As Congress breaks for its August recess with polls pointing to a decline in public support for health reform efforts, new research shows that getting Americans more involved in the debate is essential to moving the reform needle.
The research showed that after critically thinking through the alternatives, people were willing to make significant and surprising tradeoffs – like limiting treatments to those proven effective, expanding the role of government and an increased role for nurses and other non-physician health care providers – in order to improve our health care system. The report offers specific insight for congressional and other leaders to help build constituent support while back in their home states.
“Major reform efforts fail either because people have been engaged and reject them, or because they were never engaged in the first place,” said Daniel Yankelovich, a leader in public opinion research for more than 50 years and chair of Viewpoint Learning. “We found that when Americans are engaged and work through tradeoffs and take on board the experiences of others, they are willing to make more sacrifices than most experts give them credit for.”
Published in the report Voices for Health Care, the Viewpoint research was funded by the W.K. Kellogg Foundation, which supports efforts to expand civic and philanthropic engagement across the U.S. to improve the lives of vulnerable children and families.
Public support for any proposed health care plan is crucial to its approval and, ultimately, its implementation. In 1993, the Clinton Administration’s health reform plan enjoyed a 71 percent approval rating early on, but legislation quickly stalled and that rating slipped to less than 40 percent, suggesting that opposition easily swayed a public that had not yet worked through the issues and reached a firm judgment.
The Voices for Health Care project took place in three very different states over the course of a year – Ohio, Mississippi and Kansas.
First, researchers engaged with health care, political, civic and business leaders in each state to create several health care reform scenarios to work through with the public. Then they engaged a random sample of participants representative of the U.S. population (nearly 300 in total) in daylong, two-way dialogue sessions to show how everyday Americans tackled the issues. Participants first created their vision of the health care system they wanted to see, and then worked through the difficult tradeoffs they would be prepared to make to realize that vision and to pay for it. Across all nine sessions (three sessions per state) participants reached a strikingly consistent set of conclusions.
Researchers quickly observed that the public approaches the issue of health care from a pragmatic – not a partisan – perspective and that participants were willing to change views on politically contentious issues after working through the tradeoffs of alternative potential health care systems and the viewpoints of other Americans. Those perspectives also made a dramatic difference in how participants felt about broad reform issues, such as universal coverage and limits on care. (Major insights are highlighted in the “key findings” section below.)
The report also showed that Americans across all demographic groups and the political spectrum might already agree on a number of important reform elements. Americans came to a quick agreement that a new system should provide greater focus on prevention and wellness, increase personal responsibility for one’s own health, and ensure that all children have access to good care. They concluded that these topics could be used as an effective starting point to engage the public and open the door to addressing other more complex issues.
“For decades, lawmakers have focused primarily on the debate among vested and represented interest groups, and have not developed ways to engage in meaningful conversations with the American public,” said Sterling Speirn, the president and chief executive officer of the W.K. Kellogg Foundation. “Substantive dialogue with the public about health care is not only feasible, it is essential if we are to advance health care that the public will embrace in the United States.”
Today’s Voices for Health Care report indicates that engaging Americans from diverse political and socioeconomic backgrounds can substantially increase public support for meaningful health care reform. It provides specific insights and a useful starting point that leaders can adopt to ensure that the thoughtful voices of everyday Americans on health care reform are heard in Washington. The report can be accessed at http://voicesforhealthcare.org/. You can also view the project video at http://voicesforhealthcare.org/the-project/choicedialogues-video-highlight/.