Think it Through

If you read the news headlines on health care recently, you might get the impression that most people are more worried that President Obama will succeed in getting health care reform enacted than that he will fail.

The day after President Obama’s news conference last week, the Washington Post’s page one headline blared: “Obama seeks to calm fears on health care.” The New York Times interviewed people in one of the most Republican counties in the nation and concluded in a front page lede: “President Obama sought to convince an increasingly skeptical American public that proposed changes to the health care system would benefit them and strengthen the economy.”

Fears?

The headlines run contrary to the constant demand for health care reform that many of us have been hearing from people across the country for many years. In nearly every national poll over the last ten years , health care has been a top-tier concern. If you actually talk to people out in the country, health care concerns are on the top of their minds. Most Americans tell pollsters they are satisfied with the quality and accessibility of their own health care, but this does not mean they feel safe that things will stay that way. Scratch the surface of their satisfaction and you uncover fear that nothing is secure when it comes to health care: you hear stories of friends or relatives who have become destitute or have gone untreated for illnesses because they have lost health coverage somehow.

It is this insecurity that I believe is behind most polls showing clear majorities supporting President Obama’s efforts to change the way health care is delivered in the country. Our firm, Belden Russonello & Stewart, conducted a national survey last week to gauge if Americans really are worried about health care in the future.

The BRS national random digit dial survey of 800 adults, from July 20 to 24, found that:

• 72% of adults are worried that if someone in their family becomes seriously ill their health insurance might not cover enough of their medical bills. Nearly half the country — 47 % — is very worried about inadequate health coverage.
• 65% worry that if they lose or change jobs they might lose their health insurance and not be able to afford new health insurance. Again, close to one out of every two Americans — 46% — is very worried about losing health care.
• 60% say they worry that if someone in their family becomes seriously ill their health insurance might drop their coverage. 41% worry very much.
• 56% worry that if they lose or change jobs they might not be able to get new health insurance because of a pre-existing condition. Nearly four in ten –38% — worry about this very much.

When you consider that the June 2009 national survey by the AP/GfK reported 35% of Americans worry being victims of terrorism, you can easily conclude more Americans now fear their health insurance company than they do Osama Bin Laden.

The BRS poll last week also found that overall 62% of Americans favor President Obama’s efforts to create comprehensive changes in the health care system. About four in ten — 45% — feel strongly in favor. One in three (33%) Americans opposes what the president is trying to do.

Support for the plan reaches far beyond liberals and Democrats, as 65% of independents and 66% of political moderates favor what Obama is trying to do. A substantial 44% of each of these groups strongly supports his efforts.

One statistic from the BRS poll provides even more evidence that anxiety about the future rather than immediate concerns is driving support for comprehensive health care reform: younger Americans more firmly embrace comprehensive reform than their elders. Over two-thirds (67%) of Americans under 45 years old support Obama’s health care reform efforts, compared to 56% of those over 45. It is not just that Obama is more popular with young people. When you account for political affiliation and ideology, age is still an important consideration in support for reform.

This is why when I read headlines that say Americans fear health care reform, I am thinking, which Americans? Maybe reform is risky for some insurance company CEOs, some hospital big shots, and the Chamber of Commerce. For the rest of us, it is a matter of eliminating the risk of health care that may be out of reach in the future.

So far, President Obama has chosen not to use fear as a weapon to pass health care reform. As refreshing as this it is, Obama would benefit from at least reminding Americans of the insecurity they feel about the future of health care.

Update: full questionnaire here

Now that we have reached the end of the hearings on Judge Sonya Sotomayor’s nomination to the Supreme Court, someone in the Senate should state the obvious – Supreme Court hearings serve no constructive purpose and should be retired. They are just one more embarrassing spectacle produced by America’s most exclusive club.

Before the hearings began, the news media reported the details of Sotomayor’s character and her rise from the Bronx projects to the Ivy League, then back to her New York home to serve the public as a prosecutor and judge. Legal analysts filled the news pages and websites with long analytical pieces about her opinions and most agreed that her judicial record showed intelligence, adherence to the law, and impartial judgments. Journalists also covered her past speeches, and exposed her consistent predilection for giving speeches that were anything but impartial. We knew all of this before Senator Pat Leahy, Democrat of Vermont, gaveled the start of the Senate daytime television drama.

So what did we learn from the hearings?

• We found out that Sonya Sotomayor is as adept as John Roberts at speaking with a deliberate, intelligent-sounding tone while not answering questions.
• We were impressed that she looks as authoritative in her red suit and her royal blue suit as Roberts did in his navy suits. She seems sartorially ready to put on the robes of a Supreme Court justice.
• We were reassured that her mom loves her, as the elderly woman looked as sincere as Roberts’ family tableau on the front row in back of the witness.
• We were entertained by Democrat Sen. Charles Schumer of New York who gushed about the judge’s heroic personal story.
• We were puzzled and annoyed by Republican Sen. Lindsay Graham of South Carolina who worried out loud about the content of Sotomayor’s speeches, suggesting that the speeches were of equal importance to her judicial rulings.
• And if that was not enough, the television audience had the opportunity to hear Sen. Amy Klobuchar, Democrat from Minnesota, ask tough questions such as “What would you like history to say about you when all is said and done?” Klobuchar pointed out that she was just copying the exact wording that Republican senators asked nominees Roberts and Samuel Alito.

Okay, okay, the hearings have no useful purpose. But what harm can they do? Lots.

I am convinced that if the Senate had calmly and carefully studied Clarence Thomas’ record in 1991, away from the spectacle of televised hearings in which Thomas angrily accused the white Senators of conducting a “hi-tech lynching,” the Senate would have found his qualifications lacking and he would not be on the Supreme Court today. The Thomas hearings turned out to be the Anita Hill hearings, with Republican Senators putting her on trial. Then Senator Joe Biden, who chaired the hearings, allowed the process to be about almost anything except Thomas’ qualifications.

Public opinion research we have conducted over the past five years indicates the public takes the Senate’s role in the confirmation of Supreme Court justices more seriously than do many Senators. Majorities of Americans believe the Senate and the public have a right to know the nominee’s views on Constitutional issues and to learn about prior rulings and legal opinions. The public does not like lifetime appointments, but since that is the reality of the Supreme Court, Americans want the Senate to do a thorough job of interviewing someone who is applying for a lifetime job, from which he or she cannot be fired.

This does not require televised hearings. President Ronald Reagan’s appointment of Robert Bork to be a Supreme Court judge in 1987 is a good example of why we do not need hearings. Although the argumentative Bork made for great television drama, all of the objections to Bork were already displayed in his rulings as a federal judge and in his legal writings. The momentum for the Senate’s thumbs down on Bork began the minute he was announced. The hearings process just made it all tackier.

Nothing useful is gleaned from these hearings that could not be obtained better by having the Senate Judiciary Committee investigate and studiously consider the record of Supreme Court nominees, then present their reasoning in speeches in committee and on the Senate floor. In this way, the Senate and the public can focus on the nominee’s judicial qualities rather than his or her communication skills. Without hearings, we are more likely to judge a nominee’s fidelity to the Constitution than his or her ability to spin.

The process of public hearings on Supreme Court nominees is a relatively new phenomenon, born in the 1950’s, around the same time television was entering American households. It is ironic that the Senate, an institution that too often lives in the past, is not well served by using the media tools of the present.

The Senate would do well to go back to a process when Supreme Court nominees were considered, not put on display.

The recent surveys on health care reform have been reporting large-scale support for reforming our health care system but no consensus on the specifics.

• The latest New York Times/CBS poll (June ‘09) reports 85% of the American public wants either “fundamental changes” (51%) or to “completely rebuild” our health care system.
• A June survey by the Pew Research Center found 71% favoring either fundamental changes (30%) or to completely rebuild (41%) the health care system in America.
• A June survey by the Kaiser Family Foundation reports that 68% of Americans favor “creating a public heath care option similar to Medicare to compete with private health insurance plans.”

The dissonance between this broad support for reform and the reservations about the specifics of reform, shown in some polls, lead some analysts to voice skepticism that health care legislation will pass this year. Others point to polls showing that the public is generally satisfied with the quality and cost of their own health care right now, so where is the impetus for reform? Indeed, the latest Pew numbers show that majorities of Americans do not have a “major problem” with “paying for the cost of routine medical care” (65%), “paying for the cost of health insurance” (56%), or the “quality of medical care in your community.” (73%).

If you only consider the numbers showing satisfaction with the current scene, you will not understand why seven to eight in ten Americans want Congress to pass health care reform. Talk to ordinary Americans, however, and the answer is clear – it is the insecurity Americans feel about health care and their future.

When pollsters have asked about motivations, the results are revealing. The Washington Post/ABC News poll in June asked a question that begins to explain why people are calling for reform, even if they say things are ok at the moment: the Post/ABC survey found 85% of Americans are concerned about “you and your family’s health care costs in the future.” 59% said very concerned and 25% were somewhat concerned.

Along these lines, it might also be a good idea to find out how many Americans worry about:

• If someone in my family becomes very ill, our insurance will drop us from coverage.
• If someone in my family gets cancer or some other serious illness, our insurance will not cover all the costs. Could this put me at risk of bankruptcy?
• If I lose my job, I will lose my health coverage and I will not be able to afford to buy new health insurance and pay all my other bills.
• If I lose my job or if I change jobs, I will not be able to get health insurance because of a pre-existing condition.

A broad inquiry into the strongest currents behind health care reform needs to measure the insecurity that we all hear expressed every day in our lives. To what degree are Americans scared to get sick, scared to leave a job, or worried about a family member because of the way health care is administered?