Health care: high profile issue

A DEMOCRATIC PERSPECTIVE

The ceremonial first pitch thrown by President Clinton in the Cleveland Indian's new ballpark to kick-off the '94 baseball season also coincides with the start of the congressional debate on his health care reform plan.

During the past six months since he unveiled his proposal, it has not been smooth sailing for the President (with opposition to his plan almost doubling in national polls during that time). But in politics, as it certainly is in baseball, the games in spring training don't count for much.

Granted, the campaign against the Clinton plan by its critics has been effective, but the debate on health care reform has a long way to go before the American public judges the winners. Both Democrats (for reassurance) and Republicans (a word of caution) need to understand the following broad principles:

1. Don't mistake the public's attitude toward the Clinton plan as reflecting their views on the necessity of health care reform. Thirty-nine percent of Americans say there is a health care crisis, while another 55 percent characterize the situation as a problem (Time/CNN). Americans might be satisfied with their own coverage, but they also recognize that the health care system needs major repairs.

2. Attitudes toward the Clinton plan are extremely tenuous because the public has little notion of its contents. Just 19 percent of Americans say they have a good understanding of the issues being discussed in the health care reform debate (NBC News/Wall Street Journal); other survey data shows knowledge of the Clinton plan to be similarly low. In other words, the American public is more confused than opposed to the Clinton health care plan.

3. The Clinton Administration and congressional Democrats must do a better job of selling their plan. The President's critics have used the existing information vacuum to their advantage. But the corresponding opportunity also exists for the Administration to shape the health care debate, since the voters are constantly rethinking their opinions.

The Democratic message must have both offensive and defensive points. One component of the former should be the actual costs of doing nothing to reform the current system. With regard to the latter, the Administration must provide reassurance to the public on the issues of quality, choice and cost.

4. The overarching message for the Administration and Democrats is simple and straightforward: change versus the status quo. The Republican opposition has stumbled its way through the health care debate -- at one point denying the mere existence of a health care crisis -- and are saddled with the perception of being naysayers on this issue. While Clinton's plan receives mixed grades from the public, he enjoys strong credibility for his efforts to bring about health care reform.

Perceptions of Whether Selected Groups are Helping/Hurting Health Care Efforts

                                  Helping      Hurting

Clinton Administration            61%          33%
Republicans in Congress           34           48
American Medical Association      34           52
Health insurers                   26           63

Democrats must move the health care debate to where they hold the advantage: making needed reforms in the system. We can win with the following equation: Clinton/Democrats = reform; Republicans = status quo.

5. Universal coverage is the voters' bottom line. The only question is one of timing. When asked to volunteer in an open-ended question, the most important things they would like to see included in any health care reform bill that is passed, the single-most mentioned item by far is universal health coverage (NBC News/Wall Street Journal). While the timetable of implementation is an open question, the President should stand firm on the overall principle, but can be flexible on timing and cost.

6. Cost controls are important. For most Americans, their greatest concern is the rising cost of health care more than accessibility.

7. Finally, Democrats are likely to receive much of the credit for any health care bill that passes this fall. Because the public has little knowledge of the specifics of the Clinton plan, they perceive that it is the only one out there. Three in five (62 percent) voters say that there are no health reform plans in Congress that are better than the President's (Time/CNN). While the debate on health care has been fast and furious, the jury is still out. Democrats still have an opportunity to shape the debate on their terms.

A REPUBLICAN PERSPECTIVE

In the midst of their pell-mell rush to lead the American people to the land of health care reform, the Democrats looked back and realized that the people are not following. Once expected to be "radical," health care reform now appears likely to be "incremental." Thus, the only value of the much ballyhooed task force -- besides allowing Hillary Rodham Clinton to short-sell pharmaceutical stocks -- was to waste precious political time.

The Republicans have always had a problem with the health care "vision thing" -- we have not been willing to position ourselves for significant change. However, the GOP has specific ideas. The Democrats have scored strongly with the message that they are the "agents of change". Now, though, public opinion is suggesting that the concern has shifted from "radical change" to "it's the specifics, stupid."

Republicans lose the argument over whether or not there is a crisis. However, Democrats lose the argument on just what needs to be done.

In the volatile world of health care polling, there is one consistent finding: people are generally satisfied with the quality of care they receive (73 percent) and with their health insurance coverage/benefits (80 percent). That, coupled with an increasing concern about other issues (crime) and a slight fading of health care as an issue, has resulted in a sense of caution among the electorate about the pace of any proposed changes in the health care system. A majority (57 percent) in a recent national survey said it would be "better to phase in changes over time", rather than "effect changes as quickly as possible" (37 percent).

Much has been made over the Clinton plan "crossing the line" from a plurality support level to a plurality oppose level. More important, the strongest opponents of the plan are those who say they are "very familiar" with it. This finding undermines the White House contention that all they need to do is "get the message out."

Concerns about health care reform include:

* The government will be too involved in the field of health care.

* People are convinced they will have to pay more -- 70 percent now believe the Clinton plan will increase how much they personally spend on health care. For some unknown reason (probably historical precedent), people think the government is underestimating the cost.

* The plan is an entitlement program aimed at the poor, not at helping the middle class. Clinton is feeding these doubts by focusing on universal coverage instead of cutting costs.

* The plan is perceived as too complicated and likely to negatively affect quality of care. Concern about quality is the fastest growing trend we are measuring about the plan.

Thus, the buzzards of public opinion are circling the Clinton plan. However, Republicans can not underestimate the likelihood that Democrats in Congress will work to pass something more palatable to public opinion but still give Bill Clinton the credit for his vision on health care. Also, GOP candidates should not underestimate how badly the press wants Clinton to succeed on "landmark" legislation. The press likes a good story, and health care makes compelling copy.

The political traps for Republicans on health care remain. Here are a few points to keep in mind:

* First, it is important to recognize the frustrations people have with the current system. Just because they don't like the Clinton plan doesn't mean they don't want something done. Even middle class people with insurance feel anxiety about the issue.

* Second, the Democrats will attempt to paint the Republicans as naysayers with no ideas of their own. Have a health care plan and be able to spell it out at the same time you are reinforcing doubts about the Clinton plan.

Like Bill Clinton, "feel their pain." Unlike Bill Clinton, make it better; don't make it worse.

Fred Yang is vice president of Garin-Hart Strategic Research Group, a Washington, DC-based Democratic polling firm.

Glen Bolger and Bill McInturff are partners in Public Opinion Strategies, a Virginia-based Republican polling firm.

COPYRIGHT 1994 Campaigns & Elections, Inc.
COPYRIGHT 2004 Gale Group