Ruy Teixeira
Ruy Teixeira

In this edition of Public Opinion Watch:

• Between Iraq and a Hard Place

• Public Opinion on Health Care Costs

Between Iraq and a Hard Place

The remarkably poor and ineffective response of the Bush administration to the Hurricane Katrina disaster, particularly the New Orleans flood, seems likely to make a bad political situation for Bush substantially worse.

Consider Charlie Cook’s summation of where Bush was at politically before the Katrina disaster:

“From the beginning of Bush's first term through mid-June of this year, in only two out of 170 Gallup national surveys did his disapproval ratings reach 50 percent or higher. Since mid-June, eight out of 10 Gallup polls have put his disapproval rating above 50 percent. And virtually every major national poll shows his job-approval ratings this summer at their lowest level yet. News from Iraq has been worsening, and the war, along with rising gasoline prices, had driven Bush's approval ratings far below where those of every modern two-term president, save Richard Nixon, were at this point in their fifth year in office.

With violence in Iraq expected to only get worse in the period leading up to the October referendum on that country's new constitution, U.S. public opinion seems about ready to stampede away from Bush and the war……”

One might add to this summation a few of the more gaudy data points from two recent polls that underscore Cook’s viewpoint.

1. In the latest CBS News poll, Bush’s overall approval rating is 41 percent, and his ratings on the economy and Iraq are 37 percent and 38 percent, respectively.

More than three-fifths (62 percent) of the public says higher prices for gasoline affect them personally “a lot” and 63 percent believe that the price of gas is something a president can do a lot about.

On Iraq, 61 percent say the war hasn’t been worth the costs, 55 percent want to decrease or remove all U.S. troops and just 16 percent believe the Iraq was has decreased the threat of terrorism against the U.S. And, by about 2:1 (57-29), people say Bush makes things in Iraq sound better than they are, rather than providing an accurate picture.

2. In the latest Gallup poll, Bush receives the lowest approval ratings of his presidency for handling terrorism (53 percent), the economy (38 percent) and health care (32 percent) and ties his low on Iraq (40 percent).

On gas prices, his rating is a stunningly low 20 percent, with 76 percent disapproval. About 7 in 10 report suffering some financial hardship from rising gas prices and most expect gas prices to continue to rise in the coming year.

On Iraq, 53 percent now say sending troops to Iraq was a mistake, 53 percent want to withdraw some or all troops, 69 percent believe it’s unlikely that peace and internal security will be established within a year (56 percent don’t believe that’s even likely in “the long run”) and 82 percent believe U.S. military casualties will continue at the current rate or higher for the next year.

Cook initially thought, given how dire Bush’s situation was becoming, that the Katrina disaster might actually help Bush in the short run by diverting attention away from these problems, particularly Iraq. But he’s changed his mind. As he puts it:

“Natural disasters and other tragedies offer both opportunities and risks for our elected leaders. They offer the opportunity to demonstrate leadership, decisiveness, compassion and competence — all during a period of maximum visibility. The risk is that if a leader fails to rise to the occasion, a national spotlight illuminates the failure for all to see — and judge.

President Bush masterfully demonstrated leadership qualities after 9/11. (His reaction to last year's Florida hurricanes and his efforts to help their victims were also impressive.) Americans were not just satisfied with the response of their government to the tragedy of 9/11, they were proud of it. But this Wednesday, Thursday and even Friday, as I write, I doubt many Americans who have followed the government's response to Katrina are proud.”

Exactly. Failing the test of leadership in real time and in plain view seems likely to only add to Bush’s troubles. Consider how the public has reacted so far to Bush’s handling of the situation. They started out slightly positive (54 percent approval in the last two days of the CBS News poll, August 30-31), but his rating declined to 46 percent in a September 2 Washington Post/ABC News poll and has now sunk to 38 percent, with 54-55 percent disapproval, in the September 4-5 tracking polls conducted by SurveyUSA.

And, of course, people are overwhelmingly convinced that the federal government should have been better prepared, done more to help, been better organized and so on.

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.

Public Opinion on Health Care Costs

To the extent one can rank people’s personal economic worries, rising health care costs are frequently at the top of the list. For example, in a June 2005 Lake Snell Perry Mermin survey, 27 percent picked rising health care costs, 18 percent wages not keeping up with costs, 14 percent a secure retirement, 12 percent higher taxes and 9 percent rising gas prices as their chief economic worry. Just 5 percent picked losing their job.

A somewhat similar pattern can be observed in a June 2005 Kaiser Family Foundation survey. That poll asked people how worried they were about a wide range of problems. 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) and “your income not keeping up with rising prices” (40 percent). In contrast, only 24 percent were very worried about not being able to pay their rent or mortgage, 19 percent about losing their savings in the stock market and 17 percent about losing their job.

Obviously, rising health care costs are a very important problem indeed in the eyes of the public= Therefore, it would be good to know more about how exactly rising health care costs are affecting Americans’ lives today. In this regard, a just-released Kaiser Family Foundation survey specifically on the issue of health care costs provides much valuable information. Here are some key findings from the survey.

“Two-thirds (66%) of insured adults say their health insurance premiums have gone up over the past five years, including 38% who say these premiums have gone up “a lot”. About one-quarter (24%) say premiums have stayed the same, while just 5% say they’ve gone down.

Around half of insured adults say their co-payments for provider visits (52%) and health insurance deductibles (49%) have risen over the past 5 years. About four in ten say co-payments (40%) and deductibles (42%) have stayed the same, and few say these costs have gone down (5% co-payments, 3% deductibles have gone down).

More than a third (35%) of the public says high profits made by drug companies and insurance companies are the MOST important reason behind rising health care costs. The next most commonly cited reasons are the number of malpractice lawsuits (19%) and the amount of greed and waste that occurs in the health care system (14%).

Nearly one-quarter (23%) Americans have had problems paying medical bills in the past year.

More than six in ten (61%) adults who report problems paying medical bills are covered by health insurance. Among adults who had problems paying medical bills – majorities report that the bills were for basic care such as doctor bills (85%), lab fees (62%) and prescription drugs (56%).

More than one in five (21%) Americans currently has an overdue medical bill, and almost two in ten (19%) report experiencing serious financial consequences in the past 5 years due to medical bills.

Almost two in ten (18%) Americans say health care costs are their biggest monthly expense excluding rent or mortgage payments. More than three in ten (32%) name transportation, and nearly one-quarter each say food or clothing (24%) or utilities (23%) are their biggest expense excluding rent or mortgage costs.

Nearly three in ten (28%) adults report a time in the past year when they did not have enough money to pay for medical or health care, and 62% of these adults are insured. This share has been stable since the mid-1980’s, but is considerably higher than in 1976 when 15% said there was a time they didn’t have enough money to pay for care.

Nearly three in ten (29%) adults report that they or someone in their household skipped medical treatment, cut pills, or did not fill a prescription in the past year because of the cost.”

One way to control health care costs, of course, is in the context of a system that would provide universal health insurance coverage to Americans. Would Americans support government action to create such a system? They say they would, though there are nuances to that support which suggest mobilizing the public to move in that direction remains tricky.

Start with the basic fact that the public definitely wants the government to play a leading role in providing health care for all. For example, in an October 2003 WP/ABC poll, by almost a 2:1 margin (62 percent to 33 percent), Americans said 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. Finally, in a slightly different question asked more recently by Kaiser in June 2003, more than seven in 10 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.

Note, however, that support for universal coverage drops significantly if such a program would mean a limited choice of doctors or longer waits for non-emergency treatment.

Note also that, when asked specifically about responsibility for covering the uninsured, there is not unanimous support for the federal government to lead the way. Four in 10 people (43 percent) think that the federal government should have the most responsibility for providing health insurance coverage to the uninsured, compared with two in 10 (20 percent) who say state governments should be most responsible, and about one in 10 (11 percent) who say employers should be most responsible. Another two in 10 (18 percent) think the responsibility belongs to none of these or to another group (June 2003 Kaiser poll).

In a more recent Kaiser poll (June 2005), when presented with a variety of options for expanding health insurance to cover more Americans, the public did express a high level of support for nearly every option (ranging from 70 to 88 percent). (The only option that didn’t garner majority support is a national health plan financed by taxpayers that would provide insurance for all Americans [37 percent]). However, when asked to select the single best option, no one option attracted widespread support.

Finally, the public is also divided over 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 there should be a major effort, 37 percent a limited effort and 13 percent said things should be kept the way they are.

So, it appears the public is very open to a government-supported system of universal coverage, but not sure about how to get there and what kind of system it really wants. We shall see if the push of rising health care costs starts to focus the public mind more so than it has been so far.

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Ruy Teixeira

Former Senior Fellow

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