By Kip Sullivan, JD

The New York Times reported on Saturday, October 17, that Sen. Ron Wyden (D-OR) is warning his constituents that the “public option” is not going to be available to the great majority of Americans. No one who has actually read the Senate health committee’s “reform” bill or the House “reform” bill (HR 3200) disputes this. According to the Congressional Budget Office, the “option” will be available only to about 30 million people, or about one American in ten. As the Times put it (slightly inaccurately), the “option” in the Democrats’ legislation “would be out of bounds to the approximately 160 million people already covered through employers.”

Does the public understand this? According to Wyden, they don’t. Wyden says his constituents are shocked when they are told the “option” will not be available to the vast majority of Americans. When he began informing his constituents about this truth last summer, “They nearly fell out of the bleachers,” he said (“And the public option is….,” New York Times, October 17, 2009, A10).

Democrats and “option” advocates should pay attention to Wyden’s observation. Wyden is saying, in so many words, that “option” advocates, with help from the media and the blogosphere, have fooled the public into thinking everyone will be eligible to buy insurance from the “option,” and when the public finds out this isn’t true, they’re not going to be happy.

I was not surprised by Wyden’s observation. I have written several papers warning the public that they have been the object of a “bait and switch” campaign by the leadership of the “option” movement. The “bait” in this campaign was the original version of the “option” promoted by Jacob Hacker. This version would have created an enormous public program that would have insured half the non-elderly population. Among several provisions of this first version of the “option” that would have ensured large size was one that said the “option” had to be available to all non-elderly Americans. The “switch” occurred when Democrats on the Senate Health, Education, Labor and Pensions (HELP) Committee and three chairmen of House committees drafted legislation that would create a very small and weak “option.” One of the provisions in the Democrats’ legislation that ensured their version of the “option” would be weak was a provision limiting subsidies and eligibility for the “option” to a small fraction of the population, namely, the uninsured and employees of small firms.

After reading Wyden’s warning, I examined over 50 polls to see if any pollsters had bothered to investigate the issue Wyden is raising. It would be interesting, I thought, to see if (a) pollsters had allowed themselves to be fooled by the bait-and-switch campaign for the “option” and (b), to the extent that they hadn’t been fooled, what did they find out about how badly the average American had been fooled?

I discovered that the nation’s best known polling firms have allowed themselves to be fooled. Pollsters are asking the public the wrong question. They are asking the public to comment on Hacker’s original version of the “option” (the “bait”), not the actual “option” proposed in the Senate HELP Committee bill and HR 3200. Not surprisingly, the polls tell us very little about whether the public thinks the “option” will be available to everyone or to just a small minority.

Pollsters are asking about the “bait,” not the actual “option”

Pollingreport.com is a widely used source of polling data. I don’t know how they select the polling firms they report on, but I do know many of the most recognizable polling firms appear on their website. On October 17, I visited their website, clicked on their “health policy” section, and read every one of the 52 polls listed for the period June 1 to October 8. I selected June 1 as my beginning date because congressional Democrats did not publish drafts of their bills until mid-June. October 8 was the date of the latest poll listed on Pollingreport.com as of October 17.

Twenty-three of these 52 polls asked a question related to the “option.” (In a few days, I’ll post a listing of these polls and the questions they posed in an appendix). Of these 23 polls, the questions in one of them conveyed no information about who would be eligible to participate in the “option.” The remaining 22 polls all posed questions that stated explicitly or implicitly that all Americans would be eligible to participate in the “option.” One of these 22 polls asked a follow-up question (it was a follow-up to a question asserting that the “option” would be universally available) that informed respondents that the “option” might turn out to be available to only a small fraction of the populace. None of the other polls gave so much as a hint that the “option” would be available to only a small fraction of the population.

Three of the 22 polls that conveyed some information about who would be eligible to participate in the “option” explicitly stated the “option” would be available to everyone.* For example, the September 17-20 NBC/Wall Street Journal poll asked: “Would you favor or oppose the government offering everyone a government-administered health insurance plan – something like the Medicare coverage that people 65 and older get – that would compete with private health insurance plans?” (emphasis added)

The remaining 19 polls (of the 22 that conveyed information about who could participate in the “option”) used language that would lead most readers to infer the “option” would be offered to everyone. The most common method used by these 19 polls was to state (1) the “option” would be (2) “like Medicare” and would (3) “compete” with the insurance industry. Referring to the public program as “an option” without qualification implies the program will be universally available. Comparing the program to Medicare (a program that is available to almost the entire elderly population) also implies universality. And depicting the program as a competitor with the “insurance industry” or “health insurance companies” also connotes universality. Any one of these three features – employing the word “option,” comparing the “option” to Medicare, and depicting the “option” as competing with the entire insurance industry – is sufficient to mislead the average reader into thinking the proposed “option” is going to be available to everyone. The appearance of all three features in a single question virtually guarantees that outcome.

The September 12-18 Kaiser Tracking Poll illustrates this method of misleading readers. The poll asked respondents if they favored or opposed: “Creating a government-administered public health insurance option similar to Medicare to compete with private health insurance plans.” The average reader could be expected to infer from this question that all non-elderly Americans would have the choice of enrolling with the “option.”

Sometimes polls used only two of the three deceptive phrases. For example, the question posed by the June 23-29 Quinnipiac University Poll asked, “Some people say that giving people the option of being covered by a government insurance plan will keep private insurance companies honest. Do you agree or disagree?” Here, two features – saying “people” will have access to an “option,” and referring without qualification to the entire insurance industry – are misleading.

Only one poll – the one conducted by ABC and the Washington Post between September 10 and 12 – bothered to ask how respondents felt about the “option” actually being proposed by the Senate HELP Committee bill and HR 3200. And this question came only after the poll had asked a question implying the “option” might be available to everyone. Here are the two questions:

“Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans?”
Support: 55%
Oppose:42%
Unsure: 3%

If oppose/unsure: “What if this government-sponsored plan was available only to people who cannot get health insurance from a private insurer? In that case, would you support or oppose it?”
Support: 21%
Oppose: 24%

The fact that the authors of this poll felt it necessary to ask a separate question about a version of the “option” limited to the uninsured indicates they understood that their first question implied an “option” available to all. The first question doesn’t say explicitly that the “option” will be universally available, but it conveys that impression with just one of the three deceptive features commonly used by the polls examined here. It doesn’t use the word “option,” and it doesn’t compare the “option” to Medicare; it merely depicts the “option” as competing with the entire insurance industry. In my opinion, that device alone is sufficient to connote universality. By asking the follow-up question, the authors of this poll indicate they agree with me.

What can we learn from these polls?

Of the 23 polls that posed a question about the “option,” only the ABC/Washington Post poll I just discussed could be said to be accurate, and even that is a questionable statement. To put this the other way around, at least 22 of the 23 polls I examined failed to convey accurate information about the actual “option” under consideration by Congress. It is impossible, therefore, to reach any conclusions about how the public feels about that “option.” Because 21 of the 22 polls that conveyed some information about the “option” asked questions exclusively about a version of the “option” that resembles the one Jacob Hacker originally proposed, we can only draw conclusions about that version. The one tentative conclusion we can draw is that the public appears to support the original Hacker version of the “option” – the large, Medicare-like public program. We must consider this conclusion tentative because the campaign for the “option” has been so deceptive and vague, and because the polls made no effort to undo the deception or compensate for the vagueness.

With one exception, the polls that sought to measure public support for the “option” found majority support. The one exception was a poll conducted for Fox News between July 21 and 22. That poll found 44 percent in support of the “option” and 48 percent opposed. An examination of the wording of that poll does not indicate why Fox came up with such a low estimate of public support. Among the other polls, support ranged from 52 to 76 percent. My eyeball analysis of these results suggests support did not decline over the summer as criticism of the “option” and the Democrats’ plans escalated.

It is impossible to say with any confidence whether the support reported by these polls is strong or weak. I found only one poll that offered useful information on that issue. The poll – the ABC/Washington Post poll quoted above – found that the public’s support for the “option” (the original version, not the actual one) is somewhat wide but very shallow. After posing the question I quoted above and finding a 55-percent support level, the poll asked:

“Say health care reform does NOT include the option of a government-sponsored health plan. In that case would you support or oppose the rest of the proposed changes to the health care system being developed by Congress and the Obama administration?”

Fifty percent said yes to this question. In other words, only 5 percent of respondents felt the “option” was essential to effective reform. However, we should take into consideration how vague and inept the bait-and-switch campaign for the “option” has been. A more skillful campaign for a huge public program, as opposed to the know-nothing, deceptive campaign waged on behalf of the mouse version of the “option,” might have created more enthusiasm for the “option.”

Reporters and pollsters need to do their homework

In previous essays about the “option” I have called on the leaders of the “option” movement to notify their followers and the public that Congress is not talking about the original Hacker version of the “option.” That plea has fallen on deaf ears. I will not repeat it here.

I would, however, like to urge polling firms, reporters and bloggers to report on the deception being practiced by the leadership of the “option” movement or, at minimum, to stop participating in that deception by repeating the myth that “poll after poll” shows Americans want the “public option” being discussed in Congress. If pollsters, reporters and bloggers had refused to go along with the “option” campaign’s bait-and-switch tactic, the tactic would not have worked. But they did go along with it, and the tactic appears to be working. The vast majority of Americans, even Americans who attempt to stay abreast of the health care reform issue, appear to be under the impression that the “option” will be available to the entire non-elderly population (or at least to that portion without access to a non-Medicare government program such as Medicaid).

This illusion cannot, of course, last forever. But the longer it goes on, the worse the backlash will be when Americans are finally disabused of the illusion. If they are “falling out of the bleachers” now (to quote Sen. Wyden) when they learn how few Americans will be able to participate in the “option, how are they going to feel when Republicans and the lazy media start telling them, say, next January? Americans need accurate information about the actual “option” under consideration in Congress, and they need it now. If Health Care for America Now and other “option” advocates won’t provide that information, pollsters, reporters, and bloggers should. But with woefully few exceptions, pollsters, reporters and bloggers are selling the notion that the “option” will be universally available.

Pollsters, reporters and bloggers are also selling the unproven claim that the public supports the “option” described in the Democrats’ legislation. Pollster Celinda Lake, who actively participated in the bait-and-switch campaign for the “option,” was quoted recently saying, “Poll after poll shows that large majorities of Americans support reform that offers a choice of a public health insurance plan or private insurance.” To take another example, in an interview on October 15 Tamryn Hall of MSNBC asked Sen. Mary Landrieu (D-LA), “Do you believe in the polling data that says that the American people want a public option?”

Lake’s statement and Hall’s question were not demonstrably false (it’s possible a majority of Americans support the mousey version of the “option” called for in the Democrats’ legislation), but they sure were misleading. The fact is we simply don’t know what the public thinks of the moribund little “option” proposed by the Democrats. Perhaps someday we will. Perhaps someday pollsters will get around to asking accurate questions about the real “option” – questions that do not suggest the “option” will be available to all and do not suggest that it will resemble Medicare.

Kip Sullivan, JD is a member of the Steering Committee of the Minnesota Chapter of Physicians for a National Health Program.

* An earlier version of this post erroneously stated four of 22 polls explicitly stated that the “public option” would be available to everyone.


Appendix: Excerpts from 23 polls from Pollingreport.com conducted between June 1, 2009 and October 8, 2009 that posed questions about the “public option”

==

CBS News Poll. Oct. 5-8, 2009

“Would you favor or oppose the government offering everyone a government-administered health insurance plan — something like the Medicare coverage that people 65 and older get — that would compete with private health insurance plans?”

Favor

Oppose

Unsure

%

%

%

10/5-8/09

62

31

7

9/19-23/09

65

26

9

8/27-31/09

60

34

6

7/24-28/09

66

27

7

7/9-12/09

64

29

7

6/12-16/09

72

20

8

==

Ipsos/McClatchy Poll conducted by Ipsos Public Affairs. Oct. 1-5, 2009

“One of the points being debated is whether or not the government should create a public health insurance plan as an alternative to private insurance plans. Which of the following is closest to your opinion? It is necessary to create a public health insurance plan to make sure that all Americans have access to quality health care. Access to quality health care for all Americans can be achieved without having to create a public health insurance plan.”

Public Plan

Is Necessary

Public Plan Is

Not Necessary

Unsure

%

%

%

10/1-5/09

53

42

5

8/27-31/09

49

46

5

7/9-13/09

52

44

4

==

Quinnipiac University Poll. Sept. 29-Oct. 5, 2009

“Do you support or oppose giving people the option of being covered by a government health insurance plan that would compete with private plans?”

Support

Oppose

Unsure

%

%

%

9/29 – 10/5/09

61

34

6

7/27 – 8/3/09

62

32

6

6/23-29/09

69

26

5

==

Pew Research Center Poll. Sept. 30-Oct. 4, 2009

“Now I’d like to ask you about some of the specific proposals being considered to address health care. Would you favor or oppose [see below]?”

Favor

Oppose

Unsure

%

%

%

“Requiring that all Americans have health insurance, with the government providing financial help for those who can’t afford it”
9/30 – 10/4/09

66

30

4

7/22-26/09

65

29

6

“A government health insurance plan to compete with private health insurance plans”
9/30 – 10/4/09

55

38

8

7/22-26/09

52

37

10

==

CBS News/New York Times Poll. Sept. 19-23, 2009

“What if changes to the health care system do not include the option of a government-administered health insurance plan? In that case, would you favor or oppose the changes under consideration?”

Favor

Oppose

Unsure

%

%

%

9/19-23/09

38

40

22

==

NBC News/Wall Street Journal Poll conducted by the polling organizations of Peter Hart (D) and Bill McInturff (R). Sept. 17-20, 2009

“Would you favor or oppose the government offering everyone a government-administered health insurance plan — something like the Medicare coverage that people 65 and older get  — that would compete with private health insurance plans?”

Favor

Oppose

Unsure

%

%

%

10/5-8/09

62

31

7

9/19-23/09

65

26

9

8/27-31/09

60

34

6

7/24-28/09

66

27

7

7/9-12/09

64

29

7

6/12-16/09

72

20

8

==

Kaiser Family Foundation Kaiser Health Tracking Poll. Sept. 11-18, 2009

“Now I’m going to read you some different ways to increase the number of Americans covered by health insurance. As I read each one, please tell me whether you would favor it or oppose it. Here’s the (first/next) one: [See below.] Do you favor or oppose this?”

Favor

Oppose

Unsure

%

%

%

“Requiring all Americans to have health insurance, either from their employer or from another source, with financial help for those who can’t afford it”
9/11-18/09

68

29

3

“Creating a government-administered public health insurance option similar to Medicare to compete with private health insurance plans” N=649 (Form A)
9/11-18/09

57

37

6

==

ABC News/Wash Post poll Sept 10-12

“Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans?”

Support                                Oppose                                Unsure

9/10-12/09          55                           42                           3

If oppose/unsure: “What if this government-sponsored plan was available only to people who cannot get health insurance from a private insurer? In that case, would you support or oppose it?”

9/10-12/09 Support: 21%              Oppose: 24%

“Say health care reform does NOT include the option of a government –sponsored health plan. In that case would you support or oppose the rest of the proposed changes to the health care system being developed by congress and the Obama administration?”

9/10-12/09 Support: 50%              Oppose: 42%     Unsure: 8%

==

CBS News Poll. Sept. 10, 2009

“Would you favor or oppose the government offering everyone a government administered health insurance plan — something like the Medicare coverage that people 65 and older get — that would compete with private health insurance plans?”

Favor

Oppose

Unsure

%

%

%

ALL

68

27

5

Speech watchers

70

25

5

8/27-31/09

57

35

8

==

CNN/Opinion Research Corporation Poll. Aug. 28-31, 2009

“Now thinking specifically about the health insurance plans available to most Americans, would you favor or oppose creating a public health insurance option administered by the federal government that would compete with plans offered by private health insurance companies?”

.

Favor

Oppose

Unsure

%

%

%

8/28-31/09

55

41

4

==

CBS News Poll. Aug. 27-31, 2009

“Would you favor or oppose the government offering everyone a government-administered health insurance plan that would compete with private health insurance plans?” N=540 (Form B)

.

Favor

Oppose

Unsure

%

%

%

8/27-31/09

53

36

11

==

NBC News Poll conducted by the polling organizations of Peter Hart (D) and Bill McInturff (R). Aug. 15-17, 2009

“Please tell me which ONE statement you agree with more on the issue of creating a new public health plan administered by the federal government.

“Some/Other people say it would help lower health care costs because it would compete with private health plans. This new public plan would provide coverage for the uninsured and all Americans would have an option for quality affordable health care.

“Some/Other people say that patients might not always have access to their choice of doctors and the government would lower costs by limiting medical treatment options and decisions that should be made instead by patients and doctors.” Options rotated

.

Lower costs,

Care for all

Limit access,

Limit options

Unsure

%

%

%

8/15-17/09

45

48

7

7/24-27/09

41

52

7

6/12-15/09

47

42

11

==

Kaiser Family Foundation Kaiser Health Tracking Poll. Aug. 4-11, 2009.

“Now I’m going to read you some different ways to increase the number of Americans covered by health insurance. As I read each one, please tell me whether you would favor it or oppose it. Here’s the (first/next) one: [See below.] Do you favor or oppose this?”

.

Favor

Oppose

Unsure

.

%

%

%

.

.

“Creating a government-administered public health insurance option similar to Medicare to compete with private health insurance plans”
8/4-11/09

59

38

3

.

7/7-14/09

59

36

5

.

4/2-8/09

67

29

4

==

Quinnipiac University Poll. July 27-Aug. 3, 2009

“Do you support or oppose giving people the option of being covered by a government health insurance plan that would compete with private plans?”

.

Support

Oppose

Unsure

%

%

%

7/27 – 8/3/09

62

32

6

Republicans

40

56

4

Democrats

80

13

7

Independents

64

30

6

.

6/23-29/09

69

26

5

Republicans

50

44

6

Democrats

86

10

4

Independents

66

29

5

“Would you rather purchase health insurance from a private sector company or from a government program?”

.

Private

Sector

Government

Program

Unsure

%

%

%

7/27 – 8/3/09

61

25

14

6/23-29/09

53

28

19

“Would you favor or oppose a health care bill that provides for the following? . . .”

.

Favor

Oppose

Unsure

%

%

%

“Creates a government-sponsored public health insurance option to compete with private health insurance plans.”
7/27-28/09

56

36

8

==

Time Poll conducted by Abt SRBI. July 27-28, 2009

“Would you favor or oppose a health care bill that provides for the following? . . .”

.

Favor

Oppose

Unsure

%

%

%

“Creates a government-sponsored public health insurance option to compete with private health insurance plans.”
7/27-28/09

56

36

8

==

National Public Radio Poll conducted by Public Opinion Strategies (R) and Greenberg Quinlan Rosner Research (D)

[Vague mention of PO buried in long description of alleged Dem. and Repub. plans]

==

FOX News/Opinion Dynamics Poll. July 21-22, 2009

“Do you favor or oppose the creation of a government-run health insurance plan that would compete in the market place against private insurance plans?”

.

Favor

Oppose

Unsure

%

%

%

7/21-22/09

44

48

7

==

ABC News/Washington Post Poll. July 15-18, 2009

“Thinking about health care, one proposal to insure nearly everyone would require all Americans to have health insurance or pay a penalty on their income tax, excluding those with lower incomes. It would require most employers to offer health coverage or pay a fee. There would be a government-run plan to compete with private insurers. And income taxes on people earning more than 280 thousand dollars a year would be raised to help fund the program. Taken together, would you support or oppose this plan? … Do you feel that way strongly or somewhat?”

.

Strongly

Support

Somewhat

Support

Somewhat

Oppose

Strongly

Oppose

Unsure

%

%

%

%

%

7/15-18/09

32

23

10

33

3

==

Ipsos/McClatchy Poll conducted by Ipsos Public Affairs. July 9-13, 2009

“Compared with current private health insurance plans, do you think a public health insurance plan would provide higher quality care, lower quality care, or would not make any difference?” Half sample, Form A

.

Higher

Quality Care

Lower

Quality Care

No

Difference

Unsure

%

%

%

%

7/9-13/09

21

40

36

2

.

“For you and your family, do you think a public health insurance plan would make the overall cost of health care more affordable than it is today, less affordable than it is today, or would not make any difference?” Half sample, Form B

.

More

Affordable

Less

Affordable

No

Difference

Unsure

%

%

%

%

7/9-13/09

38

27

31

4

==

CBS News Poll. July 9-12, 2009

“Suppose the federal government offered a public health care plan that anyone could join at any age. What would you probably do? 1. I’d definitely join the plan. 2. I’d probably consider the plan, and compare it against my private insurance options. 3. I’d probably consider the plan only if I had no other insurance options. OR, 4. I’d probably never join the plan.”

.

Definitely

Join

Compare

Against Private

Options

Consider Only

If No Other

Options

Probably

Never Join

Unsure

%

%

%

%

%

7/9-12/09

12

43

31

11

3


==

Quinnipiac University Poll. June 23-29, 2009

“Some people say that giving people the option of being covered by a government insurance plan will keep private insurance companies honest. Do you agree or disagree?”

.

Agree

Disagree

Unsure

%

%

%

6/23-29/09

52

42

6

.

“Some people say that giving people the option of being covered by a government insurance plan would ultimately lead to the end of private health insurance and the government would end up running the health care system. Do you agree or disagree?”

.

Agree

Disagree

Unsure

%

%

%

6/23-29/09

46

49

6

==

ABC News/Washington Post Poll. June 18-21, 2009

“Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans?” If support: “Would you rather have that plan run by a government agency, or run by an independent organization with government funding and oversight?”

.

Support:

Government

Agency

Support:

Independent

Organization

Oppose

Unsure

%

%

%

%

6/18-21/09

21

41

33

5

.

Asked of those who support a new government-created health insurance plan:

“What if having the government create a new health insurance plan made many private health insurers go out of business because they could not compete? In that case would you support or oppose creating a government-run health insurance plan?”

Support

Oppose

Unsure

%

%

%

6/18-21/09

56

41

3

==

NBC News/Wall Street Journal Poll conducted by the polling organizations of Peter Hart (D) and Bill McInturff (R). June 12-15, 2009

“In any health care proposal, how important do you feel it is to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance: extremely important, quite important, not that important, or not at all important?”

.

Extremely

Important

Quite

Important

Not That

Important

Not at All

Important

Unsure

%

%

%

%

%

6/12-15/09

41

35

12

8

4

==