Public Opinion on Health Care Reform

My article with Daniel and Yair has recently appeared in The Forum:

We use multilevel modeling to estimate support for health-care reform by age, income, and state. Opposition to reform is concentrated among higher-income voters and those over 65. Attitudes do not vary much by state. Unfortunately, our poll data only go to 2004, but we suspect that much can be learned from the relative positions of different demographic groups and different states, despite swings in national opinion. We speculate on the political implications of these findings.

The article features some pretty graphs that originally appeared on the blog.

It’s in a special issue on health care politics that has several interesting articles, among which I’d like to single out this one by Bob Shapiro and Lawrence Jacobs entitled, “Simulating Representation: Elite Mobilization and Political Power in Health Care Reform”:

The public’s core policy preferences have, for some time, favored expanding access to health insurance, regulating private insurers to ensure reliable coverage, and increasing certain taxes to pay for these programs. Yet the intensely divisive debate over reform generated several notable gaps between proposed policies and public opinion for two reasons.

First, Democratic policymakers and their supporters pushed for certain specific means for pursuing these broad policy goals–namely, mandates on individuals to obtain health insurance coverage and the imposition of an excise tax on high-end health insurance plans–that the public opposed. Second, core public support for reform flipped into majority opposition in reaction to carefully crafted messages aimed at frightening Americans and especially by partisan polarization that cued Republican voters into opposition while they unnerved independents.

The result, say Shapiro and Jacobs, “suggests a critical change in American democracy, originating in transformations at the elite level and involving, specifically, increased incentives to attempt to move the public in the direction of policy goals favored by elites policies and to rally their partisan base, rather than to respond to public wishes.” They’ve written a fascinating and important paper.

1 thought on “Public Opinion on Health Care Reform

  1. I get the impression that the health care reform deal was essentially an exercise in game theory, the government's opponent being special interest groups. The administration's objective was to logroll until the threat of attack ads could be removed.

    If anything, the administration probably feels victorious, as they changed the status quo, which (witness Social Security and Medicare) is very hard to revert. So, future reform becomes a more achievable goal (and a move towards support of public opinion/preferences).

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