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    What America Thinks
    Turning the Question

    By Richard Morin
    Washington Post Polling Director
    Monday, Jan. 26, 1998

    Pollsters often are satisfied asking obvious questions that elicit obvious answers. Occasionally, we dig a little deeper – and learn a whole lot more. Here are some obvious and not-so-obvious questions that were asked in an important new survey by the Henry J. Kaiser Family Foundation and Harvard University. A random sample of 1,012 adults were asked if they would favor a law requiring health plans to provide more information about how health plans operate. Definitely yes, said nine out of 10 respondents.

    What about a law allowing a woman to see a gynecologist of her choice without first getting approval from a health plan? Of course, said eight in 10. And what about requiring health plans to provide greater access to medical specialists? Yes, again, said eight in 10.

    Large majorities also supported laws that would allow patients whose claims had been denied to appeal the decision to an independent reviewer, would make health plans pay for emergency room visits, and would allow patients to sue for malpractice.

    But what if, as a consequence, you had to pay a bit more in insurance premiums? What if some employers dropped coverage? Or what if it meant greater involvement by the federal government in health care? Would you still favor each of these laws?

    The Kaiser-Harvard research team asked those questions, too – and were stunned by the results.

    In each instance, support for the specific proposed law plummeted. In some instances, the proportion favoring the specific law was cut nearly in half once respondents were forced to confront the consequences of the legislation that had proved initially to be so popular.

    For example, support for a law requiring health plans to provide more access to specialists fell from 81 percent to 59 percent when survey respondents were asked if they would still favor the proposal if it "might result in an increase in insurance premiums." The proportion dropped to less than half when they were asked if they would support the law if it meant government might get "too involved" in health care or might cause some employers to drop health coverage. Likewise, support for a law allowing patients to sue for malpractice fell from 64 percent to 36 percent when respondents were asked if they'd still favor the law if some employers might drop coverage. And support for allowing a woman to see a gynecologist without preapproval from her health plan dropped from 82 percent to 58 percent if it might mean an increase in premiums, and fell to 48 percent if it meant some employers would opt out of coverage.

    "The falloff in support was simply astonishing," says Robert Blendon of the Harvard School of Public Health and Kennedy School of Government, part of the team that prepared and analyzed the poll.

    The reason this test is so important is because it's so relevant. The proposed laws are all part of President Clinton's proposed "Consumer Bill of Rights" and are pending before Congress.

    The "consequences" questions were carefully crafted by Kaiser Foundation and Harvard researchers to match the real objections of critics of these proposed federal regulations – or what likely would be some of the results if those proposals become law.

    "The consumer protection measures being proposed are modest steps that address some of the problems people are having in managed care," said Drew Altman, president of the Kaiser Foundation, in a prepared statement accompanying the release of the survey results. "But support may fall if the public comes to see them as part of a larger government health reform plan that could result in employers dropping coverage or higher health insurance premiums."

    What these researchers essentially found is the 1998 version of those "Harry and Louise" ads that sank the Clinton health care plan four years ago. Then, as now, the core idea of guaranteed health care for all was universally popular – until this support vanished in the face of challenges that echo those in the Kaiser-Harvard poll.

    In particular, analysts found that "Americans respond most strongly to the possibility of some employers dropping health care coverage. Hearing that a measure might increase the cost of health insurance or might get the government 'too involved' in health care also results in a drop in support, although majorities still support legislation on four out of six of the proposed requirements for health plans: providing more information, allowing direct access to gynecologists, paying for emergency room visits, and allowing independent appeals."

    Richard Morin is director of polling for The Washington Post. "What Americans Think" appears Mondays in The Washington Post National Weekly Edition. Morin can be reached at

    © Copyright 1998 The Washington Post Company

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