Ruy Teixeira
Ruy Teixeira

In this edition of Public Opinion Watch:

• End of the Bush Era?

• Public Opinion on Universal Health Care

End of the Bush Era?

Last week, I concluded my discussion of the early polling results on the impact of Hurricane Katrina with:

“As Harry Truman put it: ‘The buck stops here.’ Bush may not personally subscribe to that view, but, in this case, I think the public’s going to insist.”

Well, they’re insisting. Here are some results from the last week of public polling that clearly indicate serious erosion in Bush’s political standing from the Katrina disaster.

Bush’s approval ratings. Not one, but two polls now have his overall approval below the 40 percent mark: Ipsos-AP (39 percent, with 59 percent disapproval) and Newsweek (38 percent, with 55 percent disapproval).

Other polls report approval ratings that are exactly at 40 percent or only slightly above: Pew Research Center (40 percent in two different polls, September 6-7 and September 8-12); Zogby (41 percent); CBS News, Time/SRBI and Washington Post/ABC News (all at 42 percent). (Note that in the ABC poll, the 57 percent who disapprove of Bush’s job performance includes 45 percent who strongly disapprove, an amazing finding.)

The Newsweek poll also reports the following approval ratings in specific areas: 35 percent, with 60 percent disapproval, on the economy; 36 percent, with 60 percent approval, on Iraq; and 28 percent, with 60 percent disapproval, on energy policy. (Do I detect a pattern?)

On problems caused by Hurricane Katrina, Bush gets a 37 percent rating, with 57 percent disapproval. This is similar to ratings in the CBS News poll (38 percent, down from 54 percent on August 30-31) and Pew poll (also 38 percent).

And even on terrorism and homeland security, Bush receives just a 46 percent rating, with 48 percent disapproval. That is, even in his area of greatest strength, the war on terror, Bush is now receiving net negative approval ratings.

Showing that this result is no fluke, the Time/SRBI poll gives him the same rating–46 percent approval/48 percent disapproval–on handling the war on terrorism. That poll also finds Bush with a net negative rating on “providing leadership in times of crisis” (48 percent approval/49 percent disapproval). Clearly, the public just doesn’t think of Bush in the same way it used to.

Bush’s character ratings. This shift in the perception of Bush is illustrated most vividly by recent results on Bush’s character. In the Newsweek poll, there is now a 49-47 split on whether Bush does or does not have “strong leadership qualities,” down from a 63-34 spread in late October of last year. In addition, there is now a 49-46 split on whether Bush is “intelligent and well-informed,” down from 59-37 last October, and a 46-51 split against Bush on whether can be trusted to “make the right decisions during an international crisis,” down from a 54-42 judgment in his favor last October. In addition, just 50 percent now say he is “honest and ethical,” 45 percent say he can be trusted to “make the right decisions during a domestic crisis” and 42 percent think he “cares about people like you.”

The poll also contains the following startling finding: The public is now much more likely to think that history will judge Bush a below average president (42 percent) than to think history will see him as above average (19 percent). Wow. Remember when Republicans were talking about putting Bush on Mount Rushmore? I don’t think that’s on anymore.

Other polls have similar findings on the sharp decline in perception of Bush’s character. In the CBS News poll, 48 percent now say Bush has “strong qualities of leadership,” compared to 49 percent who say he does not. That compares to a whopping 64-34 judgment in Bush’s favor a year ago. Similarly, in the WP/ABC poll, there is now a 50-50 split on whether Bush is a strong leader, down from 62-37 in his favor in May of 2004 and a 49-49 split on whether Bush can be trusted in a crisis, down from 60-39 in May 2004. Finally, just 38 percent now say Bush does “understand the problems of people like you,” compared to 61 percent who say he doesn’t.

So: the public now has a negative view of Bush’s job performance overall and in every area, including handling the war on terror, and has lost faith in Bush’s special qualities as a leader. What’s left? Not much. The bond between Bush and the American people has clearly been broken, perhaps irrevocably. An administration that was once defined in the public eye by competence and patriotism is now associated with cronyism and incompetence of the worst sort.

That’s quite a change. In fact, it’s the end of an era. As E.J. Dionne succinctly put it in his September 13 column:

“The Bush Era is over. The sooner politicians in both parties realize that, the better for them — and the country.

Recent months, and especially the past two weeks, have brought home to a steadily growing majority of Americans the truth that President Bush's government doesn't work. His policies are failing, his approach to leadership is detached and self-indulgent, his way of politics has produced a divided, angry and dysfunctional public square. We dare not go on like this…..

The breaking of the Bush spell opens the way for leaders of both parties to declare their independence from the recent past. It gives forces outside the White House the opportunity to shape a more appropriate national agenda — for competence and innovation in rebuilding the Katrina region and for new approaches to the problems created over the past 4 1/2 years.”


Public Opinion on Universal Health Care

Last week, in the context of discussing public opinion on health care costs, I offered a few brief observations about public opinion on universal health care. Here’s a more extensive treatment of public opinion on universal health care–both what we know and what we don’t know, based on available data.

What We Know

1. Rising health care costs, not health coverage, is people’s chief health care concern. For example, in a June 2005 Kaiser Family Foundation survey, the top worry was “having to pay more for your health care or health insurance” (45 percent said they were very worried), followed by “not being able to pay medical costs when you are elderly” (42 percent), “your income not keeping up with rising prices” (40 percent), not being able to afford the health care you think you need (34 percent), losing your health insurance (30 percent) and not being able to change jobs because you’re afraid of losing your health insurance (18 percent)

2. The public wants the government to play a leading role in providing health care for all. For example, in an October 2003 Washington Post/ABC poll, by almost a two-to-one margin (62 percent to 33 percent), Americans said that they preferred a universal system that would provide coverage to everyone under a government program, as opposed to the current employer-based system. Similarly, in Kaiser polls from 1992 to 2000, a large majority of the public agreed that the federal government should guarantee medical care for people who don’t have health insurance. In a slightly different question asked more recently by Kaiser in June 2003, more than seven in ten adults (72 percent) agreed that the government should guarantee health insurance for all citizens, even if it means repealing most of the tax cuts passed under President George W. Bush, while less than one-quarter (24 percent) disagreed with this statement. Finally, the last time Gallup asked whether the federal government should make sure all Americans have health coverage, they agreed that was a federal government responsibility by 62-35 (November, 2002).

3. Americans overwhelmingly agree that access to health care should be a right. In 2000 just as in 1993, eight in ten agreed that health care should be provided equally to everyone, and over half agreed “strongly” or “completely.” In addition, in 2004, about three-quarters (76%) agreed strongly or somewhat that access to health care should be a right.

4. The public says it is willing to pay more in taxes to provide every American with health care coverage. In August 2003, Pew found Americans favoring, by 67-26, the U.S. government guaranteeing “health insurance for all citizens,” even if that meant repealing most of the “recent tax cuts.” And the majority was scarcely diminished (67-29) by referring not to repealing tax cuts but more directly to “raising taxes.” Similarly, Greenberg Quinlan Rosner/Public Opinion Strategies (GQR/POS) found, in January 2004, a 69-28 majority saying they would be willing to pay more per year in federal taxes to assure every American citizen received health care coverage.

4. But support for universal coverage drops significantly if such a program would mean limitations on access to medical care. For example, while 62 percent in the October 2003 WP/ABC poll said they wanted a universal health care system run by the government rather than the current system, that support dropped to 35 percent if that limited choice of doctors and to 38 percent if that meant longer waits for non-emergency treatment.

5. Moreover, willingness to pay more in taxes for universal coverage is a “soft” commitment. For example, when phrased as whether the respondent would be “willing to pay more – either in higher insurance premiums or higher taxes – in order to increase the number of insured Americans,” 51 percent say they would not, compared to 45 percent who say they would. And, in the GQR/POS survey, when asked how much they’d be willing to pay in additional taxes to assure universal coverage for American citizens, 40 percent would not name a dollar figure at all and 16 percent named a figure under $100.

6. The public is also not completely clear on whether the federal government actually has to lead the way on universal coverage. When asked specifically about responsibility for covering the uninsured, four in ten people (43 percent) do say that the federal government should have the most responsibility for providing health insurance coverage to the uninsured, but two in ten (20 percent) say that state governments should be most responsible, and about one in ten (11 percent) say that employers should be most responsible. Another two in ten (18 percent) think that the responsibility belongs to none of these or to another group (June 2003 Kaiser poll).

7. And the public is not sure whether the government should make a major or a limited effort to provide health insurance to the uninsured. The last time this question was asked by Kaiser in May 2003, 42 percent said that there should be a major effort, 37 percent said there should be a limited effort, and 13 percent said that things should be kept the way they are.

8. The public generally wants to build on, rather than eliminate, the current employer-based private health insurance system. In a January 2000 Kaiser poll, they preferred building on the current system to switching to a system of individual responsibility (54-39) and in a November 2003 Kaiser poll, they preferred keeping the current system to replacing it with a government-run system (57-38).

9. In that context, the public supports a wide variety of options for expanding health insurance to cover more Americans. In a June 2005 Kaiser poll, the public said they favored tax deductions or credits for businesses (88 percent); expanding state government programs like Medicaid (80 percent); expanding Medicare to cover people ages 55-64 (74 percent); tax credits for uninsured individuals (73 percent); and requiring business to offer employees health insurance (70 percent). In a December 2003 Harvard School of Public Health/Robert Wood Johnson/ICR poll, 80 percent supported expanding Medicaid/SCHIP; 76 percent supported employers being required to offer a health plan; and 71 percent supported a tax credit plan. Trailing these options, but still garnering majority support, were a universal Medicare plan (55 percent) and an individual coverage mandate plan (54 percent). Finally, the 2004 GQR/POS poll found 74 percent favoring guaranteed health care coverage for all American children under 18 and 62 percent favoring catastrophic health insurance coverage for all Americans. (Note: one of the only options that didn’t garner majority support in these polls was a single or national health plan financed by taxpayers that would provide insurance for all Americans [37-47 percent]).

What We Don’t Know

So, it appears that the public is very open to a government-supported system of universal coverage, but not sure about how (and how fast) to get there and what kind of system it really wants. This is a challenging environment for advocates of universal coverage. To be effective, they will need to resolve a number of unanswered questions about public responsiveness to a universal coverage message.

1. Does the public see a connection between universal coverage and containing health care costs? If so, what kind and how can that connection be strengthened? If not, what can be done to create that connection?

2. The public says it favors a government role in guaranteeing health insurance coverage for all. But how does the public envision that role? And what does the public really hear when terms like “universal coverage” and “guaranteed health insurance” are used? Do advocates know what kind of terminology would actually work the best when talking about these goals with the public?

3. If the public believes access to health care is a “right,” is that the best way to talk about the goal of universal coverage? If not, what is the best way to connect to Americans’ values in and around the health care issue?

4. We need to know much more about the sensitivity of the American public to the costs involved in extending health insurance coverage. How seriously should we take the surface commitment to pay more in taxes? How would the issue have to be framed to make that surface commitment into a more durable one? How important might the issue of containing health care costs be to getting the public to accept the costs of universal coverage?

5. How can advocates avoid the restricted choice counterattack that will inevitably be raised to any universal coverage plan? Should consumer choice be a central element of any universal coverage plan? If so, what is the best way to frame that?

6. The public appears to support the general goal of universal coverage but seems shaky on the scale of the effort needed to meet that goal. What is the best and most effective way of making clear the scale of effort needed to actually attain universal coverage?

7. The public appears to support a wide range of possible ways to increase coverage, but it is unclear which, if any, of these approaches the public identifies as particularly effective. Can the public be led to identify progress toward universal coverage with a few key reforms that would stand out from the rest? If so, which ones and how should advocates talk about them?

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Ruy Teixeira

Former Senior Fellow