Prioritizing the public option

PRIORITIZING THE PUBLIC OPTION…. That Americans approve of the idea of a public option is no longer in doubt. After months of polling, we’ve consistently seen a majority of Americans say they like the idea of a public plan competing against private insurers. The results have bolstered proponents of the idea, on and off the Hill.

What’s been less clear is the prioritizing. Most Americans approve of a public option, but are they demanding its inclusion in the reform bill? How dissatisfied will they be if reform passes without the public option? The results here aren’t as encouraging for ambitious reform advocates.

Surveys show that a majority of the public supports [the public option]. But those supporters value other objectives of a health care overhaul, like lowering costs, even more. A deeper look at the polls suggests a disconnect between Washington and the public over the public option. It has become magnified as a political issue beyond its immediate effect on the health insurance system, although both sides say its power, for good or ill, would become evident over time.

To begin with, a public option would attract only a few million people, the Congressional Budget Office predicts. Those people would probably be sicker than the general population. For that reason, and because their numbers would be relatively small, their premiums would be higher than for private insurance.

The public remains deeply divided about the overall health care bills, suggesting that for many, their support for the public option is not strong enough to outweigh their doubts about other parts of the bills.

Even those who identify themselves as Democrats are not that wedded to a public option. In a November survey by the Kaiser Family Foundation, released last week, they ranked it seventh in importance, far behind “affordability” and “accessibility” of medical care.

Two weeks ago, the Pew Research Center for the People and the Press asked respondents the main reason they either supported or opposed the health care bills. Among supporters, only 2 percent cited the public option. Among opponents, only 3 percent did so.

About a month ago, policymakers woke up to find a front-page, above-the-fold headline in the Washington Post that read, “Public option gains support; Clear majority now backs plan.” The article reported on the latest poll that found, even after months of attacks from the right, 57% of the country endorsed the public option — a number that had gone up since August. The news stiffened spines among lawmakers pushing for the policy — if most Americans still want a public option, even after fierce criticism, proponents felt more encouraged to fight for it.

This newer data, then, showing public flexibility on the issue, may have the opposite effect. If the politicians become convinced that the idea isn’t really a priority for most of the country, and the provision is seen as a stumbling block to finishing the debate, then they’re less likely to fight as hard as they otherwise would.