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Flawed reporting on health care polls.

What does the public think about health care reform? Difficult to say without a lengthy survey but that does not keep the media and the public polls from trying. The results, however, can often be misleading.

The desire for a easily interpretable story line ("Public divided on health care reform") and the interviewing cost constraints ("we can only afford a few questions") creates a shaky data base for potentially meaty conclusions.

Take, for example, USA Today's front-page story (March 24) three days after the House had passed the health care measure. Based on a one-night Gallup poll conducted on March 22, the lead sentence was "More Americans now favor than oppose the health care overhaul that President Obama signed into law Tuesday ... a notable turnaround from surveys before the vote that showed a plurality against the legislation."

But the Gallup question buttressing this finding was one the firm had never previously used. The March 22 wording was, "As you may know, yesterday the U.S. House of Representatives passed a bill that restructures the health care system--all in all, do you think it is a good thing or a bad thing that Congress passed this bill?" "Good" won out over "bad" by 49 percent to 40 percent.

In its pre-vote survey, conducted March 4 through 7, Gallup's wording was, "Thinking about health care legislation now being considered by Congress, would you advise your member of Congress to vote for or against a healthcare bill this year, or do you not have an opinion?" "Against" narrowly finished ahead of "For" by 48 percent to 45 percent.

Was it a real turnaround or an inappropriate comparison between two related but essentially different questions? A respondent might answer "good" to the March 24 question, for example, because the Congress finally stopped a debate that seemingly would never end and finally made a decision.

The interpretation that the March 24 result was partially generated by a morning-after sense of relief is reinforced by a March 26-28 Gallup poll when "bad" pulled ahead of "good" by 50 percent to 47 percent.

Another complicating factor for measuring public opinion is capturing a complex set of policy changes in a single phrase ("health care overhaul" or "health care bill"). The Kaiser Family Foundation has been conducting detailed monthly surveys on health reform since June 2009. The March poll, conducted the week before the House vote, found only 27 percent of the public says it knows "a lot" about "how the health care reform proposals being discussed in Congress would affect you and your family personally," a share only three percentage points higher than June 2009.

Even that self-reported familiarity probably overestimates public understanding. Also on the same survey, Kaiser asked whether the "independent Congressional Budget Office which analyzes the cost of legislation said the health reform legislation currently being discussed in Congress will increase the federal budget deficit over the next ten years, decrease the deficit over the next ten years, or is it not expected to have much impact on the deficit?" The increase/decrease options were rotated to guard against bias created by which one was mentioned first. The correct answer is "decrease" but only 15 percent chose it. The majority, 55 percent, replied "increase" and just 10 percent volunteered that they did not know.

That's far from the only example of misinformation found by the Kaiser surveys. In mid-March, 41 percent thought the health care bill approved March 21 would require "most people who currently get health insurance coverage through their employer" would be required "to change their existing health insurance arrangement."

Public opinion on health care restructuring currently is largely impressionistic, more driven by broad ideology (e.g., role of government), inflammatory rhetoric (e.g., "death panels"), and fear of change. Until the policy becomes real and familiar (think Social Security or Medicare), a process that will take up to a decade with this reform, it would premature to draw firm conclusions.

Terry Jones is professor of political science at UM-St. Louis
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Title Annotation:politics & media
Author:Jones, Terry
Publication:St. Louis Journalism Review
Date:Jul 1, 2010
Words:669
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