For a generation, advocates for the poor have been trying to win public support for substantially more aid to the needy, particularly health insurance for uncovered millions.
Their results have been extremely modest. But two studies released yesterday suggest what could be a winning strategy: make sure the public does not view the aid as just another welfare handout. Americans are much more generous if they see it as help to ordinary people who need a hand.
The first study, by Robert J. Blendon and Karen Donelan of the Harvard School of Public Health, looked at hundreds of public opinion polls on health care from recent years and concludes that more than two-thirds of Americans, a higher percentage than at any time in the past several decades, favors national health insurance.
But the study concludes that most are not willing to pay a great deal for it -- less than $200 annually; that they oppose the income tax as a way of paying for it, preferring excise taxes on cigarettes, alcohol and jewelry; and that a substantial minority believes employers should contribute as well as taxpayers.
A salient political fact, the study found, is that Americans "dislike welfare clients deeply." They think anyone who can work should, and not depend on welfare. They oppose health-care rationing except for people on welfare. But Blendon also noted this distinction: "When we asked would you spend more to help poor people with health, 61 percent said yes. But then we asked would you support a major Medicaid expansion, and 31 percent said yes." The favorable response dropped because of Medicaid's link to the welfare system, he said.
In polls asking Americans in general what they would be willing to have the nation spend money on, Blendon said, "public assistance" ranked 13th of 14 items -- only foreign aid was lower.
The second study, from Families USA, the Center on Budget and Policy Priorities and the Population Reference Bureau, seeks to dispel the notion that the poor are all welfare clients.
It shows that the poor, as the average person would define being poor, is a far larger group than the welfare population.
It makes the point that millions of people in need of aid of various types are above the government's official poverty line and are not part of the welfare population, whose eligibility for any substantial benefits is generally lower than the poverty line.
Looking at four successive Gallup Polls, from July to October 1989, the study found that the average respondent said the poverty line for a family of four should be $15,017 a year -- about $3,000 more than the official poverty line.
"The real-life poverty line is rooted in the experience of America's consumers who know the real costs they have to pay to purchase the essential necessities of life," said Ron Pollack, director of Families USA, an advocacy group for the poor.
Measured by what the average person considers a bare minimum income to escape poverty, Pollack said, there are 45 million in poverty, not 32 million -- and 26 million of them are either children or the elderly, not persons of working age, and nearly three-fifths are white.
Looking at his findings about how deeply Americans resent spending for able-bodied people who are on welfare, Blendon said that the only way to provide low-income children and mothers with full health-care coverage may be to use a device discussed by former President Richard M. Nixon and the House Ways and Means Committee years ago.
Under that idea, all children in the country would be provided coverage through a universal national children's health insurance program. Income would not be a factor. As a result, poor children would not be seen as receiving some special benefit.
Second, instead of low-income mothers going to a welfare office and receiving health care through that system, with the associated stigma, health care would be administered through unemployment insurance offices or state health department offices. A means test would still apply, Blendon said, but the highly visible link to welfare would be cut.