Polling and the public option


Opinion polls asking whether Americans want healthcare reform to include a "public option"--a government-run scheme to compete alongside private insurers--are all over the place. One shows support as low as 35%. Most seem to put it at 50% or higher. One says 83% are either strongly or somewhat in favour.

Majority support for the public option seems difficult to reconcile with what seems to be somewhat weaker support for the health bills in Congress that include the option. Are there really that many Democrats who would prefer no change at all to a reform stripped of the public plan? Well, maybe there are.

Nate Silver at fivethirtyeight.com has two good posts on the subject. One points out that most people don't know what the public option is. The other blames the variation in responses in part to subtle differences in the way the questions are put. Questions that clearly say "option"--underlining that people who like their existing arrangements can keep them--elicit stronger support. Putting the question that way gets a more accurate answer, he says. One poll, Quinnipiac, follows all his advice on framing the question and measures support at 62 percent:

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

I wonder. If you are offered a choice between (a) X, and (b) your choice of X or Y, what's not to like about (b)? One possibility, of course, is that you would worry about having to pay for Y (through taxes) even if you didn't choose it. Aside from that, if Y was even eligible for consideration, you would only prefer (a) if you believed that (b) was not really what it claimed to be, that Y might impair X in some way.

If every respondent was mindful of the effect the public option might have on their taxes and on their existing insurance, either positive or negative, that 62% support would be real. The question is, are they? How many of that 62% are thinking, "Well, if you are telling me I can keep my present policy on the present terms, fine", when it may turn out that this premise is false. In other words, is "option" really a cleaner term for this purpose than "plan to compete alongside"? If at the outset you are an individual buyer on the regulated exchange, yes: you would have the choice. If you have employer-provided insurance that your employer subsequently decides to drop, you would feel differently. For good or ill, the public option would affect private insurance--that is the whole idea, after all. I'm not sure the Quinnipiac question states the alternatives as plainly as it seems to.

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