Age-Group Comparisons (8/27)

There's been a lot of discussion of how seniors, who already are on Medicare, appear to be the least supportive age group of President Obama and the Democrats' plans for enacting health care reform. Seemingly at the center of seniors' concerns is the idea of cutting federal support for a program called Medicare Advantage. According to a Los Angeles Times article:

Although scaling back payments would have no effect on a sizable majority of Medicare users, it would create an opening for opponents to make the blanket allegation that the president wants to cut back on Medicare benefits -- as some Republicans are already starting to say.

Also, of course, seniors were more likely to vote for John McCain in last year's presidential election than were younger voters, who went overwhelmingly for Obama.

The diagram below (which you may click on to enlarge) compares different age groups' attitudes toward health care reform in four recent polls. Compiling these percentages was not as easy as I thought it might be, for a variety of reasons. First, only some pollsters make a public release of cross-tabulations between demographic characteristics and health care-related attitudes (other pollsters reserve such cross-tabs for paid subscribers). Second, age cross-tabs on a common attitude item were not always available. My plan was to use general favor/oppose items toward Obama and the Democrats' reform plan, but such an item was not always available so I had to substitute other types of items, as described below. Third, different pollsters use different cut-points to create their age groups. There's always a youngest age group, for example, but some pollsters bracket it from 18-29 whereas others use 18-34; similar discrepancies exist for other age groups, as well.


Having said all this, the pattern of seniors showing the least support for Obama/Democratic reform plans is clear and well replicated. For any given color of bar (purple, light blue, green, or orange; each representing a different pollster and question), the shortest height is with the seniors.

One other thing to notice is that two polls, ABC/Washington Post and The Economist/YouGuv, only reported on a 30-64 broad middle-age group rather than having two groups like other pollsters; whether groups in the lower and upper halves of the 30-64 age range were combined because they did not differ much in their responses, or the pollsters never broke 30-64 year-olds into smaller subsets, I don't know. For these two polls, I have taken the percentage on the respective attitude measures attributed to 30-64 year-olds and plotted them twice (linked by a light-blue or green horizontal line), where a 30s-40s group and a 50s-60s group would ordinarily go. Now that these "housekeeping" matters are out of the way, here are the question wordings used:

Survey USA (Aug. 19): “Now I am going to tell you more about the health care plan that President Obama supports and please tell me whether you would favor or oppose it. The plan requires that health insurance companies cover people with pre-existing medical conditions. It also requires all but the smallest employers to provide health coverage for their employees, or pay a percentage of their payroll to help fund coverage for the uninsured. Families and individuals with lower- and middle-incomes would receive tax credits to help them afford insurance coverage. Some of the funding for this plan would come from raising taxes on wealthier Americans. Do you favor or oppose this plan?”

ABC/Washington Post (Aug. 13-17): “Reform’s supported by 58 percent of adults under age 30, but 44 percent of 30- to 64-year-olds and just 34 percent of seniors, apparently concerned about its potential impact on Medicare” (this quote comes from an article and does not depict the actual survey item).

Economist-You Gov (Aug. 16-18): “If President Obama and Congress pass a health care reform plan, do you think you personally would receive better or worse care than you receive now?" (% Saying Better).

Kaiser Family Foundation (Aug. 4-11): “Do you think you and your family would be better off or worse off if the president and Congress passed health care reform, or don’t you think it would make much difference?” (% Saying Better).

The four polls above were not the only ones that made some type of age-related comparison. Others did, as well, but their age groupings and/or survey items appeared non-comparable in some way to the four polls whose results I plotted. Two additional polls are as follows:

A Harris Interactive poll used what I think are the most interesting age-group descriptors (shown in Table 2 of the linked document): "Echo Boomers (18-32), Gen. X (33-44), Baby Boomers (45-63), Matures (64+)." Harris plotted the percentage of respondents in each age group who rated Obama's job performance in various issue domains as "fair" or "poor." On health care, higher percentages of Matures (71%) and Gen. X (69%) gave Obama these unflattering ratings than did Echo and Baby Boomers (each 62%). Along with some of the figures from other polls plotted above, this finding from Harris shows a non-linear trend (i.e., support does not decline in perfect progression from the youngest to the oldest voters).

Finally, a Penn, Schoen, & Berland poll released in conjunction with AARP reported only comparisons between respondents younger than 50 and 50-plus. A section of this poll's report entitled "Specific Policy Proposals" (on pages 6-7) is perhaps the most worthy of attention. On most of the items, the younger respondents are more favorably inclined, but on others, there is little or no difference.

Miscellaneous (8/25)

A couple of brief notes today...

Nate Silver gives his criteria for how poll questions on a public option should be worded. To see my earlier postings on how various survey outfits have worded their public-option items, click for July and for August.

Rasmussen has surveyed Massachusetts residents on their support for health care reform plans being advanced in Washington, DC by President Obama and the Democrats. Fifty-three percent of Bay Staters support the Democratic plan for the nation. This finding is potentially important, as Massachusetts has nearly achieved universal coverage (97.4%), albeit with some growing pains. One component of the Massachusetts policy is an individual mandate to purchase health insurance, some variation of which may appear in the developing federal legislation. Granted, Massachusetts is a liberal state, but for its residents to have seen first-hand a universal-coverage program in place for a few years -- warts and all -- and still show majority support for enacting similar legislation nationally says something.

More Polling on the Public Option (8/24)

Following up on our previous charting of support for a public option, which almost exclusively covered July polling, we now look at surveys from the first three weeks of August. Support levels for the public option are depicted in the following diagram, which you can click to enlarge. Links to detailed reports of these individual polls can be found below in my entries from recent days.


The public option continues to hold its own pretty well, especially when the "choice" aspect of it is made clear in the wording of the question. Even in the Economist/You Gov poll, which as shown above registers the lowest level of support for the public option, it would take only one-third of the undecided switching to a position in favor to give the public option majority support.

From the perspective of any given Senator or Representative, however, the national numbers may not be as important as those in his or her own state or congresssional district. The latter, after all, are where the office-holder must seek re-election. Daily Kos, in association with the independent polling firm Research 2000, has been conducting surveys in the states and districts of Democrats who, in the eyes of many liberals, are not doing enough to achieve passage of a public option. Two such polls that have come out recently are for the state of Montana (whose Democratic Senator Max Baucus chairs the Finance Committee) and the Tennessee district of Representative Jim Cooper who now, as in 1994, appears lukewarm at best to the health care reform efforts of a Democratic president. Whereas a narrow plurality favors a public option in Montana, a large majority does so in Cooper's Tennessee district.

Weekly Wrap-Up (8/21)

An ABC News/Washington Post poll has been released today, adding to the bunch released yesterday.

Nate Silver of "Five Thirty Eight" (a reference to the total number of electoral votes in presidential elections) comments on the discrepancy in a recent NBC/Wall Street Journal poll between the 36% support for "Barack Obama's health care plan" in the abstract and the 53% support when a more detailed description of Obama's plan is provided:

The plan requires that health insurance companies cover people with pre-existing medical conditions. It also requires all but the smallest employers to provide health coverage for their employees, or pay a percentage of their payroll to help fund coverage for the uninsured. Families and individuals with lower- and middle-incomes would receive tax credits to help them afford insurance coverage. Some of the funding for this plan would come from raising taxes on wealthier Americans.

The Kaiser Family Foundation's report of its August poll, released yesterday, provides extensive trend data, comparing responses to the same item in August, July, June, April, and February of this year, and December and October of last year (not all items have all these data points). Despite the extensive media coverage of the August town meetings being held by members of Congress in their home states/districts, the percentage of Americans following these developments "very closely" has risen only modestly, to 33% from percentages in the mid-20s in previous months.

ADDENDUM (8/22): Pollster.com's "Outliers" feature links to several articles pertaining to health care polling.

Avalanche of New HC Polls (8/20)

Today we've seen the release of several polls, each of which is either devoted to health care or contains substantial coverage in that area:

Survey USA (previously publicized by Jed Lewison at Daily Kos)

Economist/YouGov

Kaiser Family Foundation

That should give us a lot to chew on in the coming days!

Misconceptions About Reform Bills (8/19)

A common theme in recent health care polling -- presumably stemming from the heated rhetoric at townhall meetings and elsewhere -- is the degree to which various claims have sunk in with the American people. These claims either refer to policies that are not in any of the bills working their way through Congress or appear to represent gross exaggerations of provisions that are in bills.

Three polls probing for the acceptance of misconceptions have been released in the last two days, from NBC News, Daily Kos, and Public Policy Polling (PPP). Daily Kos is a well-known left-leaning blog, but it uses the established, independent pollster Research 2000 to conduct its surveys.

NBC and Kos asked about a couple of the same areas, as shown in the chart below (which you can click to enlarge). Interestingly, the two polls appear to differ substantially in how much acceptance of misconceptions exists in the U.S. public (percentages indicative of misconceptions are shown in maroon). Whereas the NBC poll shows roughly half of the public endorsing misconceptions, Kos shows only 10-25% acceptance of them.


One possible reason for the NBC poll's higher endorsement level has been suggested by Brendan Nyhan:

The problem is that NBC asked respondents if various results were "likely to happen" under the proposed health care plan, a vague phrase that allows for implausible but increasingly popular fallback position that the provisions in question are not in the plan but will somehow result from it in practice.

A focus of the Kos poll was comparing the responses of self-identified Democrats, Republicans, and Independents. For example, on the question of whether the proposed legislation "creates 'death panels' which have the authority to subjectively determine whether or not a gravely ill or injured person should receive health care based on their 'level of productivity in society'," high percentages of Democrats (88%) and Independents (76%) correctly say "no," whereas only 43% of Republicans do so.

Two polls looked at the public's understanding that Medicare is a government program. According to PPP:

One poll question indicative of how difficult it is to gain public understanding on a complicated issue asked if respondents thought the government should ‘stay out of Medicare,’ something inherently impossible. 39% said yes.

Kos simply asked: "Is Medicare a government program or not?" Respondents of all three partisan groups overwhelmingly gave the correct response of "yes," but the percentage of Republicans who did so (76%) was somewhat lower than the corresponding figures for Democrats (89%) and Independents (83%).

ADDENDUM (8/21): A new national poll by Indiana University also addresses partisan differences in respondents' beliefs about whether certain provisions are or are not included in congressional bills.

Comparing Polls over Time (New NBC Poll; 8/18)

An NBC News poll (in the field August 15-17) has just appeared, focusing on health care issues (findings for select items were released during the day, but a comprehensive article was not available until 6:30 Eastern). One finding that was reported during the day is as follows:

...43 percent say they favor a public option, versus 47 percent who oppose it. That's a shift from last month's NBC/Journal poll, when 46 percent said they backed it and 44 percent were opposed.

Most readers of this blog are probably familiar with the concept of margin-of-error (MoE), the idea that because a poll interviews only a small (albeit scientifically selected) fraction of a large population, there's likely going to be some fluctuation in a sample's result from what the true value in the full population is.

In the present example, one probably doesn't need a lot of statistical firepower to argue that this month's 43% support for a public option (with its attendant margin of error in either direction) and last month's 46% support (with its MoE) may not really represent much of a "shift." For future reference, though, I thought I'd provide the formula for conducting a rigorous comparison of the sort implied by the NBC poll. This document from the University of Minnesota is very helpful. I've summarized some of the key ideas from the Minnesota page in the following graphic (which you can click on to enlarge).


The formula leads us to a 95% Confidence Interval (CI) for what the true difference between the proportions is. In other words, the difference between the two Jones approval ratings is highly likely to be something greater than zero, but not necessarily much different from zero. (One would typically multiply the standard error by 1.96 to get the "plus/minus" term for a 95% confidence interval, but perhaps the Minnesota writer was trying to simplify things by using 2.)

Applying the above formula to the two NBC polls' public-option support levels, one gets:


Because the CI is inclusive of zero (i.e., bounded by a negative value at one end and a positive value at the other), it is thus within the realm of possibility that the difference is indeed zero, as I implied above.

Urgency to Pass a Health Care Reform Bill (8/17)

Given the seeming volatility in what can happen in the health care reform debate -- such as the recent flap over "death panels" -- it's not surprising that President Obama wanted House and Senate floor votes before the August recess. That's impossible now, but presumably the President and Democratic congressional leaders will push for votes as quickly as possible when legislators return to Washington in September. House and Senate members will presumably be more inclined to proceed swiftly, to the extent voters express a strong sense of urgency that health care reform be enacted. How urgent do voters think health care reform is?

In the following diagram (which you can click to enlarge), I've plotted different polls' answers to this question. A couple of things should be noted. First, I've grouped together survey items that, on the surface, seem to be asking about different things; I would argue, however, that all of them get at the urgency question in one way or another. Second, the percentages listed in the headings for respondents who consider passage of health care reform a high priority are conservative (in the sense of being cautious). For example, I say that 46% of respondents in the TIME magazine poll assign a high priority to passage of health care reform. Those are only the people who said it was "very important." Arguably, however, we should add in the 23% who said it was "somewhat important," which would bring the total to 69% attaching some importance to passage of a bill.


The poll implying the least urgency for passage of a health care reform bill is Rasmussen's. I know I pick on Rasmussen fairly often, but two points seem worth making. First, across a variety of issues, Rasmussen's recent polls seem to skew Republican a bit. Second, of the 54% favoring no action this year, perhaps some of these respondents (and by extension some of the larger population) would favor a health care reform bill being passed next year, after more negotiation and compromise.

As with all the other issues for which I've been summarizing poll results, it will be interesting to see what polls coming out in the coming weeks say about the matter of urgency.

Weekly Wrap-Up (8/14)

My thanks to all who have visited this blog during its inaugural week! Thus far, I have been summarizing Americans' views on specific issues, based almost exclusively on polling done during July. I expect many, if not most, of the same media and polling outfits to come out with new results in the coming weeks. At least I'm hoping that's the case, as the best way to examine trends is by looking at the same pollster, using the same questions, over time.

One outlet that had a July poll (July 21-22) and now has an August poll (August 11-12) is FOX News/Opinion Dynamics. Self-identified Republicans are a little over-represented in this poll (D 39, R 35) compared to Pollster.com's national average (D 38.3, R 32.5), which should be taken into account in looking at FOX's overall national results. Also, many of the health-related items in the FOX poll are, one might say, a bit more "quirky" than those asked by other outfits. For example, one of the FOX items asks:

"Which one of the following [emotions] best describes how you feel about the government being more involved in your health care?"

Self-identified Democrats fall primarily into two categories: reassured (37% of Democrats) and indifferent (35%). Republicans, on the other hand, fall predominantly into frightened (51%) and angry (27%).

The question-wording iself is questionable, in my view, as most Americans' current health plans will likely remain unchanged and, for these people, the government presumably would not be "more involved in your health care." Critics have argued that Obama's claim of, "If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period..." might be somewhat misleading. The reason is that, even though nothing in the legislation would explicitly throw people out of their existing plans, the government plan might induce businesses to change or drop their employees' current plans, which could be considered a by-product of government involvement. However, approximately 90% of Americans in employer-based plans would apparently stay in them, according to a Congressional Budget Office analysis of one of the plans under consideration by the U.S. Senate:

"[By 2017] about 147 million people would be covered by an employment-based health plan, 15 million fewer than under current law."

This Yahoo News/AP "Fact Check" article also does a nice job of examining this area of contention, as well as others.

Just a couple more brief notes:

*The August 11 installment of Pollster.com's "Outliers" feature (links to various polling developments) has a number of health-care relevant links.

*The Marist Poll (which was in the field August 3-6) has now entered the fray on health care reform.

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.

Taxes to Pay for Expanded Coverage? (8/12)

With President Obama pledging that health care reform must be deficit-neutral, new revenue sources will be necessary so that the extension of health insurance to the millions of uninsured will not add to annual federal budget deficits (and, cumulatively, the national debt).

Among the proposals to add revenue, two of them are tax increases on upper-income Americans and treating the health-insurance benefits many Americans receive from their employers as taxable income (generally, the latter proposal has been restricted to employees with particularly generous "gold-plated" health plans). The diagram below (which you can click to enlarge) focuses on the four polling firms that asked about both an upper-income and employee-benefits tax.


Upper-income tax increases have clear majority support, from 56-68 percent. According to an article from earlier this summer, "House Democrats are considering a $544 billion tax on families that earn more than $350,000 a year, but [Speaker Nancy] Pelosi wants to raise the income threshold to $1 million for joint filers." The NBC/Wall St. Journal poll asked about both of these income levels and Pelosi's proposal indeed draws additional support; the NBC/WSJ item on setting the threshold for new taxes at a million dollars also draws higher support than other firms' items on higher-income taxes.

Treating employee health-insurance benefits as taxable income, on the other hand, is not very popular. Even when the survey item alludes to only health-insurance plans above a certain monetary value being taxed (Pew), support is very low. The NBC/WSJ item draws 41% support, but it refers only to insurance companies being subjected to higher taxes (presumably companies' added tax liabilities would be passed on to beneficiaries).

Just to mention a couple other polls that didn't ask both the high-income and employee-benefits questions, in late July the CBS/New York Times poll found 65% support for the item, "In order to help pay for health care reform, would you favor or oppose increasing taxes on Americans with high incomes?" Also, back in May, Rasmussen polled on various tax options, including the employee-benefits one.

The "Public Option" (8/11)

Perhaps the most contentious issue among congressional negotiators and interest groups in Washington, DC (and elsewhere) is the so-called public option. The idea is that the government would create a new health-insurance program (modeled to one degree or another on Medicare, the government insurance program for seniors) that people could join. Proponents argue that, by having it compete with private insurers, the public option would help control costs. Opponents, on the other hand, see the public option as yet another government intrusion into an area they feel should be left to the private market.

Where does the public seem to stand? Not surprisingly, the public option has been widely polled, and we shall focus exclusively on it today. As seen in the diagram below (which you can click on to enlarge), levels of support for the public option vary widely according to different polls, despite the relative consistency of question wording (all the survey items refer in some fashion to the public option being a government health-insurance program that would compete with private insurance companies). The predominant trend, I would say, is that a majority of respondents supports a public option, with five of the eight polls showing between 52-66 percent in favor.


Still, though, two other polls show support in the mid-40s and one poll (Rasmussen) has support way down at 35%. What to make of this? Let's start with Rasmussen. Whereas Rasmussen's presidential-election polling has tended to be highly accurate (relative to the actual results), other types of polls from this outfit appear to have had a Republican slant. Here are some examples:

*Whereas most polls tended to have George W. Bush's job-approval ratings during the waning months of his administration in the low-30s or even the 20s, Rasmussen consistently had it around 35%.

*Whereas virtually every pollster other than Rasmussen has shown a majority of voters to prefer the Democrats (at this early point) in next year's U.S. House elections, Rasmussen has been showing the Republicans in the lead (albeit with large percentages undecided).

Polling analysts refer to systematic differences in the results (on the same basic issue) between different survey firms (or survey "houses") as house effects. These may stem from different firms' practices regarding question-wording, sample weighting, etc. On health care reform and other issues, it looks to me as though Rasmussen has a substantial house effect.

There's one other aspect of the public-option polling I'd like to point out. As can be seen in the diagram above, I have highlighted in red the words "option" and "offering" in the wording of some of the survey items. It appears that wordings stressing the voluntariness of the public option (i.e., that it is an "option," or something "offered" to the consumer) tend to elicit higher support than wordings that don't highlight voluntariness as much. This is just a hunch. If anyone has other explanations for the large variation in support between the polls, please share them in the comments section.

Universality, Individual and Employer Mandates (8/10)

Today, we look at three specific issues in the health care debate. The first is universality (i.e., belief that any new policy should work toward or guarantee health insurance to all). The other two issues involve possible mechanisms for achieving universality, an individual mandate (i.e., requiring all individuals to obtain health insurance) and an employer mandate (requiring companies to provide health insurance to their employees -- as many of them do now -- perhaps with some assistance to the smallest businesses to help them fulfill the mandate).

We see first that, via a variety of different question wordings, universality consistently receives majority support (you may click on the graphics to enlarge them)...


The polling on personal/individual mandates reveals a huge disjunction, with two polls showing robust support and another two showing weak support. The distinguishing factor appears to be how the situation is characterized for people who would have trouble adhering to the mandate. When the survey item emphasizes "help" being available for these people, the policy is supported, whereas when punitive consequences for noncompliance are mentioned, support plummets.


Lastly, support for the employer mandate tends to be around 50% and above, except for one poll that refers to a "penalty" being imposed on companies that do not participate.


Most of the underlying data for these graphs can be found in Polling Report's health policy page, except for the FOX data, which are available here.

Welcome Statement

If you're following the debate in Washington, DC over health care/insurance reform as closely as I am, you're probably interested in what the public opinion polling has to say. One thing that I find particularly frustrating is when a media report cites only one poll to make a claim about the public's support or opposition toward some issue or another, without contextualizing the matter (i.e., is the one poll consistent with others taken around the same time or is it possibly an outlier?). My aim, therefore, is to compile all the relevant polling in one place, just like Stuart Thiel's old "Professor Pollkatz" site used to do with George W. Bush's approval ratings.

There already are at least two poll-compilation sites where you can see what's going on related to health care, but each is limited in some way. Pollster.com presents beautiful graphics compiling poll results on a given topic, but thus far at least, it is covering only two questions related to health care: President Obama's handling of the issue, and general support for the Democrats' health care reform efforts (as led by Obama or congressional Democrats). Polling Report, on the other hand, provides a lot more raw information, but (a) it's not in graphical form, and (b) it doesn't group the data together by specific issues (e.g., support for universal coverage, a public option, an employer mandate, etc.). The relevant Pollster and Polling Report pages can be accessed via the links section to the right. I will aim, however, to create additional graphic depictions on the specific components of the larger health care debate.

The next few months will be "crunch time" for health care reform. If you want to see where the public stands on all the particulars of the debate, this is the place!