Commonwealth Commonsense

Strong Support for Healthcare Reform

My headline is not one you’re likely to see in mainstream media headlines.  Not because it’s false; actually, it’s true. But the mainstream media wants a couple of things:

1. Continued access to Republican sources; ergo,
2. MSM will continue to report GOP talking points, even when they know they are not true.

A recent poll by The Washington Post and its reporting makes the case. Here’s the headline: More Americans oppose health-care law, but few want a total repeal.

More than what, you ask?  More than ever? More than the last poll? More than support it?

Actually, the simple answer is the third option. Simple, but incorrect, as interpreted by most people. And no where in the article does it explain what the headline means.

Republicans are forever saying that “the American people don’t support this healthcare bill,” or words to that effect.  They then say that’s why they want to repeal it.

As The Post reports, few really want repeal, but you will forever see the GOP make that false claim, false but duly noted by the press.

But to the question of support for the healthcare bill, The Post’s Jon Cohen buries the lede in the penultimate paragraph.

Another factor in the debate is that a quarter of those who oppose the health-care law say the legislation is faulty because it did not go far enough, not because it pushed change too far.

So if you add the number together from The Post’s poll, 45% support the bill, and about 13% of those who opposed it wish it went further, meaning 58%, a sizable majority (a landslide in electoral politics), either like the current healthcare overhaul or wish it would go further, and in all likelihood that means arguably not in the direction the GOP would take it.

Yesterday’s poll by The Pew Research Center for the People and the Press confirms this interpretation.

The public continues to be divided over what it wants to see done with the health care law – 37% favor its repeal, while nearly as many (35%) want the law expanded, and 20% would leave it as it is.

Which again gives us 55% of Americans wanting the law as is or expanded.

Complicating my view are the results from two other polls this week.  A CNN poll doesn’t ask the question about whether opposition is because the law doesn’t go far enough, and its topline support/oppose is the same as the other polls, a slight plurality opposed.  But when forced to choose to either keep it all or repeal it all, 50% say repeal it all with 42% say keep it all.  One would think that if a majority liked the law or wanted it to go further, the “don’t repeal” group would be closer to 55%, not 42%.

But I think another question, asked in this week’s  CBS/New York Times poll, puts the entire debate into perspective. When asked if any of the provisions that have already taken effect (keep children on policy until age 26 or that children can not be rejected for insurance if they have a preexisting condition), apply to the respondent, we learn only 13% have benefited from the law yet. Once people start seeing the benefits to themselves, support could grow.

Another key issue is this from the CNN/NY Times poll:

Those who support repeal were asked whether they would continue to do so if it meant that insurance companies were no longer required to cover people with pre-existing medical conditions; 52% said they would, but 35% said in that case, the law should not be repealed.

Someone (the Press? the Dems? Both?) have not done a good job of explaining the bill.

A critical question is this” Should it be the media’s responsibility to explain the bill. That depends on what one think the media’s role should be. If it is to simply report what is happening or whether it is to find the truth. I believe it is the latter and cite the Code of Ethics of the Society of Professional Journalists, an organization to which, admittedly, not all journalists belong.

Members of the Society of Professional Journalists believe that public enlightenment is the forerunner of justice and the foundation of democracy. The duty of the journalist is to further those ends by seeking truth and providing a fair and comprehensive account of events and issues.

…Journalists should:

— Test the accuracy of information from all sources and exercise care to avoid inadvertent error. Deliberate distortion is never permissible. [emphasis added]

Yet, throughout this debate one issue that confounds people in my business (communications consulting). Again, from the CBS?NY Times poll:

And finally, there may be some lingering confusion about the provisions of the bill. 56% of Americans say the bill’s impact on themselves and their families has not been explained well to them.

Given what’s at stake, which is not only the relentless false impressions of the bill duly stenographed by the media, maybe the best option is an advertising campaign. What would it cost to widely distribute this 30-sec. ad in an attempt to bypass the media:

The new federal health law means:

1. Insurance companies can’t drop coverage when you get sick, and they can’t cap your coverage.
2. They cannot deny you or your children coverage because of pre-existing conditions.
3. You won’t lose your insurance when you change jobs.
4. Reduced costs for drugs for seniors.
5. Tax credits for small businesses offering health insurance
6. A reduced federal deficit.

The new federal health law—do you want all these provisions repealed?

On TV, these bullet points should be on the screen as the narrator reads them to ensure that people who can’t hear the ad but see the TV can read them.

Will this ad overcome the misleading information disseminated by the MSM and the false information by Fox News and conservative talk radio. I’m not sure, but clearly proponents of healthcare reform are losing the messaging war.  This can’t hurt.

Note: An edited version of this post appears on News Commonsense, my media blog.

Why Insurance Companies Oppose Reform Repeal

But investors say they’re increasingly optimistic on health insurers’ future for two crucial reasons: regulations released this year have been relatively industry-friendly, increasing stability, and the health reform’s new business opportunities are beginning to look more tangible.

…Over the past year, there has also been a noticeable shift in rhetoric, as insurers that had previously warred with the administration signaled a willingness to play nice in 2011.

Wellpoint spent much of last year sparring with the Health and Human Services Secretary Kathleen Sebelius over a double-digit rate hike and policy recissions, at one point writing a letter to President Barack Obama accusing the president of spreading “false information.”

Speaking on Monday, CEO Angela Braly framed health reform as a collaborative project with the Obama administration.

“We’re working collaboratively with the administration and intend to continue to do so,” she said. “We have brought to them input both from our voice and our consumer advisory group, and they give us a lot of feedback.

Maybe it would be a good thing if the law were repealed.

Dems Again Beef Up Messaging Strategies

Democrats are forever telling us they will get better at messaging. But it’s like telling your kids to clean up their mess and when they don’t, you pick it up for them. There’s no consequence. Banish the free talkers to obscure committees and you might get more discipline. But maybe it’s that Democrats think they all are the smartest people in the room, and that they can sell ice to Eskimos. Or maybe they think that if only voters knew all the details of their policies and procedures, they’d all vote Democratic. So I’m not optimistic that Sen Chuck Schumer’s latest effort will be more successful.  But let’s hope he starts by scrapping the Democratic National Committee’s talking points on repeal of healthcare reform. Here’s how they start:

Instead of working to find bipartisan solutions to create jobs, grow the economy, and make America more competitive, Republicans in Congress are spending all of their time re-fighting the political wars of the last two years by trying to repeal health reform and give control over your health care back to insurance companies.

The Affordable Care Act provides Americans with more freedom and control in their health care choices.

o It gives families the freedom from worrying about losing their insurance, or having it capped unexpectedly if someone is in an accident or becomes sick.

o It frees Americans from the fear of insurance companies raising premiums by double digits with no recourse or accountability.

o It frees Americans from discrimination when insurance companies deny women health insurance because they are pregnant, or refuse to provide coverage to children who are born with disabilities.

The bullet points go on…and on. Unless they plan to buy a five-minute infomercial, no spokesperson will ever get to the end of the list. The problem with a long list is that it gives every Democrat a choice of what he or she wants to highlight. In other words, no message discipline.  Without discipline, it’s difficult for the media to pick up on key points to include in stories. And in fact, some of the points at the bottom of the list should be near the top. For example:

o Republicans will allow insurance companies to once again DENY coverage to children with existing conditions, CANCEL coverage when people get sick, and LIMIT the amount of care you can get − even if you need it.

o When the insurance companies are free to pursue their profits without any accountability, people have fewer choices, fewer options, and little recourse.

· And, by rolling back the Affordable Care Act, Republicans are adding a TRILLION dollars to the deficit.

o They would give back to insurance companies subsidies of hundreds of billions of taxpayer dollars. And they would cut back on efforts in the law to stop waste, fraud, and abuse in government spending. We can NOT afford to add another trillion dollars in debt that our children and grandchildren will have to pay - especially when it goes to wasteful spending and outrageous subsides for insurance companies.

They need editing, but you can’t lose by attacking insurance companies. Put them near the top of the list.

But the bigger problem with the list is that…it’s a list. Democrats continue to believe that voters consider policy minutiae when making decisions. Sure, when polled, people say they like individual parts of the reform bill, and there’s no reason Dems shouldn’t mention some of them. But they need to lead with the overall framing.

The DNC statement actually starts out good: let voters know that Republicans aren’t addressing the jobs issue, but then pivot to the Dems positive framing:

Instead of working on creating jobs, Republicans in Congress are working for insurance companies. Democrats believe that children and their parents should not be turned away when they are sick. They should be able to afford to see a doctor. That’s what the healthcare reform bill does. To Republicans, if you get sick, you’re on your own.

We believe, as did the founding fathers, that we should “promote the general welfare.” That’s the first sentence in the Constitution. Developing a healthcare system that is efficient, affordable and available to everyone is what we accomplished. We won’t let Republicans and insurance companies take it away.

That’s a little over 30 seconds. If that’s all you get to say in a cable show interview, that’s good enough. If a print reporter takes just one of the paragraphs, Dems have made their point. (Note: There’s much more ground to gain than many Democrats think by appealing to a responsible social norm. I’ll have more on that in a few days after finishing a book on behavioral economics that has some lessons for politicians.)

As far as the list goes, it needs to be condescend:

Our health reform bill means you can’t lose your insurance if you become sick, pregnant or your child has disabilities…or you change jobs. Your children can be on your policy until they are 26. It lowers drug costs for seniors and protects Medicare. And it prevents insurance companies from jacking up prices to pay their CEOs huge salaries. And bottom line: It lowers the deficit.

Those three short paragraphs have all the points Dems need to push back—and most important—to resell their healthcare reform. They can expand any point, hopefully with some anecdotes, which tend to personalize the problem and allow people to see themselves in similar circumstances. They can point out the hypocrisies in the GOP actions, who won’t give up their own extravagant healthcare insurance they get with their jobs and how repeal increases the deficit. Maybe with the elections now behind them, they will take some pride in what they accomplished.

Fact-Checking Healthcare Overhaul

NPR’s Julie Rovner fact checks some of the bill’s supporters’ and opponents’ claims. Basically, three GOP claims are mostly false; two Democratic claims mostly true.  Which is to say that Rover can’t bring herself to say yeah or nay forcefully.  But she makes pretty clear that truth mostly resides with the Dems.

Healthcare Bill Repeal: Good, Bad, DK?

There have been a number of polls about Obama’s healthcare bill that suggest when you ask people their opinion of the bill, a sizable slice of the “don’t like it” crowd actually don’t like it because it doesn’t go far enough, meaning that a solid majority of Americans want healthcare reform along the lines of the current law or more “liberal,” according to the most recent CNN poll.

Then we have the latest Gallup Poll: 46% favor repealing the bill; 40% oppose repeal. So where are the other 12%? They don’t know—by now, after nearly two years of wrangling over the issue? That doesn’t reflect well on the media, of course. It means journalists haven’t done a good job of explaining the bill. Do those 12% reflect the number who not only oppose repeal but want it replaced by a stronger law?

But, looking at the big picture, here’s the good news:

In the poll, a majority of men endorse repeal while women are inclined to want the law to stand.

You never want to bet against women getting their way, especially when it comes to the health of their children.

And speaking of those children:

One of the most dramatic divides is by age. By 50%-30%, young adults under 30 support the law. But their middle-aged parents, those 50-64 years old, favor repeal by an almost equally wide margin.

Can we put those 50-64 year olds in front of a death panel and, in a class action suit, ahem, eliminate them? Wait, that includes me.

In any case, like “don’t ask, don’t tell,” gay marriage and marijuana, it’s just a matter of time.

U.S. Healthcare Ranks Worse Among ‘Rich’ Countries

I hope the next time a reporter or a progressive hears someone say, “We have the greatest healthcare system in the world,” they point to this.

The findings, published in the journal Health Affairs, looked at 11 developed countries and compared the experience of patients — from costs, to paying medical bills, to dealing with insurance companies.

The U.S. came out at the bottom on almost every count, sometimes with shocking gaps between it and the next country.

Here's a rundown of the various ways the U.S. is falling behind Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom:

• Only 58 percent of U.S. adults said they thought they could afford the care they needed
• A solid 20 percent of U.S. adults had major problems paying medical bills, compared to 9 percent in France, with the next highest figure
• 31 percent of U.S. adults reported getting caught in insurance snafoos: either dealing with mountains of paperwork, having their insurer deny a claim, or receiving a lesser payment than expected
• Americans are coughing up more from their own wallets: one-third of U.S. adults paid $1,000 or more out-of-pocket in the past year for medical bills, much higher than all of the other countries.
• Among the worst-off are uninsured Americans: nearly half of them went without needed care and one third had problem with bills

The complete survey is here.

Measuring Healthcare

As I reported last week, the level of displeasure over the recently passed healthcare reform legislation is often overstated.  The impetus for that post was the CNN/Opinion Research poll of last week.

There’s another CNN/OR poll this week.  Here again is a key data point.

"Thinking about the health care bill that Congress passed this week, which of the following statements best describes your view of what Congress should do in the future? Congress should leave the bill as it is. Congress should make additional changes to increase the government's involvement in the nation's health care system. Congress should repeal most of the major provisions in that bill and replace them with a completely different set of proposals." Options rotated

Leave as is……………………………….23%

Increase govt. involvement…..27%

Repeal and replace………………..47%

Unsure……………………………………..3%

So 50% like it or want more govt. involvement.

Another question:

"Which of the following statements best describes your views about the health care bill that Congress passed this week? You approve of the bill becoming law and have no reservations about it. You approve of the bill becoming law but you think it did not go far enough. You disapprove of the bill becoming law but you support a few of its proposals. You disapprove of the bill becoming law and oppose all of its proposals."

Approve, no reservations………………….15%

Didn’t go far enough………………………….27%

Disapprove, but support some of it….31%

Oppose all of it……………………………………25%

Unsure………………………………………………….1%

So 74% like at least some of the reform.

Here’s the way the CNN’s polling director interprets the poll.

The 47 percent who favor "repeal and replace" is significantly lower than the 56 percent who say they disapprove of the bill's passage last week.

"That's because opposition to the new law comes in many different forms and not all of them benefit the GOP," says CNN Polling Director Keating Holland. "Some Americans continue to say that they disapprove of the bill because they want even more government involvement in health care than the bill created. Only a quarter are against the entire bill; one in three support at least a few proposals in the new law. [Emphasis added] And a handful of Americans appear to dislike the bill but don't want Congress to spend any more time on health care."

When will the press get it?

Cross posted on News Commonsense.

Support for Healthcare Downplayed by Media

As I reported yesterday, the press is tending to underplay the actual support for healthcare reform.  If I were asked in a poll if I support the bill that was passed, I would have said no because it doesn’t go far enough.  The CNN/Opinion Research poll conducted during the weekend showed that when you combine those who supported the legislation signed by the president yesterday and those who opposed it because it did not go far enough, 52% of Americans support the bill and/or even greater reform.

Today in The Washington Post, reporter Scott Wilson again mischaracterizes the level of support for reform.

In staging such a high-profile event, the Obama administration was helping to make health-care reform something for Democrats to run on in the midterm elections this fall, despite the fact that a majority of the electorate opposes it, according to opinion polls conducted before the vote. Rarely, if ever, have such events been as raucous as the ceremony-turned-political rally that rocked the ornate East Room for just over half an hour.

Looking at the healthcare polls on PollingReport.com, few of them ask whether opposition is based on the idea that the current bill or general principles about reform don’t go far enough.  But I found two that did.

A Ipsos/McClatchy poll in late February found that overall 41% supported “health care reform proposals presently being discussed" and 47% opposed them.  The poll then asked those who “opposed” the proposals, “Is that because you favor health care reform overall but think the current proposals don't go far enough to reform health care; OR you oppose health care reform overall and think the current proposals go too far in reforming health care?"  The result:  37% said they favored reform but that the current proposal didn’t go far enough, meaning another 17% actually support greater reform.  The overall support for reform, then, is 58%. 

In a CBS poll in early January, 57% of respondents said the “changes to the healthcare system under consideration in Congress” either were about right or “don’t go far enough.”  When asked about the proposals to “regulate the health insurance industry,” 61% said they were about right or didn’t go far enough.

Electorally, I can’t imagine that those who are disappointed that reform hasn’t gone “far enough” or isn’t “liberal enough” would vote for Republicans in 2010 based on their opposition to reform.  They may stay home because they are disappointed with Democrats, but they won’t be GOP voters.

If you like, write Post reporter Wilson ([email protected]) and ask that he not mischaracterize the public’s opinion of healthcare reform.

Cross posted on News Commonsense.

Support for Healthcare Reform

Just heard the chattering on MSNBC between Chris Matthews and Patrick Buchanan.  They misrepresented the recent CNN/Opinion Research poll.  They focused on the top line:

As you may know, the U.S. House of Representatives and the U.S. Senate are trying to pass final
legislation that would make major changes in the country’s health care system. Based on what you
have read or heard about that legislation, do you generally favor it or generally oppose it?

Favor 39%
Oppose 59%
No opinion 2%

But the next question tells the real story:

(IF OPPOSE) Do you oppose that legislation because you think its approach toward health care is
too liberal, or because you think it is not liberal enough?
QUESTIONS 20 AND 21 COMBINED

Favor (from Question 20) 39%
Oppose, too liberal 43%
Oppose, not liberal enough 13%
No opinion 5%

So what you get is this:

52% support the bill or wish it went further in the direction the Democrats wanted, while 43% oppose it.

You can make an argument that the term “not liberal enough” leaves much to the imagination.  But I’ll bet most folks would include a public option or a single payer system within the “not liberal enough” definition.

Cross posted on News Commonsense.

UPDATE:  Looks like most people now like Obama’s plan.

A Big Idea

Congressional Republicans achieved a goal during yesterday’s healthcare summit. They shed their “party of no” label. They had ideas.

But Obama saw them and raised them one. He framed them as the party of small ideas while Democrats have a big idea. As in, we’re planning to fix healthcare instead of, as Sen. Tom Harkin said of the GOP plan, throw 10 feet of rope to a man drowning 50 feet from the boat—with a promise that at some later point, we’ll throw him a 20 foot rope.

The GOP did their homework well. As is usual the case, they were, in large part, more articulate than many of the Democrats, the president included. They had fire in their bellies and a list of facts and ideological bon mots. Even when they threw hanging curve balls, the Dems took called strikes. When I commented on that in a contemporaneous post yesterday, a friend also in my line of work called incredulous himself. The response to that oft charge of letting the government makes decisions instead of “the American people and their doctors” is, “Oh, if it were only so. Now it’s the insurance exec making millions of dollars a year who now gets to make that decision.”

But the Dems warmed up a little by the late innings, both rhetorically and passionately. The best I heard all day was by Sen. Dick Durbin. After the two Republican doctors lorded their experience over the crowd, Durbin gave them the view from the street. He’s been a good old fashioned—and as the GOP would characterize, “ambulance chasing”—trial lawyer. He’s defended victims of medical malpractice and the doctors that perform it. And showing his summation skills, he spoke in smooth paragraphs.

As any good lawyer would, he eviscerated the “common knowledge.” Both the number and award amounts of medical malpractice have dropped precipitously over the years, not increased, he said. The number of paid malpractice claims decreased 50 percent in the last 20 years, and the amount of awards have dropped the same 50 percent in the last five years. Then, he played the jury’s heart strings by telling the story of a woman who went in to have a mole surgically removed only to have the oxygen ignite, scarring her face for life and submitting her to repeated operations.

“Her life will never be the same. And you are saying that this innocent woman is only entitled to $250,000 in pain and suffering. I don't think it's fair.”

Certainly, GOP Chairman Michael Steele could understand that, he who thinks one million dollars, after taxes, “is not a lot of money.” Two hundred fifty thousand isn’t even walking around money for the chairman.

CNN, probably taking a cue from, I believe it was, GOP Sen. Mitch McConnell that Republicans weren’t getting enough hot air time, tracked the minutes party representatives talked.

Democrats spoke for a total of 135 minutes while President Obama spoke for 122 minutes, for a total of 257 minutes. Republicans, meanwhile, spoke for just 111 minutes, about 30 percent of the total speaking time.

The president spent too many of his minutes hemming and hawing as he is wont to do in extemporaneous situations. He often starts off searching for words in bursts of disconnected phrases. But when he warms, he can cut you with a butter knife.

His summation, which started in that same hesitant fashion, got legs. He cut through the GOP apocalyptic rhetoric.

“I know that there's been a discussion about whether a government should intrude in the insurance market. But it turns out, on things like capping out-of-pocket expenses or making sure that people are able to purchase insurance even if they've got a preexisting condition, overwhelmingly, people say the insurance market should be regulated.

And so one thing that I'd ask from my Republican friends is to look at the list of insurance reforms and make sure that those that you have not included in your plans, right now, are ones, in fact, that you don't think the American people should get.”

He reminded our representatives that they should be willing to let the American people have the same insurance coverage they have. He deftly framed his solutions as market driven as Sam Walton. His comparison of a wide open insurance market left to the states with what happened in the credit card market was one people could easily understand. He cited new statistics demonstrating how Americans already have chosen the government as their main source of insurance because companies can’t offer it anymore. And he used a little humor to undercut GOP criticism of the bill’s length and make the point that small ideas won’t work.

“I did not propose and I don't think any of the Democrats proposed something complicated just for the sake of being complicated. We'd love to have a five-page bill. It would save an awful lot of work.

The reason we didn't do it is because it turns out that baby steps don't get you to the place where people need to go. They need help right now. And so a step-by-step approach sounds good in theory, but the problem is, for example, we can’t solve the preexisting problem if we don’t do something about coverage.”

By this time, Obama has found his voice. He’s talking smoothly and minimizing the “hums” and “uhs.”

He then made the observation that I would have put a little differently, though his way sufficed. The Republicans think compromise is first, Dems put their ideas out there. Then Republicans put theirs. And then we all accept the GOP plan—lock, stock and barrel. Voila, bi-partisanship!

Finally, in music to the ears of those who thought he has no soul or fight in him,

“We cannot have another year-long debate about this. So the question that I'm going to ask myself and I ask of all of you is, is there enough serious effort that in a month's time or a few weeks' time or six weeks' time we could actually resolve something?

And if we can't, then I think we've got to go ahead and some make decisions, and then that's what elections are for. We have honest disagreements about -- about the vision for the country and we'll go ahead and test those out over the next several months till November. All right?”

Yes, Mr. President, that’s all right.