Thursday, August 13, 2009

Anticipated Effect on Quality of Care (8/13)

How do Americans think health care reform will affect the quality of health care? Pollsters have addressed this question from two frames of reference, how people think health care will be affected for the nation as a whole, and for oneself and one's family. As shown in the diagram below (which you can click to enlarge), the polling is clear. Americans appear far more sanguine that reform will improve health care at the national level (darker-shaded boxes) than in their own personal lives (lighter-shaded boxes). Regarding anticipated impact on health care for the nation at large, two recent polls (Kaiser and Gallup) show sizable pluralities in a positive direction -- in other words, more people think health care nationally will be improved than degraded. A third recent poll, Quinnipiac, has it essentially even. (A Rasmussen poll from back in January produced more pessimistic results.)

When it comes to perceived personal impact, however, there's near-unanimity in the polls that reform will damage the care individuals and their families receive (the one exception is the poll by Kaiser, where a slight plurality thinks its own care will get better).

The above pattern -- where Americans have responded relatively favorably regarding how they think reform will affect health care nationally -- may be a good sign for President Obama and the Democrats as they seek to enact (and potentially at a later time, implement) health care reform legislation.

While I was studying for my Ph.D. in social psychology at the University of Michigan in the 1980s, I took a course on public opinion from political scientist/social psychologist Donald Kinder. One of Prof. Kinder's ideas at the time, as I understood it, was that support for an incumbent president is driven more by individual voters' collective ("we") perception of how well the economy is doing for the nation as a whole, than by an individualistic ("me") perception of how that particular voter is doing. I just found an online document that summarizes this research more formally:

Early studies assumed [support for an incumbent president] was indicative of pocketbook voting −- citizens rewarding and punishing incumbents based on their own economic circumstances (Key 1968; Kramer 1971). But subsequent studies established that the effect of personal economic circumstances was small in magnitude relative to perceptions of the state of the national economy (Kinder and Kiewiet 1979; Markus 1988, 1992). This phenomena of evaluating the president based on national rather than personal economic circumstances, known as “sociotropic” voting, has become one of the main ways in the political science literature that voters systematically hold presidents accountable for their performance in office (Fiorina 1981; Achen and Bartels 2004).

A couple of cautionary notes are in order before folks at the White House begin popping the champagne corks. First, will the sociotropism phenomenon hold as well for health care as for the state of the economy (especially given the current recession/depression)? Second, the above poltical-science excerpt makes clear that it's actual -- not merely anticipated -- results that voters are looking at. On the whole, though, these poll findings would seem to provide reasonably good news for the Democrats.

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