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.

Some of the changes away from the president and the Democrats in this poll stem from a more GOP-leaning sample than in previous surveys. In this poll, the Democratic advantage in partisan identification has been shaved to six points, the first time in more than a year that the gap has been lower than double digits. There is also near-parity between the parties, when nonpartisans who "lean" toward one party or the other are counted, also a first for 2009.

The numbers of Democrats, Republicans and independents varies by poll, with each random sampling of adults producing slightly different population estimates. Samples are statistically adjusted to known census demographics, but not to predetermined levels of partisanship, which themselves change over time. A single poll is not enough to draw conclusions about a lasting GOP resurgence, or a short-term shift.

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Following the twists and turns of the health-care debate has proved dizzying for insiders and the public alike, with provisions appearing and disappearing as Democratic leaders in the House and Senate try to assemble enough votes to pass legislation. The survey suggests the advocates of comprehensive reform have not been able to produce broad national support for change.

In the poll conducted this month, 51 percent say they oppose the proposed changes to the system; 44 percent approve of them. Two-thirds say the health-care reforms would add to the federal deficit, with two-thirds of those people calling such an increase "not worth it."

More than six in 10 favor expanding Medicare to people ages 55 to 64 who lack insurance--a proposal included in one Senate compromise effort that appears unlikely to survive final negotiations. By a 2 to 1 margin, more Americans say a new system will weaken rather than strengthen the Medicare system.

On the issue of whether and how to expand coverage to those who do not have it, 36 percent favor a government plan to compete with private insurers, 30 percent prefer private plans coordinated by the government and 30 percent want the system to remain intact.

On Afghanistan, the president's improved standing stems from a popular policy position -- about six in 10 back his decision to send the new forces -- and is bolstered by other big movements in public views on the war.

A narrow majority, 52 percent, see the war in Afghanistan as worth its costs, a six-point increase from last month. Most, 56 percent, now see success in Afghanistan as critical to making progress in the broader war on terrorism, the most to say so in polls back to July 2008.

For the first time, Democrats tilt toward seeing winning the Afghanistan war as essential to the overall campaign against terrorism (48 percent say so to 41 percent who say it is not). Independents -- 56 percent say essential, 38 percent say not -- are also more in this camp than ever.

One of the motivating forces here is that nearly three-quarters of Americans are "extremely" or "very" angry at the Taliban for having supported Osama bin Laden and al-Qaeda before Sept. 11, 2001. Across party lines, those who are intensely angry at the Taliban are more apt to see success in Afghanistan as critical to winning the U.S. campaign against terrorism.

At the same time, barely half of those polled are confident the president's new strategy for Afghanistan will succeed, with about one in 10 highly confident.

About four in 10 say the July 2011 timeline Obama set for the beginning of a troop drawdown is "about right," about three in 10 want the pullback to start sooner and about two in 10 want it later. Regardless of their assessment of the timing, most, 55 percent, oppose Obama's having set a specific deadline for this to occur, with Republicans and independents broadly opposed and Democrats largely supportive.

More than seven in 10 expect large numbers of U.S. troops to remain in Afghanistan for many years to come, with a near-even split among those who anticipate a long-term deployment on whether that is allowable. Republicans and Democrats are about equally likely to foresee a lengthy U.S. military role there, but Republicans tilt toward supporting this, with Democrats against it.

The poll was conducted Thursday through Sunday by conventional and cellular telephone among a random national sample of 1,003 adults. The margin of sampling error for the full survey is plus or minus three percentage points.

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