Public Opinion

Is Opposition to Health Care Reform About the “Process”?

Jan 24 '10

The Washington Post describes this finding from the poll I noted earlier:

bq. Among Brown’s supporters who say the health-care reform effort in Washington played an important role in their vote, the most frequently cited reasons were concerns about the process, including closed-door dealing and a lack of bipartisanship. Three in 10 highlighted these political maneuverings as the motivating factor; 22 percent expressed general opposition to reform or the current bill.

Karen Tumulty says that this dovetails with what she was hearing on the ground in Massachusetts:

bq. Normally, you’d be surprised if people in Massachusetts even know who the Senator from Nebraska is. But the number of people I talked to who brought up Ben Nelson’s name, unprompted, was striking. I’m also told, by some who were doing phonebanking, that they got an earful about it over and over.

bq. Voters I talked to also brought up the deal with labor. How come, they wanted to know, that everyone has to pay this “Cadillac Tax” on high-cost insurance plans except for the unions, who get a five-year exemption? People are so disgusted by the process, I think, that they have ceased to believe that there is anything in this bill for them.

Jon Bernstein tackles this from one angle, and I agree with him that Tumulty’s reporting is important. But I want to tackle the role of “process” from a public opinion standpoint. “Process” does appear salient in the minds of 30% of MA voters who voted for Brown. But there are three challenges in interpreting its importance:

1) What does process mean?
Well, according to the Post — see p. 5 of the pdf — it could mean “don’t like the way it is being handled” or “politics” or “deal-making” or “too complicated” or “not what the people want” or “partisanship” or “moving too fast” — among other things. The category is very broad and includes multitudes of different sentiments. Tumulty refers to something that sounds like the Post’s “deal-making.” The problem is that deal-making isn’t separated from “politics” or “don’t like the way its being handled” and several other sentiments. So the 13% who were classified as saying something in that category may or may not have in mind the deals with Ben Nelson or labor unions.

I would guess that only a small percentage of voters could tell you that there was a Cornhusker compromise and perhaps what it was. That’s just a hypothesis, but it strikes me as plausible because of the low levels of knowledge of many political facts, especially arcane ones like the Nelson deal. To take one example, 69% of respondents in a recent CBS poll (pdf) couldn’t even provide a basic favorable/unfavorable for the Tea Party movement, and it has been in the news for months.

2) How many opponents of health care reform care about process?
In Post’s poll the fraction of self-reported voters who (1) considered health care extremely or very important, (2) were therefore asked the open-ended question, (3) cited something related to process and (4) voted for Scott Brown was about 7% of their sample (my math).

So we’re not talking about a large number of people. It’s possible that they were easy for Tumulty to find in Massachusetts — at rallies or wherever — but this is not necessarily a widespread phenomenon.

3) Is process really the reason why people oppose health care reform?
Here I am pretty confident in saying no — and I would be equally confident even if large numbers of people knew of the Nelson deal. First, it’s important to remember that the “reasons” that people give for their choices — e.g., as in the Post’s open-ended question — are not necessarily the factors that actually caused those choices. People do not report accurately on their own mental processes, and often times their “reasons” are rationalizations. Lee had a nice post on this.

Second, there has been no increase in opposition to health care reform in the last couple months, even as the Nelson deal and the exemption for labor unions came together. In fact, according to the Pollster chart, there’s actually been a slight decline in opposition, although I doubt that’s anything meaningful. The Nelson deal didn’t seem to change anyone’s mind. It just gave bill opponents another reason to hate the bill, and it was salient enough at the time of the Post poll in Massachusetts for some unknown fraction to cite it.

Given how quickly partisan polarization on health care reform emerged, I think most people’s opinions were formed via the usual cue-taking from elites (as John Zaller’s work would suggest). The public routinely complains about aspects of the legislative process — see John Hibbing and Elizabeth Theiss-Morse’s work — but these are
general concerns not so much concerns about specific bills.

Tumulty thinks that the Cornhusker compromise was “one of the biggest blunders in modern political history.” I think that absent the deal, public opinion about health care reform would be no different whatsoever. Ultimately, most people do not base their views of legislation on the process by which it was debated or enacted. And after a months-long debate, I doubt that details of the process are changing many people’s minds.