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The Health Care Information Gap: More Information Needed

It’s rare that I disagree with Gallup’s straight-shooting Frank Newport, but I don’t think the data he’s citing in this blog post (from a Gallup survey conducted in November) does much at all to contradict the notion that a substantial amount of the opposition to health care reform is based on misinformation:

[Obama and Gibbs reinforce] the same talking point: The public’s lack of robust support for healthcare reform legislation is based on misunderstanding engendered by the debate, the process, and the strong forces arrayed against the bill.

We don’t necessarily see it in the data. When we ask Americans why they oppose healthcare legislation, the two dominant responses are: “cost” and “too much government involvement.” Neither of these objection categories reflect — at least not directly — a failure to understand the specifics of what is in the bill. Or personal self-interest. The objections appear to be more global in nature.

Here, again, is the survey that Newport refers to; it asked an open-ended question about what “concerns” people had about the health care bills and then broke those numbers down between those people who supported the bill and those who opposed it. I’ve reproduced their numbers below the fold.

There are relatively few items in this tally that unambiguously reflect either legitimate reasons for opposing the health care bill or unambiguously reflect false beliefs. The former category would probably include: “Overall costs to government, taxpayers” (7 percent of those opposed to the bill), increased taxes (5 percent), “how it will be paid for” (3 percent), and the individual mandate (3 percent). Perhaps also the public option belongs here (7 percent) — it was still “alive” at the time Gallup’s survey was conducted (although there are a lot of people who don’t know exactly what the public option is). If we do count it, these probably legitimate concerns amount to about 25 percent of those opposed to the bill, or 12 percent of the country overall.

On the other hand, there are also relatively few concerns that unambiguously seemto point toward false information. “Coverage for illegal immigrants” (4 percent of those opposed to the bill) is probably one. Items like “ability to get needed care”/rationing/wait times (4 percent), “being able to see current doctors” (3 percent) and “effect on quality of care” (8 percent) most likely also fit into this category, although even here there is some ambiguity.

And in most other cases, there is a lot of ambiguity. The largest single reason for opposition that Gallup identifies — 28 percent of those opposed to the bill — is what they call “government-run healthcare / bureaucracy / socialized medicine / government takeover”. Perhaps there are a few people in this group who have legitimate worries about the government’s ability to effectively regulate insurers or believe that the imposition of additional rules and regulations may carry unintended or undesirable consequences. But phrases like “socalized medicine” and “government takeover” are talking points that more likely than not are symptomatic of incorrect beliefs about what the health care bill would actually do.

A lot of categories are like this. The category “effect on senior citizens/Medicare” (5 percent) for instance — does this reflect legitimate concerns about the savings that the bill would try to achieve in Medicare, or people worried about death panels and the plug being pulled on granny?

Finally, there are quite a few people who don’t know why they’re opposed — 9 percent of those opposed can’t cite a reason at all, another 6 percent simply say they don’t understand the bill, and a further 9 percent say “costs”, but don’t specify which type of costs they’re concerned with.

This isn’t really a criticism of Gallup’s survey — unlike the Kaiser poll that I’ve cited frequently, they weren’t really trying to test people’s knowledge about the bill. But also for that reason, it can’t really be used to refute Kaiser’s data. People, to use Newport’s term, may have concerns which are “more global in nature” — but why do they have those concerns? (If I ask you: “why do you oppose the health care bill” and you say “because it’s bad”, we haven’t really learned anything.)

In a perfect world, indeed, what I’d like to see is a survey that even more explicitly related people’s knowledge about the bill to their beliefs and overall impressions about it. You might ask a battery of questions related to:

— Overall support/opposition to the bill.
— Knowledge of bill contents.
— General beliefs about the bill (e.g. effect on coverage, costs, premiums, etc.)
— Self-rating of informedness (about the bill and about politics in general)
— Change in support based after being read various descriptions of the bill.
— Volume and type of news sources consumed.
— General political ideology.
— Demographics.

I’m not going to design a whole survey in a blog post, but you get the general picture. You’d need to design the survey fairly carefully, but you could probably get pretty close to an objective answer about how much of the opposition to the bill (and the support for it) was indeed based on false beliefs about its contents.

Nate Silver founded and was the editor in chief of FiveThirtyEight.