Summary: Why do Americans oppose the the Affordable Care Act (ACA, Obamacare) while supporting so many of its provisions? What does this tell us about America? Today Chet Richards “asks the mineshaft” for answers. It’s a community exercise, from the German Gemeinschaft (see Wikipedia). Please post your views in the comments!
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Contents
- The oddity of Americans’ view of the ACA
- Polls of US public opinion on the ACA
- For more information: other posts about health care
(1) The oddity of Americans’ view of the ACA
One of the more curious aspects of the current political season is opposition to the Patient Protection and Affordable Care Act (aka PPACA, ACA, Obamacare). Polls (such as this recent one by Gallup) show that 31% of Americans say they want Congress to entirely repeal ACA — and another 21% want certain parts repealed (most the individual mandate, which finances much of the rest). On the other hand, when the provisions are listed individually, most Americans support them.
One way to explain this phenomenon is that most Americans are “fatally stupid,” to quote University of Michigan professor Juan Cole. But this is intellectual laziness.
A better approach is to understand the orientations of the people who oppose ACA, although they may support the provisions outside of the act. Can we do this? That’s the question we’re posing to the mineshaft in this posting.
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Here’s an example of the type of question we’re asking. Polling after the OJ Simpson trial (1995) showed that a majority of white Americans believed that OJ was guilty and that the largely African-American jury had erred, or worse, had refused to convict because of race. Interviews with jurors after the trial however, painted a different story.
Jeffrey Tobin, for example, who sat through the entire trial and firmly believes that OJ is guilty, explained it this way (in a PBS interview):
Look, I think if you asked the jury why they reached their verdict, as I did, they’ll say, “Well, there was reasonable doubt.” I think the reason they thought there was reasonable doubt was it fit into their conceptions of how the LAPD acts towards black people, which I think is true in general. I think it is not true specifically in the case of O.J. Simpson.
But I believe the jury was sincere. I don’t think they were faking. But I think they’re just wrong.
Tobin was referring to errors made by the prosecution and allegations of evidence tampering that are described by other commentators in the PBS series.
In other words, if you shared the jurors’ orientation on previous misconduct by the LAPD towards blacks, and saw attempts by the LAPD to manipulate evidence in this case, you might logically conclude that there was reasonable doubt. Something that originally seemed beyond logic suddenly seems plausible.
As Charles Ogletree (Prof. Law, Harvard) put it:
They can’t make up evidence; they can’t assume evidence. They have to evaluate the evidence that was presented to them, and having done that, having seen the examination by [defense attorney] Barry Scheck of the DNA evidence, having seen the cross-examination by Johnnie Cochran of police witnesses, having seen the cross-examination of Mark Fuhrman by F. Lee Bailey, they had plenty of doubt about what happened, and all they had to do was to go in and take a poll. And I think it wasn’t a hard job to do.
What’s going on with ACA? We invite our readers to comment on the orientation of people who oppose ACA and particularly by those who would either be helped by it or who generally support its provisions outside the context of the act itself.
We are NOT asking for comments on the act (or on the guilt or innocence of OJ Simpson).
(2) Polls of US public opinion on the ACA
(a) How much do Americans know about ACA’s features?
Polls show the answer to be “not much” (but they nonetheless have strong opinions on the ACA). Here’s one example: “Public Opinion on Gender Rating“, Kaiser, 2 May 2012 — Excerpt:
{T}he majority of Americans like the idea of getting rid of gender rating, but at the same time most aren’t aware that the health reform law already has plans to do so. … Gender rating refers to the practice of charging women higher health insurance premiums than men.
{R}oughly a third (35%) of Americans were aware that the health reform law prohibits insurance companies from charging women higher premiums than men, down from about half (48%) in June 2010, just 3 months after the ACA was signed into law. Although the provision directly impacts women, particularly those under the age of 50, women as a whole were no more likely than men to be familiar with it. Democrats were more likely than Republicans to be aware of this provision (43% versus 25%), but still fewer than half were familiar with its inclusion in the law.
(b) What do they think of the ACA’s features?
Most show that many of the ACA’s provisions are quite popular. “Poll shows Parts of Health Reform Law Gaining in Acceptance“, Harris, 30 January 2012 — “While it remains controversial, many support key elements of the bill” — The trends in this continued though the year, as shown by the CBS/NY Times Poll and Kaiser Poll in March. Excerpt:
… support for certain components of the law seems to be slowly increasing with time. For instance, 71% support for certain components of the law seems to be slowly increasing with time. For instance, 71% of those polled now back the law’s provision that prevents insurance companies from denying coverage to those already sick. At the end of 2010, a Harris Interactive/HealthDay poll indicated that 64% supported this provision.
The poll released today shows some other provisions of the health reform law gaining acceptance. They include:
- Allowing children to stay on their parents’ insurance plans until they turn 26 — 57% in Jan. 2012 versus 55% in Nov. 2010.
- Creating insurance exchanges where people can shop for insurance — 59% versus 51%.
- Providing tax credits to small businesses to help pay for their employees’ insurance — 70% versus 60%.
- Requiring all employers with 50 or more employees to offer insurance to their employees or pay a penalty — 53% versus 48%.
- Requiring research to measure the effectiveness of different treatments — 53% versus 44%.
- Creating a new Independent Payment Advisory Board to limit the growth of Medicare spending — 38% versus 32%.
(c) The result is a paradox
“The Paradox of the Affordable Care Act and Public Opinion“, Gallup, 28 March 2012 — Conclusion:
We are thus faced with a “Paradox of the PPACA.” To attempt to fix some self-evident problems with access to healthcare and the cost of healthcare, experts in the federal government concluded that the federal government needed to go all out and bundle together a wide range of changes in the system. In particular, the experts decided that it was necessary to include the very wide-ranging individual mandate. But by bundling together the mandate with all of the other changes in the system, the federal government increased the concern and angst of average citizens who were already worried about the federal government’s power and influence.
Hence the current public opinion stalemate. Americans don’t like the individual mandate, but might be willing to support a number of the individual provisions of the law if they were passed individually and without the mandate. But, the argument is that it is not possible to pass the individual tweaks without passing the mandate. So, those in favor of the federal government’s attempting to “fix” the nation’s healthcare problems have a conundrum on their hands.
(d) Other polls:
- “Americans’ Views on the Healthcare Law“, Gallup, 22 June 2012 — A summary of the polls.
- Americans’ Views about the US Healthcare System, Gallup –A summary of polling results
- “Early Reaction to Supreme Court Decision on ACA“, Kaiser, 2 July 2012
- “Healthcare Law Helps Some, Hurts Others“, Gallup, 16 July 2012 — “Democrats think law will benefit all; Republicans skeptical”
(3) For more information: other posts about health care
- Beginning of the end of the Republic’s solvency. Soon come the first steps to a reformed regime – or a new regime., 14 August 2009
- Hidden truths about American health care, 19 January 2010
- A note about practical propaganda, 22 March 2010
- About the political significance of the conservatives’ health care propaganda, 23 March 2010
- The core truth about our health care system, 3 April 2010
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