Health-reform: More Americans know...

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Health-reform: More Americans know...

by Mark Silva

SCHENECTADY, N.Y.On a high, scenic ridge that straddles the vallies of old coal country from Frackville to Wilkes-Barre and Scranton, Pa., the government has posted an oversized sign in the median strip of Interstate 81 where roadwork is under way: Federal "Recovery and Reinvestment" dollars at work.

And here in the old industrial city that built the steam turbines that turned the generators that made the electricity that generations of coal-burning Americans relied upon, the morning paper delivers a stark cartoon about the health-care debate.

"I'm afraid the health care plan is in trouble,'' the cartoon-characters advising President Barack Obama tell their boss. "How serious,'' Obama asks in the cartoon by Trever of the Abuquerque Journal. "We may have to come up with one,'' the advisers reply.

All signs lately point to the possibility that Americans are suffering from an overload of information:

It started with a recession that delivered a series of monthly reports about retirement accounts evaporating before the eyes of a generation that hoped to live well for a long time. Add the sagging value of the best investment that many Americans hold, their own homes. Add the jobs which millions have lostsome 15 million Americans without work now as unemployment nears 10 percent.

Many of the well-paying manufacturing jobs that sustained thriving middle- and working-class Americans in places such as the city that lighted the world here in Schenectady are long gone.

And then came a government spending spree that was supposed to help make it all better: A $700-billion bailout for financial giants, a multibillion-dollar bailout for ailing automakers, a $787-billion economic stimulus act offering limited tax relief and supporting "shovel-ready'' work such as the repavement of I-81 and now, if the president can win his way in Congress, a trillion-dollar health-care overhaulwith projected annual deficits amounting to nearly $10 trillion over the next decade.

President Barack Obama faces a singular challenge in the coming week and months: Selling a health-care plan that many tens of millions of Americans, indeed a majority, mistrust, if the polls are any guide. He will address a joint session of Congress next week with the hope of clarifying his agenda, reviving flagging support among members of his own party and capturing the attention of a minority party demanding a "reset'' of the debate.

But the question remains: The more Americans learn of the president's plans, what will they make of them?

(In the TV ad below, the Republican National Committee warns Americans that Democrats are threatening the health care of senior citizens. In the TV ad above, the Democratic National Committee warns that "Republicans are no friends of seniors.'' President Barack Obama's challenge next week involves a search for the truth.)

Joel Benenson, the president's pollster circulated a memo to congressional Democrats this week which asserts that, "By large margins, the American people support major reforms to the health care system.'' He cites a CBS News poll showing that 82 percent of Americans say the health care system needs either fundamental changes (55 percent) or needs "to be rebuilt" (27 percent).

But only 31 percent say they "understand the health care reforms under consideration in Congress, while 67 percent say they find them confusing, this survey released Aug. 31 shows.

"When voters learn about the composition of the plan, support grows considerably,'' Berenson wrote, citing an NBC News poll which found that initially, only 36 percent said that the president's health care plan is "a good idea" while 42 percent called it a bad idea. However, 53 percent said they favored the plan after hearing a short description including requirements on insurance companies to cover people with preexisting
conditions, requiring all but the smallest employers to provide health coverage or pay a percentage of their payroll to help fund coverage for the uninsured and offering tax credits to help families and individuals to help them afford coverage.''

"As we enter this final stage of the health insurance reform debate, there is a significant opportunity to clearly define health insurance reform, replacing Republican misrepresentations with facts,'' Berenson wrote. "Voters still see a strong need for reform.''

Yet the Republicans are eager to point to another possibility: That the more Americans know about the president's plans, the less they will buy them. And the GOP has been investing its own money in ads warning that senior citizens, in particular, have a lot to worry about in the cuts in Medicare spending that the White House envisions as part of the means for paying for the plans. The White House maintains that no benefits will be cut in the bargain.

Most Americans favor "the abstract concept of remaking the medical system,'' according to the co-author of an article in the New England Journal of Medicine, who also suggests that details may favor the bedeviling critics of the president's plan.

"President Obama needs to convince Americans that the country, at a minimum, would be better off and that most families would not be worse off," Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health and the John F. Kennedy School of Government, tells the Prescriptions health-care reform blog at the New York Times.

(The medical journal notes that Dr. Blendon reports also serves on the board of directors of and holds stock in Assurant, and he and co-author John Benson are receiving grant support from the Blue Cross Blue Shield of Massachusetts Foundation. )

Blendon sees parallels to the 1940s and the 1990s, when President Harry Truman and later President Bill Clinton proposed health care "make-overs.' But, he contends, Americans initially favored the idea of revamping the medical system but grew disillusioned as the details of the presidents' policies became explicit and opposition to the plans took hold.

"The basic outline is not different in that, early on, people were dissatisfied with the system and called for change, but they distrusted the government and public support fell substantially as the debate wore on," Blendon tells the Times' Prescription blogger. "It could work out the same way here."