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Opinion, Choices, and Health Care Reform

The insightful post below from our friends at Public Agenda is a great piece that puts the government shutdown into the context of public dialogue and deliberation, highlighting the need for much more of it around health care issues. You can read the full post below or find the original post on PA’s blog by clicking here.

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We Must Help, Not Hinder, the Public on Understanding Health Care Reform

The argument to delay implementation of the Affordable Care Act, which led to this week’s government shutdown, is partly rooted in the assertion that the public does not support the law. Yet public opinion of the health care law is not as simplistic as some members of Congress (of both parties), and even the media, have painted it. Before we continue basing decisions that have real consequences on opinion regarding the Affordable Care Act, it’s worth taking a deeper look at how the public is really thinking about this issue.

Many of the recent polls, when taken together, suggest that the public is confused and unclear about many aspects of the Affordable Care Act. In the most recent health tracking poll from the Kaiser Family Foundation, 51 percent of respondents said they don’t have enough information to understand how the law will impact them and their families. When asked to provide, in their own words, the one question they would most like to have answered to help them understand this impact, many focused on very basic information:

“Will the medical insurance be free or will I have to pay?”

“Can you just put it in plain laymen language so we can understand what you’re doing for us?”

“How is my care going to change?”

Furthermore, while most recent polls suggest the public does not support the Affordable Care Act as a whole, when the law is broken down into its respective elements, they support what’s in it. For example, in a 2012 poll from the Kaiser Family Foundation, majorities viewed individual elements of the law as either very or somewhat favorable:

  • Closing the Medicare prescription drug coverage gap (78%)
  • Allowing children to stay on parents’ health insurance until 26 (71%)
  • Expanding Medicaid to cover more low-income, uninsured adults (66%)
  • Prohibiting insurance companies for charging women more for coverage (61%)
  • Prohibiting insurance companies from withholding coverage for preexisting conditions (60%)

Many people also don’t realize that the Affordable Care Act and Obamacare are one and the same, and their opinions depend on how the law is referred to. In a CNBC poll from September, 24 percent of respondents said they felt “very negative” about the Affordable Care Act. In the same poll, 35 percent felt very negative about Obamacare.

When people lack basic information about a policy, and when they are unable to clearly understand how the benefits and tradeoffs of a policy will affect their lives, it’s very difficult for them to get past impediments like denial and wishful thinking. And people need to resolve these impediments before we can fairly consider their opinion a clear-minded judgment of a policy or approach.

This confusion is a normal part of what happens when people are working through an issue and figuring out where they stand. Politicians are doing their constituents a disservice by playing political football with this issue when the public is still unresolved and in flux. In fact, their game-playing is creating even more hurdles for the public to navigate as they try to develop clear judgment on the issue of health care reform.

Our leaders ought to be helping, not hindering, the public as they grapple with complex issues like health care reform. And there are ways for them to do so. In fact, we have experimented with some approaches to engaging the public on this issue, with encouraging results.

In a forthcoming report from Public Agenda and the Kettering Foundation, we study how citizens think about the challenge of controlling health care costs. In particular, we examine how, when the public has the opportunity to examine choices and think through a few strategic facts – like how our health care spending and outcomes rank against other countries – they feel more confident about the issue. They are able to work through denial and wishful thinking and reach common ground on the sorts of policies they’d support as well as the policies that concern them.

As we wrote in the last Public Agenda Alert, when given the chance and with the right kind of support, citizens want to engage on long-term solutions to health care spending, and they do so with surprisingly productive results. Instead of bludgeoning the public with political spin and consequential brinksmanship, our leaders should provide more resources and opportunities to help citizens better understand the issue and come to a clear judgment on the approaches they support.

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Roshan Bliss
An inclusiveness trainer and group process facilitator, Roshan Bliss serves as NCDD's Youth Engagement Coordinator and Blog Curator. Combining his belief that decisions are better when everyone is involved with his passion for empowering young people, his work focuses on increasing the involvement of youth and students in public conversations.

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