Are health system reform polls meaningful?

Washington -- The American public can't be counted on for informed opinions about complicated health care issues, and poll results can vary dramatically based on how questions are asked. That's the consensus of a panel of public opinion experts meeting at an Oct. 23 forum convened by the Alliance for Health Reform.

Some public opinion on health system reform has been fairly consistent, said Mollyann Brodie, PhD, director of Public Opinion and Survey Research at the Kaiser Family Foundation. Since October 2008, monthly tracking polls have found a majority of Americans say now is the time to tackle health reform. Also, since the 1930s, more than 80% of Americans have said they believe the federal government has a strong role to play in health care, said Karlyn Bowman, a senior fellow at the American Enterprise Institute.

Some questions are more likely to get supportive answers, panelists said. For example, Americans react warmly to questions about providing health options, choices or competition, Bowman said. "Americans like having choices, especially in the abstract." But if pollsters tell people a health program would be administered by the federal government, those still in support become the minority.

"When we throw concepts to people to evaluate, they react to the words," said Mark Blumenthal, editor and publisher of Pollster.com, which critiques polls and publishes their results.

Americans are also lukewarm to proposals that would require them to pay more for health care, Brodie said. "They don't understand what's driving health care costs. They think it's fraud, waste, abuse and profits," she said. "What we have found is that the public is willing to ask others to pay."

Health care pollsters usually ask questions about personal health care experiences or about policy proposals, Blumenthal said. The policy questions could produce unreliable results if they introduce new concepts to the respondent, such as an individual health insurance mandate. "Those things are distant from most Americans. They're not familiar with the details," he said.

On the other hand, Americans' interactions with and knowledge of health care can be intensely personal and emotional, Blumenthal said. "Our experiences with the health care system are most vivid when our children are born, when our parents or loved ones pass away," he said. "It's about our greatest fears and most fond hopes."

Public opinion on hypothetical questions in general are notoriously unreliable, Bowman said. For example, polls conducted from 1984 to 2005 showed strong support for privatizing Social Security, but President Bush's 2005 proposal to do so flopped. Public support for the Medicare prescription drug program also sank after Congress adopted Part D but has since rebounded, Blumenthal said.

"It's really too early to tell where the public will ultimately come out on health reform," Brodie said.

Although 66% of Americans support requiring individuals to have health insurance -- a feature of the current House and Senate bills -- 73% would oppose such a mandate if it forced some people to buy expensive health plans or coverage they don't want, according to the Kaiser health tracking poll released in October. Likewise, 71% of those who oppose an insurance mandate would change their minds if the lack of a mandate meant insurance companies could still deny coverage to the sick.

"What this implies is whatever side ... gets their message to break through and become the real perception of Americans -- that's who's likely going to win," Brodie said.

Americans aren't watching members of Congress debate health system reform minute-by-minute, Blumenthal said. "They're getting a very broad sense."

When policy issues are complicated, poll results may bring more confusion than information, said Humphrey Taylor, chair of the Harris Poll, conducted by the research organization Harris Interactive. "And health care reform is fiendishly complicated."

Individual Americans can manage to hold contradictory opinions on health care, Taylor said. Many people don't want cuts to Medicare, Social Security or defense spending, but they also don't want to increase the national debt. "This is an example of an area where leaders should lead and not try to follow public opinion."