Is “the Process” Driving Opinion about Health Care?

Time emphasizes what Americans hate and distrust about the legislative process (which is, put simply, the workings of the legislative process), and that drives them away from the bill.

That’s Ezra Klein, drawing on the book Stealth Democracy, by political scientists John Hibbing and Elizabeth Theiss-Morse (buy it here!). Ezra quotes this passage from the book, which nicely summarizes their argument:

…they are consequently turned off by political debate and deal making that presuppose an absence of consensus. People believe these activities would be unnecessary if if decision makers were in tune with the (consensual) public interest rather than cacophonous special interests.

But there’s one problem in trying to explain opinion about health care with process considerations. What about the extraordinary partisan polarization on health care? See the graph from Gallup below:


Klein talks about what “Americans” think about the process and the bill. But there are no “Americans” here. There are groups of partisans with strongly divergent views. Clearly, the lengthy process isn’t turning off Democrats. In fact, their support has increased of late, according to Gallup:


Is it turning off Republicans? Perhaps. But a much more plausible explanation is that Republicans either didn’t support health care reform from the outset because it was associated with Obama and the Democratic Party, or came to dislike it after a barrage of criticism from Republican political leaders.

Okay, but what about independents? Are their views on health care due to their revulsion at “the process”? That would strike me as plausible if independents support for the bill kept declining as the process dragged on. In the graph above, there was a decline from the middle of September to the beginning of November. But no decline thereafter, even as the allegedly “worst” parts of the process—the Cornhusker compromise, the backroom conversations among Democratic leaders, etc.—took place. This is a point I’ve made before.

In fact, most of the growth in opposition to health care took place in the early stages of the process, not as the process wore on:

So while it’s true that opposition to health care reform is positively related to the length of the process, that doesn’t imply any causal relationship. The rapid increase in opposition and the partisan polarization in opinion suggests that the lengthy process matters not by opening people’s eyes to the cruel realities of legislating, but by giving opponents of reform additional time to attack it.

6 Responses to Is “the Process” Driving Opinion about Health Care?

  1. Scott McClurg February 3, 2010 at 5:13 pm #

    Not to quibble too much John, but the huge growth in the graph is supported by far fewer data points. It looks to me like after the process started, we see a divergence in the favor and oppose graphics.

    Plus, I’m not sure that these are exactly the right questions to ask. Americans still favor health care reform to be sure. But do they favor *this* health care reform? And do they not favor this bill because of the policies in it (like health care mandates or patients’ rights) or because they feel like something untoward is happening? I know you’re constrained by available data, but I wonder if we could ask questions about the current health care process (e.g., who do you think benefits the most from the health care bill) that we might get a different set of answers.

  2. John Sides February 3, 2010 at 8:21 pm #

    Scott: The data is certainly thin early on. But if we start where the polling begins in earnest, that still leaves open the question of whether “the process” affects opinion. I certainly don’t think that the public’s opinions are based on any detailed knowledge of various reform proposals. But the “something untoward” doesn’t necessarily have to do with the process of legislating (Klein’s point), it could have to do with general perceptions of the proposed reforms themselves. You cite the question of “who benefits the most.” I actually see that as not a question of process but a question of policy.

  3. tnoord February 3, 2010 at 8:42 pm #

    Has anyone looked at polling about Health Care Reform that excludes those in medicare, or close to medicare eligibility (say, anyone 60+) from the poll? It seems like that group would have little to benefit from HCR, and are probably the ones most frightened by the whole “death panel” and “rationing” spin. Does that group of people skew the polls to the negative?

  4. Sam Giancana February 4, 2010 at 2:11 pm #

    We need to keep our eye on the independents in the polls since they determine the election outcomes.


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