A Public Plan: It Depends On How You Ask the Question

Survey questions that equate the public option approach with the popular, patient-friendly Medicare system tend to get high approval, as do ones that emphasize the prospect of more choices.But when framed with an explicit counterargument blatant fear mongering lie, the idea receives a more tepid response. In the new Post-ABC poll, 62 percent support the general concept, but when respondents were told that meant some insurers would go out of business a right wing talking point that nobody can ever prove and is counterfactual to the "the government can't run anything" argument they have made for years, support dropped sharply, to 37 percent.

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Fixt, and you're welcome.

Funny how free marketers had a system that is truly free.

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"21a. (IF SUPPORT) What if having the government create a new health insurance plan made many private health insurers go out of business because they could not compete?"
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Feature, not bug...
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We already have Medicare...why can it not be opened up for all?

"Opponents will raise the prospect of losing what you have. Which meme takes root will very likely determine the outcome."
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And everyone should be reminded that they are going to eventually lose what they have right now anyway. With costs going up and up its going to happen. If you have insurance through your employer he or she will have to decide if you the employee are going to take on more and more of the costs or determine that it is not cost effective for them to provide it in the first place. The days of finding major employers offering health care as part of your compensation are coming to a end. Just like the traditional retirement plans have mostly ended in favor of the 401K.
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If you get insurance on your own then you have to worry about being cancelled because of pre-conditions at the time you will need your insurance the most. The evidence is there. The insurers have told you so via the recent hearings in Congress. They are going to do it because it saves them money. Period. They make a profit by not paying for your health care when your are sick, but accepting your premiums as long as you are healthy. The first time you are diagnosed with a medical condition that is expensive to treat the insurer will go through you back ground with a fine tooth comb and find a reason to cancel your policy. Even if they are wrong it won't matter. Do not believe the insurers at your own risk. They have flat out told you they will cancel you it you cost to much to insure.
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Any efforts to lower cost to you will take money out of your for profit insurer pockets who will in turn attempt to make it up by charging you higher and higher premiums, co-pays and eventually they will add fees to the mix that you have to pay in addition to other costs. This is how the system is set up to work right now.
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I'm not trying to scare anyone into supporting a public option, but if you buy the framing that you have the prospect of losing what you have. Well, just wait because you will and there will be nothing for you to fall back on until you are flat broke, in bankruptcy and praying for your already cash strapped state to step in and save you.

The Washington Times, I mean Post I get them confused, commissions a poll with an explicit counterargument (read: what they perceive to be a worst case result) to show push back against recent polls showing support for a public option.
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Frank Luntz is smiling.

KT
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If the polling question contained all the nuance of the Lewin report then it would be a fair question. But being as that instead it comes off as a right wing talking point with no explanation of why those companies would go out of business to me it invalidates the question. Hell we have the post office but we also have fedex and other carriers too. I don't think many people are complaining that we don't have any more competition there.

The President asked the right question yesterday. Why would any private insurers fold unless its because they suck and no one wants them?

KT,
Has anyone looked carefully at what percentage of Doctor and Hospital charges are actually inflated hedges against the no-pays and bankrupcies?

To emphasize sgw's and PD's point, here's Nate, with hat tip to Sully:
http://www.fivethirtyeight.com/2009/06/george-f-will-admits-public-option-will.html

Robert Reich's opinion on the public option.

"Why the Critics of a Public Option for Health Care Are Wrong

By Robert Reich - June 24, 2009, 1:17AM
Without a public option, the other parties that comprise America's non-system of health care -- private insurers, doctors, hospitals, drug companies, and medical suppliers -- have little or no incentive to supply high-quality care at a lower cost than they do now.

Which is precisely why the public option has become such a lightening rod. The American Medical Association is dead-set against it, Big Pharma rejects it out of hand, and the biggest insurance companies won't consider it. No other issue in the current health-care debate is as fiercely opposed by the medical establishment and their lobbies now swarming over Capitol Hill. Of course, they don't want it. A public option would squeeze their profits and force them to undertake major reforms. That's the whole point.

http://tpmcafe.talkingpointsmemo.com/talk/blogs/robert_reich/2009/06/why-the-critics-of-a-public-op.php#more

"Opponents will raise the prospect of losing what you have. Which meme takes root will very likely determine the outcome."
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This is a very different statement from "insurance companies may go out of business." The reason they would go out of business is that people would not choose a more expensive, less comprehensive private plan over a public option. Choosing something better is not the same thing as losing what you have.
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This is what Obama was saying yesterday. He did NOT, as a NYT headline reads this AM, say that "Obama Says Government Health Coverage Plan Would Not Hurt Private Insurers."
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He used a complex and sophisticated rhetorical tool called "logic." He said the insurance companies say they provide great care at a fair price, that a government plan would be run by awful bureaucrats and would suck and that it would put them out of business.
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These three propositions are not mutually consistent.
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In fact, insurance companies would reduce their costs of providing coverage (as retailers have lowered their costs in the face of competition from Walmart) or provide higher quality coverage at higher prices (as with luxury retailers who don't compete with walmart) or go out of business (as have many retailers in the face of competition with walmart).
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This really is not difficult to explain in a news article, just as it was not difficult for Obama to explain yesterday. There is no reason to repeat these ridiculously inconsistent talking points as based in reality just because Frank Luntz writes a memo that all the Republicans read and implement. Will we hear John Boehner response to Obama's refutation of what he was writing last week?

KT:
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...report showing that indeed both arguments could be true. it all depends on how the public plan is structured.
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What you mean, I believe, is that part of the report that specifies this:

If the public plan is opened to all employers as proposed by former Senators Clinton and Edwards, at Medicare payment levels we estimate that about 131.2 million people would enroll in the public plan. The number of people with private health insurance would decline by 119.1 million people. This would be a two-thirds reduction in the number of people with private coverage (currently 170 million people). Here again, if the higher private payer levels are used, enrollment in private insurance would decline by only 12.5 million people.

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This leads to the reasonable conjecture that a loss of those premiums is an insurmountable financial catastrophe for many of even the largest insurance companies...conjecture that would be reasonable if 119.1 million people suddenly switched insurers literally overnight.
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The report doesn't actually mention a timeline to this fewer/smaller private insurer eventuality, it only briefly mentions that older individuals are less like to switch no matter what their options.
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What's fear-mongering and misleading about the claim "many private insurers will go out of business, leaving the public with fewer options", is that it's dependent on a report that does NOT tell us when that state of affairs will be reached. It doesn't say "over the next 20 years". It doesn't say "over the next decade". It doesn't say anything at all about the time necessary for over one hundred million people to all do something different than what they're currently doing.
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The report (probably unintentionally) gives one the impression that the public option is some kind of mass extinction event like a tsunami or an asteroid striking the earth, at which point there will be a sudden, drastic change. Of course that's anxiety-producing for many people --even people dissatisfied with what they currently have!
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But this is only an impression!
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Look, if I told you that in 1929 there was a report establishing the high probability that, given recent advances in consumer refrigeration, if the electrical grid were extended to all rural and urban areas, most ice delivery companies would go out of business, and you immediately sold your stock, wouldn't you be a fool? Even the most highly predictable and thorough business extinction events don't happen overnight, they take decades
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What's may be occurring is that this so just happens to be the exact moment in history that the press is itself fertile ground for concern over business extinction events, and so the claim "they'll all go out of business!" resonates with reporters in a way that serves the industry's "catastrophic event" fear-purveyors.
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The report did NOT say some very important things:
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1) that insurance companies would go out of business
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2) that insurance companies would change their rates and benefits to compete over customers (they explicitly assume that private insurers won't lower rates to a dollar above public plan rates)
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3) that any of these changes would be complete by a probable date
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KT, if you're really reading this whole report, can you tell me where I'm wrong on any of this?
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Isn't a fair, completely true statement "Many large private insurance firms who do not lower rates or provide better service will go out of business over the next two decades."?
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Shouldn't the question really have been asked this way, KT? --
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"What if having the government create a new health insurance plan made many private health insurers go out of business over the next ten or twenty years because they could not complete?"
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Unless a reasonable time-line is included in the phrasing, isn't the question putting a sudden catastrophic event into peoples' minds?
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As far as I can tell, the Lewin Group's report contains no time-lines on which to base reasonable estimates as to when in the future "many private insurers go out of business".
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In the interest of accuracy, could you please ask somebody at the Lewin Group specifically (not somebody familiar with the report who may be willing to conjecture, somebody who understands the data) who knows the programmatic models referenced by the authors of the report "What is the time-line for 119.1 million people switching from private to public insurance?", KT?
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If reporters and pollsters are possibly unintentionally giving the American people the impression that something sudden and drastic may happen, isn't it their objective duty to make certain that this truly is a likelihood, and not use their own industry's current woes as the model their reporting assumes?
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Don't Americans deserve to know the time-line of the possible events in question, KT?

Or, as nate asks "Why is the Washington Post Testing Republican Messages on Health Care?"
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http://www.fivethirtyeight.com/2009/06/why-is-washington-post-testing.html

jayack -
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They be not testin' mate - they be askin' th' questions t' plant th' idea, believin' it will be stickin', an' no amount o' logic 'r reason comin' down th' pike later will be able t' dislodge their initial plant.
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An' I be believin' they be ri'.
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We're losin' this thing b'fore it even gets started, I'm fearin', b'cause "news" be already on board, bought an' paid fer, frame set, narrative adopted, nothin' else t' see here, deal done.
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YARR!

PW
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I've recently become very aware of just how much health care advertising there is on my teevee....
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Obama is pushing back, though.

my entry into the "explain to karen that its not about "how you frame the question", its about asking false/misleading questions and presenting them as appropriate (and reporting on them for Time, Inc as if they were not false/misleading" contest....
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Karen, how do you think the responses would have been if those who were opposed to a public option were asked "Would you support a public option whose competition may result in the private insurance industry providing better health care at lower prices?"
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my guess is that you'd find a lot more support, because that question is really push-polling, as is the ABC/Post question.
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The real story here is how the ABC/Post poll contains PUSH POLLING; and a good reporter on the health care beat would be investigating who ordered up a question phrased in this manner.....

jayack -
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I be afeared it be too late.
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Even on th' NPR this mornin' th' line was all about how th' press corp' were finally beginnin' t' show their "gumption" yesterday, an' how "testy" th' President were in 'is response.
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An' even 'ere in KT's post...were she pointin' out who sourced th' poll framin' th' question so's t' drive th' PO support numbers down? No, she were not. She be comin' ve' near t' a "they say, they say" presentation.
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Now, don't be gettin' inta' a tizzle, KT - ye be doin' fine work on th' all an' all! Bu' even ye be havin' yer limits in this thing, an' ye be one o' only a few on th' front lines facin' an overwhelmin' avalanche o' Bullsh*t t' wade through. It be able t' cause a bit o' numbness even in th' sharpest o' minds!
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Arrgh!

An, WE may be knowin' th' WAPO be havin' their finger in th' pie, bu' I be slap sure it be goin' t' be presented on th' "news" as objective evidence o' support slippin', wi' no context 'r background added.
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Arrgh!

Karen you really need to look at Jayackroyd's link to Nate.
Nate shows a comparison of the Post ABC poll to one the Kaiser Family Foundation did.

PW
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the president was, at least, "testy." I'd say "contemptuous" and "mocking" are also fair characterizations.

jayack
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I'm thinkin' "showed an incredible amount of restraint and patience in dealing with a room full of rabid jackasses."
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Arrgh.

KT:
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I will email john shiels at lewin and ask him, though i assume that is hard to answer until we know the time line for implementing any public plan.
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Thank you so very much for your diligence and concern for accuracy; I'm beyond gratified. Even if there's no answer forthcoming, this is the kind of interaction and effort from a representative of a publication for which I would gladly show support with my available income (say, if there were a "donate" button to PayPal next to your name, for example).
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BTW: I believe that an implementation date need not be specified for a reasonable estimate to be given, based on their models --unless Lewin's programmers (inexplicably) just didn't include any date factors whatsoever.
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If we assume the time-line for implementation of a public plan is a given date, say January 1, 2012, how long before the last of the 119 million people made that switch from private to public? 10 years? 20 years? 30 years? A week?
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(the question still assumes the Lewin Group report's debatable premise that private insurers would do nothing differently whatsoever in terms of price and service to compete with any public plan, once people began to switch)