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Tilting at Windmills

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October 25, 2007
By: Kevin Drum

THE HEALTHCARE ENIGMA....From an LA Times poll on healthcare, an interesting finding:

In one of the most politically significant results, the poll finds that independents and moderates were generally lining up with Democrats in the healthcare debate.

The survey also suggested an explanation for the emerging alignment: Independents were most likely to complain about "job lock" — the view that they are stuck in jobs they don't like solely because of health benefits. In all, 20% of independents said they or someone in their household were forced to stay in a job because it provided healthcare, compared with 13% of Democrats and 5% of Republicans.

The "job lock" argument has always seemed like a persuasive one to me, but I've long wondered whether it really had concrete salience for very many people. This survey suggests that it does, but then adds a further layer of mystery. Why, after all, should political independents suffer from it more than Democrats or Republicans? Very odd.

Elsewhere in the story, we get further evidence that Americans basically have completely incoherent views about healthcare:

The poll found that Americans were divided on one of the basic questions surrounding the healthcare debate: who should bear the main responsibility in securing health insurance.

Twenty-nine percent said it is the responsibility of government; 23% said employers; 24% said individuals should take care of themselves, without help from government or employers; and 19% said it is a shared responsibility.

....The survey found that 53% supported the idea of extending Medicare to cover all Americans, creating a government-run system; and 36% opposed it. But Blendon, the Harvard expert, said that finding was suspect because the poll question did not make clear that such a system would be financed by taxes.

So 29% think government should be responsible for providing healthcare, but 53% approve of extending Medicare to cover everyone. Uh huh. And then this Blendon fellow suggests that maybe this contradiction is the result of people not realizing that Medicare is paid for with taxes. That's completely crazy, of course, but it's also quite possibly true.

So what to think? Two things: (a) Support for national healthcare really isn't as strong as a lot of liberals would like to believe. (b) People really are confused on this subject, and their opinions are shallow and malleable. Genuine leadership could change a lot of minds.

Kevin Drum 1:56 PM Permalink | Trackbacks | Comments (121)

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No Kevin thats wrong. When its an actual program they support it in droves. When given 1 of 4 chances they data is pretty much what you'd expect if they were picking randomly.

Posted by: Rob on October 25, 2007 at 2:02 PM | PERMALINK

"24% said individuals should take care of themselves, without help from government or employers"

WTF? Have these people ever heard of "pre-existing condition"? With one, you are totally screwed in this society.

I note that 24% is also Bush's base. So we know the % of people with severe brain damage...

Posted by: Gore/Edwards 08 on October 25, 2007 at 2:02 PM | PERMALINK

One of the conservative complaints (last heard, from Hannity): where is government providence going to end? If healthcare (that really means "insurance"), why not all food, housing, etc? Well G already covers some of that for those at the very bottom, but health insurance is fundamentally different from other services and goods we buy. The main reason: you are paying for someone to do something in the future event an unexpected occurrence happens, and their expected compliance and the cost of their not doing it is unpredictable. Contrast housing: you pay X per month for something evident to you in direct utility, similarly for each item of food, car, etc. That is very classical market economy, with rather good real-time information held by buyers.

However, with health "insurance" as exists now, you don't know what value you've really paid for until something big happens, and then the "provider" will try to deny the service it is supposedly being paid to provide. That makes it all different. Also, there is the more expensive consequences of not getting the care early, whereas living in scruffy housing isn't going to make given housing even more expensive for you in the future compared to someone else.

For those reasons, it makes sense to have "national healthcare" (national health insurance.)

tyrannogenius

Posted by: Neil B. on October 25, 2007 at 2:08 PM | PERMALINK

Definitely (b); with maybe a little (a), although I think this is mostly because people are not informed on the subject.

Posted by: Dan on October 25, 2007 at 2:10 PM | PERMALINK

Well, the two poll question results don't really represent a "hard" inconsistency.

One can reasonably believe that the main responsibility for providing health care costs should be employers, and yet recognize that, because employers aren't doing the job (especially, and obviously, for those who are unemployed), the government should step in with a Medicare like program to cover everyone.

Posted by: frankly0 on October 25, 2007 at 2:10 PM | PERMALINK

instead of "health care costs", I meant "health care insurance".

Posted by: frankly0 on October 25, 2007 at 2:12 PM | PERMALINK


Republicans are more likely to be able to move from one well-covered job to another. Being rich means never having to worry if you'll get good health care.

Democrats are less likely to have health insurance at all.

If Republicans don't lose coverage, and Democrats don't have coverage, Independents are in the economic middle. As middle class wages stagnate and benefits keep shrinking, they are HURTING.

Posted by: EthanS on October 25, 2007 at 2:13 PM | PERMALINK

Public opinions about health care are more incomplete than they are shallow.

People with adequate insurance -- a majority, and a large majority of people who vote -- recognize it as their gateway to generally excellent health care. They may not like the cost, they may gripe about the paperwork and the jargon, but their devotion to protecting that gateway is anything but shallow. Propose something that they think might threaten it and watch what happens.

The public's view of health care issues that do not directly and immediately affect them is much more likely to be subject to change. The uninsured and what to do about them, coverage of various kinds of specialty care most people don't think they will ever need, the staggering overall cost of the health care system as a whole -- these are all areas in which most Americans have few fixed opinions and a generally open mind.

But the situation here is a little like tax reform. Do most Americans want a fair tax system that treats people with similar incomes similarly? Sure they do. Are they willing to see their own taxes go up to get an equitable, simple tax code. Nope. That's the puzzle prospective health care reformers will have to work out.

Posted by: Zathras on October 25, 2007 at 2:15 PM | PERMALINK

The job lock issue seems really important to me. I know a number of people who would have started their own businesses (creating jobs! building the economy! entrepreneurship!) but ultimately decided against it because the health care risks were too great. It seems like the party of free markets and small business would recognize this market failure and do something about it. It's weird to me that I've never heard a politician discuss this problem.

Posted by: Joe on October 25, 2007 at 2:15 PM | PERMALINK

The "job lock" argument has always seemed like a persuasive one to me, but I've long wondered whether it really had concrete salience for very many people.

Take it from someone with two children: yes. This is especially true if the benefits are good.

Posted by: JeffII on October 25, 2007 at 2:19 PM | PERMALINK

Government and personal responsibility are not incompatible. A "Medicare for All" program that provides 1)preventative care and 2) a high deductible -- with 3) partial assistance before the deductible is met -- might fit the bill.

This structure would prevent health problems from causing financial ruin. Making us more responsible for our initial health spending seems reasonable to me, and would appeal to conservatives and libertarians. In addition, we could use supplemental insurance (Blue Cross, Medicaid, etc.), Health Savings Accounts, and the like to pay for services before the deductible kicks in.

Posted by: Dan on October 25, 2007 at 2:21 PM | PERMALINK

I think that most people just don't think about health insurance very deeply unless/until they or someone in their immediate family has an illness that they can't/couldn't cover without insurance. For 10 years the most I ever thought about my health insurance as a vague resentment that the premiums were so high when I never spent that much in a year. Then I developed cancer and got great care because neither my doctors nor I had to think about whether I or my insurance company would pay. So, now I'm a "health care voter" who really does want to see a way for everyone to get what I got, and to not have to have a high paying job to get it.

Posted by: elisabeth on October 25, 2007 at 2:27 PM | PERMALINK

Why would political independents experience job lock due to health care more than Democrats or Republicans?

Because a larger percentage of middle-class people define themselves as independents. The poor either define themselves as Democrats (because they want help) or Republicans (because they want the blacks/gays/terr'sts gone). The rich define themselves as Republicans (because they're rich) or Democrats (because they are in a position to influence policy, or rarely because they're altruists). The middle-class is disproportionately filled with people with no firm ideological leanings. So they have a disproportionate number of independents.

And it's the middle class who feel job locked due to health care. The poor are job-locked due to a need for food and shelter, if they even have jobs. And the rich don't get job locked.

Health care is a problem for the poor because they don't have it. Health care is a problem for the middle class because they have it, and cannot rise further along the social ladder without endangering it.

Now do you see how a rigorous caste system comes into being? One ideology wins and they become the upper class, and the system breaks for all other ideologies, who then become the poor.

Posted by: Remus Shepherd on October 25, 2007 at 2:29 PM | PERMALINK

The other thing this data shows is that a new health plan should be REALLY EASY TO EXPLAIN. Because people don't know what the hell they think.

Medicare For All.

Posted by: tatere on October 25, 2007 at 2:33 PM | PERMALINK

In other words, it's the old "Don't let the government get control of my Medicare" problem -- too many people have been so scared off the idea of government-run health insurance that they can't even recognize it as something they would actually like.

Posted by: Isaac on October 25, 2007 at 2:34 PM | PERMALINK

add that 29% to the 19% who say it is a shared responsibility and you come out with 48% of people who think that government should be involved in some way.

That is not too far off of the number of ppl who support expanding Medicare (53%). Let's turn Kevin's statement around and say that maybe people DO think that Medicare is paid for in with people's taxes....and they think it is implicit when they think of Medicare that it is a "shared responsibility" with the taxpayers.

Posted by: zAmboni on October 25, 2007 at 2:36 PM | PERMALINK

Reminds us of the old saw of the lady who approached then-Sen. John Breaux during the early 90s, when we last discussed health reform, and said: "Don't let the government get its hands on my Medicare!"

His gutless answer: "No ma'am, I won't."

Posted by: chocolate thunder on October 25, 2007 at 2:37 PM | PERMALINK

Kevin: What is it with you and the either A) or B) questions lately?

And by the way, which attack would you have preferred the President didn't prevent?

That's how I feel your posts have been lately.

Posted by: Doubting Thomas on October 25, 2007 at 2:40 PM | PERMALINK

I've had to negotiate the health-care maze for a couple of years. Before I retired, I was a lawyer and a pretty smart person, generally, but I made a couple of mistakes and I may have to rely on California's major risk insurance program (which maxes out benefits at 75k per year) IF I can get into it. (It is fully subscribed at the moment.)

My advice is to find a good insurance broker, because NO ONE can do this themself if they have a "pre-existing condition."

Confused? Anyone who isn't confused either has employer-paid health insurance (and therefore not much choice) OR they haven't tried to get individual coverage.

Posted by: Cal Gal on October 25, 2007 at 2:41 PM | PERMALINK

Lots of people, including me, get confused between
health care financing
and
health care administration.

Any good sequence of health care reform proposals enacted into law are going to involve reforms to both financing and administration.

And, Republicans are pretty good at invoking the specter of "government-run" health-care: a nightmare vision, in which health-care becomes a behemoth scarily like the DMV.

Posted by: Bruce Wilder on October 25, 2007 at 2:43 PM | PERMALINK

"Health care is a problem for the poor because they don't have it."

Well, I think they do, actually. It's called Medicaid (or in California MediCal).

Because the poor GET health care, perhaps that's why Democrats are less worried about it than Independents.

The middle class, as has been pointed out, are the ones getting screwed by the current system. Of course, once they spend everything they have saved, sell their houses, and basically lose it all because of a health emergency, THEN they will become poor and get "socialized medicine" in the form of Medicaid.

Posted by: Cal Gal on October 25, 2007 at 2:47 PM | PERMALINK
The "job lock" argument has always seemed like a persuasive one to me, but I've long wondered whether it really had concrete salience for very many people. This survey suggests that it does, but then adds a further layer of mystery. Why, after all, should political independents suffer from it more than Democrats or Republicans?

People whose attachment to external groups generally is more a matter of potentially transitory convenience rather than tribal identity are more likely than others both to politically identify as "independent" and to chafe at being stuck in a job.

Elsewhere in the story, we get further evidence that Americans basically have completely incoherent views about healthcare

Perhaps somewhere, but not in the material you quote.

So 29% think government should be responsible for providing healthcare, but 53% approve of extending Medicare to cover everyone.

You are overlooking the 19% who think healthcare is a "shared" responsibility that doesn't rest solely with employers, individuals, or government, and you are overlooking the fact that people can believe, without inconsistency, e.g., that healthcare is an employer responsibility, but that employers are taking care of it badly and it is impractical to compel them to do it well, therefore, notwithstanding that it should not be a viewed as a "government responsibility", it would nonetheless be better if the government stepped in and handled it and passed the costs on to employers in the form of taxes as the only practical way of compelling employers to meet their responsibility. I, therefore, see the results showing 71% of the population holding views that can not be fairly portrayed as logically inconsistent with expanding Medicare to cover everyone, and 53% actually holding that position. There is no incoherence.

You can sometimes find polls that find genuinely incoherent priorities (particularly when you find that genuinely inconsistent views are not merely held by groups that may have some overlap, but positively correlated.) But what you point to isn't the least bit inconsistent or incoherent, even if might be a little bit surprising.

And then this Blendon fellow suggests that maybe this contradiction is the result of people not realizing that Medicare is paid for with taxes.

Well, maybe their conservatives: the right always excludes payroll taxes from any discussion of taxes. OTOH, no such ignorance is necessary to explain the statistics that are being explained, since none of the expressed preferences are inconsistent with everyone in the poll recognizing that Medicare is paid for with taxes.

So what to think? Two things: (a) Support for national healthcare really isn't as strong as a lot of liberals would like to believe.

Nothing earlier in your post or the quoted material even begins to support this "conclusion".

(b) People really are confused on this subject, and their opinions are shallow and malleable.

Nothing earlier in your post or the quoted material supports this "conclusion", either, though I suppose you conclude this from your single spurious example of "incoherent" preferences.

Posted by: cmdicely on October 25, 2007 at 3:08 PM | PERMALINK

What Kevin? No post about the most recent Judith Millering from the NYT?

Posted by: Disputo on October 25, 2007 at 3:12 PM | PERMALINK

Genuine leadership could change a lot of minds.

So could demagoguery, unfortunately.

Posted by: ColoZ on October 25, 2007 at 3:15 PM | PERMALINK

The survey found that 53% supported the idea of extending Medicare to cover all Americans, creating a government-run system; and 36% opposed it. But Blendon, the Harvard expert, said that finding was suspect because the poll question did not make clear that such a system would be financed by taxes.

Methinks the Harvard expert is suspect, or full of BS. Most assessments show that in the U.S., the non-medical costs of private insurance make it not only more expensive than Medicare, but more expensive per capita than any national health care system in any developed country in the world - with nothing to show for in terms of better health care. I would suspect that the percentage supporting the extension of Medicare would be even higher if people were told that it would be financed by taxes, but would involve getting rid of or reducing their health insurance premiums to the point where they would be paying less than they currently are if they have private coverage.

Posted by: mb on October 25, 2007 at 3:19 PM | PERMALINK

Being afraid government will get it's hands on Medicare makes perfect sense when you think about how government takes Social Security funds for other purposes.

People can't make judgments or choices about things in the abstract. Give them real complete options to consider and then you'll get more useful responses.

Basically people should take care of themselves. But, what if they can't? What if the health care system is pricing people out of the 'market' and bankrupting America?

We need to help those who can't help themselves and when it becomes a majority of Americans we need a big program to help restrain the private system or to compete with it or, in the extreme, to replace it. Right now I think we haven't been restraining it much and people are leaning toward competing with it (the Edwards plan is an example).

John Edwards for President -- Real Leadership!

Posted by: MarkH on October 25, 2007 at 3:21 PM | PERMALINK

"And then this Blendon fellow suggests that maybe this contradiction is the result of people not realizing that Medicare is paid for with taxes."

Another possibilty is that many respondents associate payroll taxes as Employer related. Given the options, people who support employer based healtcare which makes up a large part of coverage in this country picked that option despite the fact that it actually a form of shared responsibilty.

Many people view payroll taxes as different from income taxes since they never actually get the money and is automatically taken out of their paycheck by their employer.

Posted by: Catch22 on October 25, 2007 at 3:22 PM | PERMALINK

Forget changing minds. Just repackage Medicare as a new insurance company, Red White and Blue Shield, on offer to anyone. Premiums can be paid through payroll deduction with employer contribution or directly if that is not an option. It will be less expensive, more efficient, and have better service than anyone else. Plus, members are automatically shareholders with the right to elect Directors and Executives at regular intervals. Let that compete in the marketplace.

Posted by: apm on October 25, 2007 at 3:22 PM | PERMALINK

I'm in 'job lock' right now. I'd like to go independent and be my own boss, but I can't see doing that with the cost of health insurance.

And I suspect most employers see that as a feature, not a bug. If more people became independent actors, the employers might have to pay more to get things done.

Posted by: tom on October 25, 2007 at 3:33 PM | PERMALINK

Incoherance is not an abstract thing; I handle HR administration for the small company where I work. We are in the process of securing a new healthcare plan, making it affordable for our employees for wider participation. Beyond the details of that excercise, I was in a dicussion with a ProBush guy here who is totally opposed to any government healthcare program except when he would enroll in the State program to help him out financially with the impending birth of his twins

Posted by: bcinaz on October 25, 2007 at 3:42 PM | PERMALINK

Job lock is real. I just changed jobs after a 14 year run at the same company, and quickly dismissed the possibility of striking out on my own because of concerns about health insurance. We could weather reduced income for awhile, but the risk of financial wipeout from a badly timed health emergency was way too much to take on.

Posted by: just sayin on October 25, 2007 at 4:35 PM | PERMALINK

And I suspect most employers see that as a feature, not a bug. If more people became independent actors, the employers might have to pay more to get things done.

Given the crushing cost to employers of providing health insurance, it's hard to explain their strange silence on the topic of UHC without considering that yes, much of corporate America does appear to see job lock as a feature. I'm not sure that companies would end up paying more for contractors than they do for full-time employees, since benefits represent such a huge piece of employee costs, but it does cost a bundle to turn employees over. Portable heatlh insurance does mean mobility for a lot of people who were stuck before.

And of course people who really, really need their jobs for the health care tend to be more grateful, less likely to complain and possibly harder working, although that's not something that's easy to quantify. I've been looking for research on this very subject lately and not having a lot of luck. Why isn't business leading the charge for UHC?

Posted by: shortstop on October 25, 2007 at 5:05 PM | PERMALINK

A tale of 3 Independents:

My brother is age 55, self employed for about 30 years, making shy of $100,000/yr. His wife left her job as a 911 operator due to health & they now pay for COBRA coverage, which will soon end, costing them about $15,000/yr. Her pre-existing condition from a stress related illness makes them uninsurable otherwise. She will be returning to work at her former job next month solely to be able to obtain health coverage. Her chances of being able to keep working are slim. But it is their only option if they are going to have the coverage that is keeping her alive.

My sister is an RN making about $50,000/yr. +/-, age 60. In 2 years she will be eligible for SS retirement benefits, but will keep working because of the cost of maintaining her health coverage, until age 65.

I am 63, living on SS, & cannot obtain any health coverage until I reach age 65, when I will be eligible for Medicare.

Ten years ago, we were all against universal health care. Today we are all in favor of it in some form. It's amazing what changes in circumstances will do for one's beliefs.

Posted by: bob in fla on October 25, 2007 at 5:14 PM | PERMALINK

Why isn't business leading the charge for UHC?
Posted by: shortstop on October 25, 2007 at 5:05 PM
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Actually, many of the large corporations are. A parallel trend among big business is offering buyout packages for older employees, even though they still usually cover their health care costs after retirement. Though reasons vary between individual companies, the general reason is it is cheaper to hire new, younger help who have more energy & skills that better fit the new workplace.

Just one example is the auto companies no longer hire welders to assemble the cars. Robots now do the fitting & welding. The worker sets up & operates the robots, which is an entirely different set of skills.

Posted by: bob in fla on October 25, 2007 at 5:25 PM | PERMALINK

bob, thanks. Can you give me some examples of large companies publicly advocating UHC? Not that I don't believe you; I'd just like to follow up on this.

Posted by: shortstop on October 25, 2007 at 5:41 PM | PERMALINK

One other factor in the issue about independents being more concerned about job lock is that probably union members are more likely to consider themselves party members. My father has great benefits from the IBOE. It pays for his
medication and most of his health care, as it did for my mother.
Of course, he still has always called himself a Republican because he lives in Indiana and always has been a Republican. Don't know if he's reconsidered lately.

Posted by: JeffL on October 25, 2007 at 5:55 PM | PERMALINK

Why are voters confused about healthcare or incoherent as KD says? Perhaps it's because the media from print to radio to TV and cable can't (or won't) tell US voters a simple fact.

Here's Paul Krugman (7/9/07)
Meanwhile, every available indicator says that in terms of quality, access to needed care and health outcomes, the U.S. health care system does worse, not better, than other advanced countries — even .

Want US voters to be less incoherent, why not start with this fact and pound it through every media outlet. And ask why it's only Krugman who writes this and not every single "liberal" mouthpiece in this country. Or wouldn't that be prudent?

Posted by: TJM on October 25, 2007 at 6:02 PM | PERMALINK

Bob Somerby at The Daily Howler has written about this topic viz. Edwards' candidacy. See here and follow the links.

Posted by: TJM on October 25, 2007 at 6:07 PM | PERMALINK

Curses, somehow I cut off the important part of the column (preview is your friend, stop feeding the dog while trying to type)

Krugman:Meanwhile, every available indicator says that in terms of quality, access to needed care and health outcomes, the U.S. health care system does worse, not better, than other advanced countries — even Britain, which spends only about 40 percent as much per person as we do.

Posted by: TJM on October 25, 2007 at 6:11 PM | PERMALINK

Most people who rail against tax money paying for health care do not realize just how much their employer spends on their health care. Or how much more they could have in their paycheck if the employer did not have to finance health care.

Posted by: veloer on October 25, 2007 at 6:51 PM | PERMALINK

Veloer - and what makes you think if the employer stopped financing health care that the employee would see a thin dime of the savings?

Posted by: denise on October 25, 2007 at 11:12 PM | PERMALINK

Kevin writes:

"The "job lock" argument has always seemed like a persuasive one to me, but I've long wondered whether it really had concrete salience for very many people."


I'm a case in point. I've been fighting cancer on and off for 30 years. Three seperate instances (melanoma, bladder cancer, and colon cancer), and so far, so good. I'm currently clean, healthy, and middle aged, but no health insurance company will even talk to me. The only way I can stay insured is in a dead-end job. I could make triple my current income by freelancing, and I have to work on the side to save for retirement. But to leave my day job would be a death sentence.

I'd be of much more value to society and my family if I could switch jobs, and were I living in any other of the industrial countries, I would. Alas, nobody's taking in middle-aged cancer survivors unles they have big assetts, and you can't really blame them.

In 3 more years, Medicare kicks in, and If I live that long, my life will change for the better.

George Bush and Dick Cheney get the best socialized medicine that money can buy, and some of that money was mine. So it goes with the aristocrats. They've got theirs and everybody else is on their own

Posted by: Slideguy on October 26, 2007 at 10:29 AM | PERMALINK

I know some elderly people who are convinced, absolutely, that social security is private insurance. They know that they are not the kind of social parasites that receive government benefits, they receive social security, therefore social security is a private, commercial program that they paid into. And they say they are not getting a penny beyond their past contributions. I cannot convince them otherwise. Very odd.

Posted by: socialinsurnace on October 26, 2007 at 4:31 PM | PERMALINK

I would imagine that job lock is a phenomenon that crosses party affiliation, but that independents feel more aggrieved by it.

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