Public opinion will be a decisive factor in the outcome of healthcare reform. But the extent to which Americans' views influence the debate will depend on how involved the public gets at the grass-roots level and how much they listen to critics of the Clinton administration, experts said.
Healthcare reform is so complicated that the public will never fully understand it, said John Rother, chief lobbyist for the American Association of Retired Persons. Already, ads run by the Health Insurance Association of America criticizing potential restrictions on consumer choice and other key elements of the Clinton plan are "slowing the momentum" for reform, he said.
But if Americans make their views known on key issues, such as universal coverage and basic benefits, their input can make a big difference, he said. The alternative would be "business as usual," in which interest groups control the debate and its outcome, Mr. Rother added.
Americans will base their opinions on how healthcare reform would affect them personally, said Robert Blendon, a healthcare polling expert and chairman of the department of health policy management at the Harvard School of Public Health. "People are deciding this as a personal matter," he said.
A recent analysis of public opinion polls, conducted by Mr. Blendon for the House Ways and Means health subcommittee, found that Americans' rating of the Clinton plan, as well as their willingness to pay additional taxes to support it, have eroded since the president unveiled his health plan in a speech to Congress in September. On Sept. 26, 59% of Americans said they approved of the plan. But by Nov. 14, support had dropped to 46%. In addition, only 39% of Americans said they would favor higher taxes to pay for a plan on Nov. 14, down from 45% who said they'd be willing to do so in September, before the president's speech.
The public's negative opinions reflect the effectiveness of Clinton plan critics, Mr. Blendon said. The public also is influenced by press coverage that highlights "anxieties and uncertainties about the plan," particularly about the effect of health budgets and the bureaucratic nature of health alliances, he said.
Henry Aaron, director of economic studies at the Brookings Institution, said the administration will have to stress the theme of universal coverage to win the public opinion war.
Sustaining public interest in such a complicated issue can be achieved "if the president's popularity continues to grow and if he makes this the overwhelming focus of attention in 1994," Mr. Aaron said. "Then, the chance that he can get a large part of what he's been seeking goes up."-Lynn Wagner