Health care is the hottest political issue in Colorado in 2007. Governor Ritter and the legislative leaders have given it a top priority, and Colorado has established a Blue Ribbon Commission on Health Care Reform to make a recommendation for comprehensive health care reform to the legislature at the end of 2007.
Where is the public when it comes to supporting reform efforts? The pundits will confidently be telling us what the public thinks about health care, and what the public will or will not support. We should look very skeptically on what they pretend to know.
The Colorado Progressive Coalition is independently holding public health care forums throughout the state to inform the public about the work of the Blue Ribbon Commission and give people a chance to speak about their health care experience. We are also assisting people in giving their input into the Commission and the state legislature. One means of doing this is in asking participants to fill out a survey questionnaire about their opinions on health care and health care reform.
Our experience illustrates just how difficult it is to say what the public thinks about a complex issue. We have revised our questionnaire four or five times, trying to find the right questions to ask and the right wording for each question. For example, the New York Times/CBS Poll asked, “Would you be willing to pay higher taxes so that all Americans have health insurance?” and they got a solid majority in favor (60% for, 34% against.) The question assumes that taxes would have to be higher, but other developed countries with universal health coverage pay about half of what we do per capita on health care. In our poll, we ask the respondent to choose between the existing health care system and “a universal health insurance program like Medicare that is financed by taxes and pays private health care providers for medical services,” and we get a much greater majority in favor of universal health care. The bias in their question is in “higher taxes;” the bias in ours is in mentioning Medicare and “private health care providers” which are both very popular. Which is better? The answer, I think, is that there is no perfect question.
When we speak of “opinion” we’re really thinking of “attitude,”—a propensity to act in a particular way—whether it be voting, obedience to the rules of the church, or whatever.
Attitude is a composite of information, emotion, and social interactions; and it changes over time, sometimes rapidly. Opinion polls can’t assume that how a person answers a question today is the same as how the person will act tomorrow.
First, we need to consider what information the respondent has about the topic and what effect new information, and misinformation, may have on the respondent’s opinion. There is much attention paid to finding the right words to describe a legislative bill or a public program—or a laundry detergent—because people respond to words that sound good or bad in the absence of more factual information.
Second, the depth and intensity of the opinion is a major factor. Opinion polls tell us that over 95% of Americans are said to “believe in God,” but some of these believe fervently—and would burn at the stake before renouncing their belief. Others could not tell you what their belief is founded upon or what meaning it gives to their lives.
Third, opinions are formed in interaction with others; they do not occur in isolation. Opinions are made. On one level they develop in response to the opinions of family, friends and neighbors; at another level, in response to proposals put forth by leaders and other “opinion makers.” Until something is presented as an issue, there’s no opinion about it. For example, people now have opinions about “universal health coverage” because influential public figures are again talking about it.
Finally, there is the problem of time. There’s something absurd about pollsters reporting public opinion now on the 2008 election. As long as the future is unpredictable, the prediction of future behavior on the basis of opinions expressed in the present will always be a guess. In the last national elections, pollsters told Democratic candidates that the corruption issue wouldn’t work for them, and Democratic candidates focused more on other issues. When they later polled voters leaving the polls, the voters said that the corruption issue influenced their votes more than Iraq or the economy.
Given all these difficulties, what can we say about public opinion? We make no claim that our small sample represents “Colorado public opinion,” but together with the stories we collect it presents an interesting picture. One thing that stands out is the number of people, not included in the 770, 000 uninsured, who have failed to receive necessary medical treatment, been unable to purchase medications, or suffered financial hardship because of the cost of medical services. Almost everyone is worried about health care: losing their health insurance, becoming unable to afford insurance premiums, deductibles and co-pays, and being unable to cover the cost of a serious illness. Those who attend our forums are dissatisfied to the point of anger with the present health care system.
They are clearly dissatisfied, but what conclusions can one draw from this? What will they do when offered an opportunity to become active or to vote on the issue? By the end of 2007, with the experience of many forums and surveys across the state, we may have a clearer picture. However, we will only know what the widespread discontent with the current system means in practical political terms when the Commission has issued its recommendation and the legislature asks the public to support specific proposals. Until then, we would be wise to listen with skepticism to those who “know” what the public opinion is.
Clark Bouton, PhD
Health Justice Organizer,
Colorado Progressive Coalition
Phone 720-313-5173; email cbouton@viawest.net
I am a retired professor of political science and sociology, now working as a volunteer in the Colorado Progressive Coalition health care program. |
