With Congress dashing to overhaul a health care system representing 17% of the economy and affecting the life of every American man, woman and child, respondents to our latest IBD/TIPP Poll are far from a consensus on the path those reforms should take and clearly confused about the options before them.
The poll, taken July 6-12, indicates that 48% support the so-called "public option," a government-sponsored health insurance alternative, but that 34% oppose it and 18% aren't sure.
Large and comparable numbers of individuals of every political stripe are uncertain about the option: 18% of Democrats, 17% of Republicans and 16% of independents.
Support or opposition to the public option is rooted firmly in partisan self-identification, with 70% of Democrats supporting it, 64% of Republicans opposed and independents divided, 49% to 34%.
Americans are split almost equally on whether a public plan would eventually drive out private insurers, leading to a single-payer system, with 44% agreeing with that prospect and 42% disagreeing.
While Americans believe our health care system needs a "complete overhaul" or "major changes," as shown in June's IBD/TIPP Poll by 73% of respondents, they lack confidence in the government's ability to deliver quality health care.
Nearly half of all respondents (49%) say government-run health care would decrease the quality of care they receive, while just 12% believe it would improve. One-third of respondents said their quality of care would be unaffected.
With high personal approval numbers, President Obama has a unique opportunity to make his case for health care to the American people, and to apply popular pressure on Congress as he continues his push to complete a health care bill by the August recess.
But the lack of consensus poses a risk for the president, in that delays in moving the legislation could result in further fracturing of the coalition in support of major restructuring, making the effort more vulnerable to well-coordinated opposition efforts.
For their part, conservative Blue Dog Democrats in Congress may begin to see the president's rush to pass the legislation by August as comparable to the stimulus package that was hurried through Congress amid inflated expectations about its ability to keep unemployment levels below 8%.
Our poll shows signs of a growing "buyer's remorse" about the stimulus measure, with increasing numbers of Americans saying it has been ineffective and has needlessly driven up the deficit.
In fact, concerns about the deficit and persisting unemployment in the wake of the stimulus are among the reasons for the decline in the IBD/TIPP Presidential Leadership Index from 64.3 in June to 58.1 in July.
The Blue Dogs are clearly nervous about the impact the health care package will have on their re-election prospects, and believe they have a tail wind. "Last time I checked, it takes seven Democrats to stop a bill in the Energy and Commerce Committee," Rep. Mike Ross, D-Ark., said last Wednesday. "We had seven against it last Friday; we have 10 today."
Moderate Republicans seem equally troubled. After a meeting with Obama on Thursday afternoon, Sen. Olympia Snowe, R-Maine, a member of the Senate Finance Committee and one of the few Senate Republicans who may support the measure, told reporters that "we shouldn't be restrained by an artificially compressed timeline" of passage by the Aug. 7 recess.
Then there's the question of how to pay for it all. Under questioning by the Senate Budget Committee on Thursday, the chief of the non-partisan Congressional Budget Office, Douglas Elmendorf, said that far from helping avert a coming fiscal crisis, the health care bills that congressional Democrats have proposed would likely make the nation's already-gloomy budget prospects even worse.
During the presidential campaign, Obama denounced the notion of taxing health benefits, calling it "the largest middle-class tax increase in history," but White House officials are reluctant to take any options off the table as negotiations continue.
As adviser David Axelrod recently said, "there are a number of formulations, and we'll wait and see. The important thing at this point is to keep the process moving, to keep people at the table, to keep the discussions going. We've gotten a long way down the road and we want to finish that journey."
The IBD/TIPP Poll shows more than 2-to-1 across-the-board opposition to a tax on health insurance benefits. Fully 55% oppose such a tax, compared with 22% who support it, and opposition crosses party lines, with Democrats opposing it by a margin of 41% to 32%, Republicans lopsidedly against by 70% to 14%, and independents likewise opposed by a margin of 62% to 18%.
Mayur is president of TechnoMetrica Market Intelligence, which directs the IBD/TIPP Poll that was the most accurate in the last two presidential elections.