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RealClearPolitics HorseRaceBlog

By Jay Cost

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Does the Public Want a Public Option?

Progressives in the blogosphere and the halls of Congress are pushing for the so-called "public option." One of their major arguments is that the public wants it.

But does it?

From a certain perspective, the public option polls very well. Let's look at some of the polls on this in the current RCP average of Obama's job approval, being careful to note question wording.

Here's ABC News/Washington Post:

ABC News:WaPo.jpg

Here's Marist:


Here's CBS News/New York Times:

CBS News.jpg

Here's CNN:


Case closed, right?

Not exactly.

In the aggregate, the polls present a very mixed picture. These numbers are good for reform efforts, but other numbers are bad. For instance:

-Respondents don't generally approve of the reform bills. In some polls, a majority disapproves.

- Respondents give mixed marks to Obama for his handling of the issue.

-Respondents strongly disapprove of the job Congress is doing with health care.

-Only a small portion of respondents believes they will actually be helped by the health care reform proposals.

-All in all, since the health care debate really heated up in July, Obama's job approval has dropped in the RCP Average from about 59% to 52%. His disapproval rating has gone from about 34% to 43%

How can we reconcile these gloomy numbers with the sunny results on the public option?

It might be due to the public's lack of information. I'm sure that the average polling respondent is paying some attention to the health care debate, but she is paying much less attention than political junkies. This will limit the amount of information she actually has in her mental filing cabinet. So, the crucial question is: even if she has absorbed some pro- and anti-reform arguments, does she have enough information to relate them to specific reform proposals? Color me skeptical on that one. I think your average respondent - even with some general opinions on reform - will have a hard time using those broad considerations to evaluate items like the individual mandate, guaranteed issue, community rating, and...wait for it!...the public option.

So, asking about specific proposals might be taking the conversation too far into the woods for the average respondent - and she is going to have a hard time recalling a relevant piece of information upon which to base a response. Instead, she might use the question itself as a basis for her answer. It follows that the information or perspective given in the question could make her more or less partial to the proposal under consideration.

And the pollsters are frequently providing information that is partial to the Democratic side of the ledger. As Kellyanne Conway argues:

Asking an under-informed public in a poll about "public option" is incomplete. It calls for a response to feel-good phraseology rather than a probing of underlying ideology. "Public option" in health care is not so different from "campaign finance reform," "Violence Against Women's Act," "revenue enhancements" or for that matter, "world peace' and "no rain this Saturday."

The pollsters are using plenty of "feel-good phraseology." ABC News/WaPo presents the idea that the government insurance plan would "compete" with private insurance plans. This is a contested notion, as Republicans think that the public option will drive private insurance away.

Marist uses the phrase "public option," which has become the conventional term for this insurance reform - but is nevertheless an intentionally constructed phrase designed to garner maximum public support. "Government-run health care" is foreboding, but "public option" is inviting.

CNN uses the phrases "public health insurance option" and "compete."

CBS News/NY Times specifically relates the public option to Medicare, a program that is so popular that Democrats are now thinking about reframing their pitch for the public option as merely an extension of Medicare to all. I wonder if they got that idea from CBS News/NY Times!

If the theory that question wording is playing a role is correct, then altering the wording should induce a change in the results. So, what happens when information less partial to the Democratic side is introduced? To start answering this question, let's consider the Gallup results, which are decidedly less bullish on the public option:


Like ABC News/WaPo, Gallup uses the Democratic buzzword "compete." However, Gallup also uses a Republican buzzword: "government-run." This is opposed to the weaker formulation - "government administered" - offered by CBS News/New York Times and CNN. With this more balanced choice of words, Gallup finds a roughly even split. I would not call this definitive evidence, but it suggests that we might be on the right track.

Let's take a look at Rasmussen. He has offered a series of really interesting questions on health care. First, he gives a basic version of the question that ABC News/WaPo, CBS News/NY Times, Marist, and CNN asked:

Would you favor or oppose the creation of a government-sponsored non-profit health insurance option that people could choose instead of a private health insurance plan?

That gets strong approval, as per usual when people hear words like "choose," "compete," and "option."

Then Rasmussen asks this follow up:

Suppose that the creation of a government-sponsored non-profit health insurance option encouraged companies to drop private health insurance coverage for their workers. Workers would then be covered by the government option. Would you favor or oppose the creation of a government-sponsored non-profit health insurance option if it encouraged companies to drop private health insurance coverage for their workers?

What happens when this Republican argument is substituted for the Democratic argument? Support for the public option plummets dramatically. Nearly 3/5ths of all respondents voiced opposition to the public option when it was phrased in this way.

Additionally, Rasmussen asked whether respondents thought the public option would save taxpayers money (they didn't), whether they thought it would offer better health insurance than private insurance (again, no), and whether people preferred to have a public option or a guarantee that nobody will lose their current coverage (the guarantee won in a landslide).

These results are very consequential. After all, Rasmussen is holding a lot of factors constant, enabling us to observe: same poll + same methodology + different frame for the question = different answer. That strongly suggests that the frame used for the public option question goes a long way in determining the answer the public gives.

So, does this mean that the public is actually against the public option? I'd say no. Instead, I would suggest that the public lacks sufficient information about that specific item to deliver a firm opinion. Accordingly, its opinion varies depending upon question wording, priming effects, the ebbs and flows of the news cycle, and so on.

-Jay Cost