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In an Oct. 20 column ("Sun Rises in East, Sets in West"), I asked why the press was treating as news the public's support for a "public option" government health insurance program when tracking polls showed that support to be nothing new. I came up with three reasons describing subtle biases within Washington journalism. I now realize I should have included a fourth, less subtle consideration: Some of the public option's opponents are telling lies.
House Minority Leader John Boehner, R-Ohio, recently kept a straight face while saying: "I'm still trying to find the first American to talk to who's in favor of the public option, other than a member of Congress or the administration. I've not talked to one, and I get to a lot of places. …" An even bigger whopper appears in an editorial in the Oct. 22 Wall Street Journal ("The Public Option Makes a Comeback"). Like me, the Journal was underwhelmed by an Oct. 20 Washington Post story trumpeting support for the public option at 57 percent. The Journal's reasons, however, were quite different. The "reality is that no one wants a public option except the political left," the Journal said. "Doctors and hospitals hate the idea as much as insurers do—and they're far from natural allies. The media are able to counterfeit public support, such as this week's Washington Post/ABC News poll showing 57% in favor, only by asking rigged questions about 'choice' and 'competition.' Who's opposed to that?"
This passage contained two whoppers:
1.) "Doctors and hospitals hate the idea [of a public option] as much as insurers do—and they're far from natural allies."
Wrong. The American Medical Association has endorsed the House version of health reform (text, summary), which contains a public option. Ah, you say, but that's just what the leadership thinks. What about the members? Sixty-three percent support the public option, according to a September poll by the Robert Wood Johnson Foundation. This support "was demonstrated across all demographic characteristics, specialties, practice locations (census division or urban vs. rural setting) and practice types." And that 63 percent does not include an additional 10 percent that favors the more radical single-payer option. When you combine these two figures, 73 percent of doctors favor government expansion into health insurance at least as extensive as what's currently under consideration.
Perhaps the Journal was thinking about a September Investor's Business Daily poll purporting to show that two out of three practicing physicians opposed not just the public option, but health reform generally. The poll got some attention from Fox News and Michelle Malkin, but its methodology was laughably poor, as Nate Silver has demonstrated. Among other problems, the poll was conducted by mail (the same methodology the Literary Digest rode to oblivion in predicting Franklin Roosevelt's landslide defeat in 1936), and the findings were tabulated while responses were still coming in. "There are pollsters out there that have an agenda but are highly competent," Silver concluded, "and there are pollsters that are nonpartisan but not particularly skilled. Rarely, however, do you find the whole package: that special pollster which is both biased and inept."
Or perhaps the Journal is thinking about a June 10 New York Times story by Robert Pear that reported the American Medical Association opposed the public option. If so, it chooses to ignore that the AMA quickly reversed itself (perhaps after hearing from its members?) and endorsed the House bill. The public option goes unmentioned in the AMA's July 16 letter to House Ways and Means chairman Charles Rangel, a principal sponsor of the bill.
The Journal's on somewhat firmer ground when it comes to hospitals, but it still overstates the case. On Sept. 15 the American Hospital Association's chairman, Tom Priselac, voiced "concerns" to the House Democratic steering and policy committee about the public option included in the House bill. On Oct. 12 the AHA stated that it favored the Senate finance committee's alternative—creation of nonprofit co-ops—over the Senate health committee's public option. But I read Priselac's concluding statement about the House version ("Any public-sponsored insurance option should require that provider payments be based on negotiated rates with no link to Medicare payment rates") to leave open the possibility that the AHA will eventually support, however grudgingly, a health reform bill that contains a "soft" public option.
Let's not forget who works in hospitals. Doctors do. And they favor the public option. That may be why the AHA has kept relatively quiet on the subject.
2.) "The media are able to counterfeit public support, such as this week's Washington Post/ABC News poll showing 57% in favor, only by asking rigged questions about 'choice' and 'competition.' "
Let's have a look at these "rigged questions."
Here is the wording of the Washington Post/ABC News poll, which tracked support for the public option from August through October at majorities of 52, 55, and 57 percent:
"Would you support or oppose having the government create a new health insurance plan to compete with private health insurance plans?"
Here is the wording of a September Kaiser Family Foundation poll, which tracked support for the public option from July through September at majorities of 59 percent, 59 percent, and 57 percent:
"Do you favor … [c]reating a government-administered public health insurance option similar to Medicare to compete with private health insurance plans?"
Here is the wording of a September New York Times poll, which tracked support for the public option from July through September at majorities of 66 percent, 60 percent, and 65 percent:
"Would you favor or oppose the government offering everyone a government administered health insurance plan—something like the Medicare coverage that people 65 and older get—that would compete with private health insurance plans?"
Here is the wording of a newly released CNN poll, which tracked support for the public option in August and October at majorities of 55 percent and 61 percent:
"Would you favor or oppose creating a public health insurance option administered by the federal government that would compete with plans offered by private health insurance companies?"
None of these four questions include the words choice or competition, abstract nouns that arguably might color the response. All four contain the verb compete merely to describe objectively what the public option would do.
The Journal's beef, I would guess, is with one of its own polls. (As a onetime Journal reporter, I can attest that long-standing practice forbids parties on either side of the news/editorial divide to go public with mutual criticism. Polling is the province of the news side.) In June the Wall Street Journal/NBC News poll asked the following poorly worded question:
"In any health care proposal, how important do you feel it is to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance—extremely important, quite important, not that important, or not at all important?"
The question is faulty partly because it characterizes the plan using the potentially loaded term choice but mainly because it doesn't allow the person taking the poll to oppose the public option while acknowledging that it's an important issue. Indeed, the more passionately you oppose the public option, the more important you may rate the issue.
"Would you favor or oppose creating a public health care plan administered by the federal government that would compete directly with private health insurance companies?"
The first, poorly worded version of the question found that 76 percent thought a public plan was "extremely" or "quite" important. The second, better-worded version still found that a 46-percent plurality supported a public option. The third, using the same wording, found that a 47-percent plurality opposed it. I call that a split decision. Even though the Journal/NBC News poll didn't find a majority favoring the public option in July when it asked a better-worded version of the question, it still found that more people supported the public option than opposed it. Only in August, when right-wing loonies were disrupting town meetings on health reform, did support slip to a hardly catastrophic 43 percent.
I'd be remiss if I didn't point out that a late-July Fox News poll came up with a plurality opposed to the public option (48 percent) similar to that found a few weeks later by its corporate sibling, the Journal (47 percent). In this instance, the wording of the question was unobjectionable ("Do you favor or oppose the creation of a government-run health insurance plan that would compete in the marketplace against private insurance plans?"). But some of the other questions that preceded that one were loaded to such a ludicrous degree that they almost certainly influenced subsequent responses. Here are two examples:
"President Obama has appointed over 30 czars to oversee the administration's top initiatives. Czars are advisors to the president who work outside of the cabinet and do not have to be confirmed by the Senate. Are you comfortable with the Obama administration's use of czars as advisors or are you concerned the administration is trying to get around Congressional oversight?"
"Since the 9-11 terrorist attacks, did you think it was the job of the CIA to kill senior Al Qaeda leaders, or not?"
Fox News' somewhat slack attention to detail with regard to polling was nicely illustrated in August when Washington managing editor Bill Sammon and America's Newsroom co-host Bill Hemmer discussed at length the latest Washington Post/ABC News poll, which they stated (incorrectly) demonstrated public opposition to the public option. As the liberal watchdog Media Matters for America pointed out, Hemmer and Sammon had gotten the Post/ABC News poll confused with a July Ipsos/McClatchy poll that showed a 40 percent plurality of respondents believed a public-option health plan would provide lower-quality health care than the private sector. What Sammon and Hemmer neglected to point out was that a separate question had asked respondents to identify which of four statements was "closest to your opinion." Here they are, along with the percentages.
"It is necessary to create a public health insurance plan to make sure that all Americans have access to quality healthcare." (52 percent)
"Access to quality healthcare for all Americans can be achieved without having to create a public health insurance plan." (44 percent)
"There should not be a health care overhaul." (None.)
"Don't know/Not sure." (4 percent)
People may have misgivings about the quality of government-supplied health insurance, but they want more of it anyway. Is that so hard to grasp?
E-mail Timothy Noah at email@example.com.