling at the time found comparable levels of public support for Medicare. In addition, Harris showed that, by 46% to 36%, more Americans said they preferred “medical care for the aged funded by Social Security taxes over a plan of expanded private health insurance.”

Public reactions are very different these days: First, the polls show the public divided over the government requiring all people to have health insurance. Second, there is opposition to increasing taxes — except on the very wealthy — to pay for insuring the uninsured. Third, even before debate began, nearly half (46%) said in a Pew Research survey they were concerned about government getting too involved in health care, despite their desire for the government to take up the issue. By July, a Kaiser Family Foundation poll found 54% worrying that the Congress and the president would pass a bill that will not be good for them. Fewer (39%) worried that health care reform will not pass this year.

Broad distrust of government — which was not evident in the 1960s — is an important reason why Americans are reacting so differently to health care reform in 2009 than they did in 1965. In 1966, the National Election survey found, as in four previous surveys starting in 1958, a large majority (65%) saying they trusted the government in Washington to do the right thing just about always or most of the time. That majority held through the rest of the decade but withered in the early 1970s. By 1974, just 36% of the public said they trusted the government. And from that point on, pollsters have never again found anything close to a majority of Americans saying they trust Washington.

So when a CBS News/New York Times poll shows that 69% are concerned that the quality of their health care will worsen if the government provides health care for everyone, credit a deep cynicism and suspicion about government that even trumps confidence in President Obama. More that anything else, proponents of reform have to overcome distrust of government that was once only evident among Republicans, but today is shared by most independents, and even some Democrats.

In addition, fully 65% in a recent Time poll say they think health care reform is going to make things more complicated, and 78% in an ABC News/Washington Post poll worry that their choice of doctors will be limited. This is another reflection of distrust in government playing out in the current health care debate — opinions that are significant challenges to proponents of reform.

One of the ironies in all of this is that the strongest critics of health care reform, and those most worried about government involvement in health care, are seniors, who are satisfied with their Medicare-provided health care.