The Don't Knows: Proof the Health Care Debate Isn't Working for the Public

This has to count as one of the most damning survey figures we've seen recently: the CBS News/New York Times poll today finds 46 percent of the public doesn't know enough about the health care reform plans to have an opinion.

That's after all the town halls and the presidential events, after all the viral rumors and the earnest fact-checking, after all the obsessive bloviating and arm-twisting on health care that has dominated Washington for months. After all that, we still end up with nearly half of Americans saying they don't know whether it’s a good idea or not. Even more, 59 percent, say the health care reforms are "confusing."

And it isn't as if the public hasn't been trying to figure this out: three-quarters in the CBS/Times survey say they've heard or read at least something about health care reform, and 33 percent say they've heard "a lot." That's a significant number. Other surveys like the Pew News Interest Index also show high levels of public attention to health care.

This is what failure to engage the public looks like. We're not talking about the ability to gather a crowd for or against – obviously the American political system has that honed to an art. But real public engagement is more than that. The whole point is for the public to be able to come to firm conclusions about what their choices are, which approach they prefer, and what they're willing to do to accomplish it. Clearly, that hasn't happened here.

There's lots of blame to go around. Proponents haven't been able to agree among themselves, much less be clear with the public. Opponents have been content to roadblock discussion rather than propose alternatives. The media coverage has been mostly about the high-volume political tactics rather than the real options for change. And there are few chances for the public to actually compare plans side-by-side, much less the big picture problems behind them.

That's not the same as saying a bill won't pass – that depends as much on the dynamics in Congress as on public opinion. A reform bill could very well pass. But how well that reform plan fares in the real world, where sick people wrestle with insurance jargon and doctors and hospitals try to figure out how they make a living, is another story. Passing legislation isn't the end of the tale, it's the beginning. And how that story comes out will depend on how well the public has thought through want it wants from the health care system – exactly the sort of thinking that politicians and the media have failed to help along over this brutal, disheartening debate.