Embracing Confusion: What the Health Care Surveys Really Mean

If you've been following Public Agenda's work, you've heard us talk about the process of "working through" the public goes through on complicated problems. And rarely have we seen a better illustration of "working through" in action than in the two major surveys on health care released today.

The news coverage of the new CBS/New York Times and NBC/Wall Street Journal surveys is focusing almost entirely on flagging support for the health care reform plan in Congress. But there's a lot more evidence that the public is still thinking this issue over – and a clear sense that people haven't made up their minds.

Consider this: there's a strong "damned if you do, damned if you don't" flavor to the new surveys. The CBS/New York Times poll, for example, finds that large numbers are worried about what will happen if the government "creates a system of providing health care for all Americans." Significant numbers say they're "very concerned" that their taxes will go up (45 percent), that their own health costs would rise (42 percent) and that the quality of their own health care will get worse (41 percent).

On the other hand, the same survey found the public just as worried about what would happen if the government doesn't provide universal health care. Just as many are "very concerned" the number of uninsured people will rise (43 percent), that the cost of their health care will increase (41 percent), and that they might be without insurance themselves (37 percent).

These are significant numbers: people can worry "somewhat" about a lot of things, but when four in 10 or more say they're "very concerned," it's serious. And it's worth revisiting that cost question. When you combine the "very" and "somewhat" numbers, you end up with 77 percent who are concerned their health costs will go up with health care reform, and 75 percent who are concerned they'll pay more without reform.

While the news coverage properly points out that the public is becoming more skeptical about the health care proposal, one of the most interesting points in the NBC/Journal survey is the declining – but still large – number of "don't knows." The number who said they didn't know whether President Obama's health plan is a good idea or a bad idea fell from 30 percent to 17 percent in just one month. In survey terms, that means the "don't knows" have shifted from enormous to merely huge, because double-digit "don't knows" always show that results are volatile. Most of those seemed to have moved into the "bad idea" camp, which increased 10 points, to 42 percent.

All of this is perfectly normal.

There are some people you could call up at any time, day or night, who would have firm, settled opinions about just about any political issue – policy wonks, experts, activists, political animals in general. But most people aren't like that. People need to think things over when confronted with a new problem, and they go through a pretty clear process to do that.

First, there's a period of "consciousness-raising," where they first start learning about an issue. Then, there's a process of "working through," where people start to consider different proposals, weighing options and thinking about the tradeoffs involved in solving the problem. Finally, there's resolution, where people reach firm conclusions about what they want. (For a more detailed view of this, have a look at Public Agenda chairman and co-founder Dan Yankelovich's presentation explaining the "Learning Curve™" approach to discussion of public policy.)

These two surveys show what "working through" looks like when viewed through the lens of a public poll. When people are in this process, surveys often show conflicted and contradictory results. And that's what we've got here. There's consensus on some key areas, such as the health care system is in need of change. But people haven't figured out what tradeoffs they're willing to make to accomplish change. There's nothing wrong with that. You can even argue that the public's realization of how hard reform will be is a sign of progress. The chances for solving the problem would be would be worse if most people were clinging to the idea that the whole thing could be solved by cutting "waste." In any case, working through rarely happens overnight.

But at this point, it really does seem like the public, and health care reform in general, is on a deadline. Most politicians and analysts argue there's a limited window for change. Congress is about to go on its summer break, with plans to take up health care again in September. The fate of that legislation is going to greatly depend on how far the public advances in its thinking over the next few weeks.

This is the challenge for leaders and policymakers this August, to help the public move forward. The big advocacy guns of August can make this task easier, or harder, depending on how they're used. Americans are trying to choose between a status quo they don't like and a reform plan they don't understand. But the real measure of success is whether the nation ends up with a health care system that the American people can live with.