Public cooling to health-care reform as debate drags on, poll finds

By Dan Balz and Jon Cohen
Washington Post Staff Writers
Wednesday, December 16, 2009; 12:30 AM

As the Senate struggles to meet a self-imposed, year-end deadline to complete work on legislation to overhaul the nation's health-care system, a new Washington Post-ABC News poll finds the public generally fearful that a revamped system would bring higher costs while worsening the quality of their care.

A bare majority of Americans still believe government action is needed to control runaway health-care costs and expand coverage to the roughly 46 million people without insurance. But after a year of exhortation by President Obama and Democratic leaders and a high-octane national debate, there is minimal public enthusiasm for the kind of comprehensive changes in health care now under consideration. There are also signs the political fight has hurt the president's general standing with the public.

One bright spot for the president in the poll is Afghanistan. His announcement Dec. 1 that he was ordering an additional 30,000 U.S. troops to that country, to bolster the 68,000 already there, wins majority support. More than half of all Americans, 52 percent, approve of how he is handling the situation there, up from 45 percent before the speech.

But Obama and the Democrats have had decidedly less success convincing the public that their health proposals will bring positive change. More than half of those polled, 53 percent, see higher costs for themselves if the proposed changes go into effect than if the current system remains intact. About as many (55 percent) say the overall cost of the national health-care system would go up more sharply. Moreover, just 37 percent say the quality of their care would be better under a new system; 50 percent see it as better under the current set-up.

Even among those who presumably stand to benefit most from a major restructuring of the insurance market -- the nearly one in 5 adults without coverage -- there are doubts about the changes under consideration. Those without insurance are evenly divided on the question of whether their care would be better if the system were overhauled.

The findings underscore the political risks for Obama and the Democrats as they push to enact health-care legislation. Democrats believe passage of the bill will give them a political boost, despite the fractious debate that has surrounded the legislative struggle. But they are moving ahead in the face of a sharply divided country, with no certain guarantees that their efforts will be rewarded politically.

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Obama's domestic battles have taken their toll, as his approval ratings on key issues have sunk to the lowest points of his presidency. On health care, 53 percent disapprove of his performance, a new high. On the economy, 52 percent disapprove, also a new high mark in Post-ABC polling. Same on the deficit, on which 56 percent now disapprove of his stewardship. On the politically volatile issue of unemployment, 47 percent approve of the way Obama is dealing with the issue; 48 percent disapprove.

Under the weight of these more negative reviews, the president's overall approval rating has dipped to 50 percent, down from 56 percent a month ago. Other national surveys have recorded his ratings at or below 50 percent in recent weeks, but this is his lowest level yet in a Post-ABC News survey.

The erosion in the president's standing has been driven by continued slippage among political independents, particularly among independent men. For the first time, a majority of independents disapprove of his overall job performance, and independents' disapproval of his handling of health care and the economy tops six in 10.

Americans still trust the president more than Republicans in Congress to handle the economy, health care and energy policy, although they do so by smaller margins than in recent months. Obama's advantage on the economy has been sliced in half since June, and he now holds just a narrow seven-point edge on health care.

At the same time, nearly a quarter of those who disapprove of Obama's handling of health care say they trust neither party on the issue, a sign that Republicans still have work to do to win the confidence of many Americans.

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