Why the Washington Post is hyping the public option.

Why the Washington Post is hyping the public option.

Why the Washington Post is hyping the public option.

How to fix health policy.
Oct. 20 2009 6:20 PM

Sun Rises in East, Sets in West

Why the Washington Post is hyping the public option.

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"Public Option Gains Support" reads the lead headline on the front page of the Oct. 20 Washington Post. Citing a new Washington Post/ABC News poll, Dan Balz and Jon Cohen report that "support for a government-run health-care plan to compete with private insurers has rebounded from its summertime lows and wins clear majority support from the public."

Given the story's prominent placement, readers might be forgiven for believing that something dramatic has occurred, such as a huge change in support for the public option. Actually, the public option went from having a lot of support to having a smidgen more support. Fifty-seven percent of respondents said on Oct. 18 that they favor "having the government create a new health insurance plan to compete with private health insurance plans," compared with 52 percent in August and 55 percent in September. Notes the MSNBC blog First Read: "Wow, did the Washington Post pump up a very minor uptick when it comes to the public option."


That the public option maintained steady majority support throughout the summer is not, strictly speaking, news. A similar tracking poll by the Kaiser Family Foundation measured support for a public option at 59 percent in July, 59 percent in August, and 57 percent in September. A New York Times/CBS News poll showed essentially the same three-month trend but with a one-month dip in August (when tea-baggers and other nutcases were disrupting town meetings on health reform): 66 percent, 60 percent, and 65 percent.

Why, then, is the Post pretending that 55 percent supporting the public option represents some miraculous resurgence? There are three likely reasons.

1) Majority support for the public option has been ignored in Washington. A common misapprehension here in the nation's capital is that the priorities of any random grouping of elected officials reflects the views of "the American people." That isn't true of the U.S. Senate, which overrepresents the small number of people in sparsely populated states, and it most especially isn't true of the Senate finance committee, whose consideration of the health reform bill dominated news coverage these last couple of months. A mere eight-to-10-vote minority of the 23-member finance committee may favor a public option, but that tells you nothing about what the public thinks.

As it happens, a slim majority of the Senate supports the public option—52 percent according to Senate health committee chairman Tom Harkin, D-Iowa, and 51 percent according to the liberal blogger Chris Bowers of Open Left—though this count includes supporters of Republican Sen. Olympia Snowe's worthless "trigger" plan. (See "Triggernometry.") Because conventional wisdom currently holds (wrongly) that health reform can pass only with a filibuster-proof 60-vote majority, Washington reporters lately developed the sloppy habit of deeming 59 percent to represent a minority even in non-senatorial contexts. That, they now realize, is bad math.


Interestingly, until two days ago, anyone who raised the possibility that the public option might clear the Senate risked scorn from the Washington commentariat. When Sen. Chris Dodd said on NBC's Meet the Press on Oct. 18 that a public option ought to be in the final bill, David Gregory shot back: "But aren't we beyond—Senator, aren't we beyond strong beliefs?  I mean, isn't this brass tacks time? What have you got in terms of the votes? You've got one Republican senator who's not for it, you've got conservative Democrats who are not for it. They seem to have most of the influence over the final package here."

That was Sunday. This is Tuesday, when the chattering classes risk overestimating the public option's odds of success. Which brings us to:

2) Political reporters are momentum junkies, forever plotting out momentary trends to infinity. If they were meteorologists, they'd interpret 90-degree temperatures in July to predict 160-degree temperatures in December. This is true even when they know circumstances will change. Reporters were fully aware that once the health reform bill cleared the Senate finance committee, it would be combined with a version passed by the Senate health committee that contains a public option. Yet it was greeted as revelation that this would cause negotiators to consider the public option anew ("Baucus: Public Option 'Alive' "). With the public option suddenly plunked in front of their noses, political reporters look to public polls to find an objective correlative. A three-point rise becomes a Page One "rebound."

3) The insurance lobby goofed. As Greg Hitt and Janet Adamy point out in the Oct. 20 Wall Street Journal ("Public Option Gets New Life in Senate"), America's Health Insurance Plans annoyed Democratic senators when, on the eve of the finance committee vote, it released a report attacking the bill and started airing granny-scaring TV ads. With insurers threatening to oppose health reform with or without a public option, there's less reason to consider their views in shaping the bill. This prompted the Post to seek a corresponding reaction in the public at large, even though most people aren't really following the insurance lobby's chess moves. (Raise your hand if you live outside the D.C. area and have ever heard the name "Karen Ignani." Thought so.) It's not even clear that the insurers' screw-up changed actual Senate votes.


Another way the insurers goofed was by making an issue of the next decade's projected premium increases. As I've noted previously, that isn't smart if the only plausible remedy is to create a public option. It's especially dumb if you point out, as the insurers did, that the portion of the 10-year increase attributable to health reform is less than half the portion attributable to medical inflation, which will occur with health reform or without it. Incidentally, the insurers' 10-year projection of a 79 percent premium increase without health insurance reform probably understates it, because it assumes premiums will track the general rate of medical inflation. But Len Nichols of the New America Foundation points out that during the past 10 years, health insurance premiums have risen faster than medical inflation. One study said premiums increased by more than 150 percent of the rise in actual health care costs (hospital fees, doctor fees, pharmaceuticals, medical devices). It would be lovely if this bêtise changed a few votes, but I repeat: We don't yet have the evidence.

The Post poll does contain some interesting information. When the public option was described more narrowly as being "run by state governments" and "available only to people who did not have a choice of affordable private insurance," I would have expected support to fall, because that describes a program less likely to serve the person answering the poll. Instead, it rose from 57 percent to 76 percent. Apparently the public's distaste for expensive public programs run out of Washington exceeds its desire to benefit personally from such a program. Which is probably good, because the more narrowly defined public option has a much better chance of becoming law.

Among Republicans, the more narrowly defined public option was favored by 56 percent. A Sept. 24 New York Times poll showed a plurality of Republicans supporting the public option, but this is the first poll I've seen where a majority of Republicans did so.

These tidbits are news. That a majority of the public favors the public option, on the other hand, is an old story. Even so, I'm grateful that somebody finally noticed. And I won't deny the alluring possibility that this phony momentum will generate the real thing.

E-mail Timothy Noah at chatterbox@slate.com.