The increasingly favorable climate of public opinion for health care reform that Clinton had in 1993 eroded enough by 1994 to dissipate any strong push on the public’s part for reform . . . All signs on the surface were that Obama took office in January 2009 with the same--or an even greater--impetus for health care reform. . . . It would therefore not be surprising to find--and there was every reason to expect--that Obama would have behind him even a more favorably disposed public than Clinton had to help move reform legislation forward. But has this been the case? Our best estimate is, overall, probably not, and this explains the battle that Obama has faced in getting public support to help the reform effort along through Congress or to offer approval later of any landmark legislation that is passed and implemented.
Shapiro and Arrow look at 18 survey questions on health policy, comparing average responses in 2009 to those in 1994. They define change in opinion as a shift of six
percentage points in the balance of opinion in one direction or another. This is what they found:
* 5 questions where opinion was more favorable to health care reform in 2009 than in 1994: Does the health care system need to be rebuilt? Do you think the president's reforms will decrease the amount you'll pay for medical care? Do you think the Democratic party is more likely than the Republicans to improve the health care system? Do you approve of the way the president is handling health care policy? Do you favor the president's plan?
* 4 questions where opinion was less favorable in 2009 than in 1994: do you favor national health insurance, which would be financed by tax money? Would you be willing to pay higher taxes so that everyone can have health insurance? Would you be willing to pay more--either in higher health insurance premiums or higher taxes--in order to guarantee health insurance coverage for all Americans? Do you think the federal government should guarantee health care for all Americans?
* 1 question with a change whose direction is ambiguous: more people think that the country spends too much on health care, which is either in favor of Obama's plan (national health care as a cost-saving move) or against it (if national health care is viewed as an extra public expenditure).
* 8 questions where public opinion is essentially unchanged.
In balance, then, Obama has faced a public opinion climate similar to Clinton's in 1994.
As we're all aware, opinion is volatile on these issues: support of health care reform does not necessarily translate to support for any particular policy. And a lot depends on Congress, where the Democratic majorities have a strong interest in seeing their party succeed. When translating opinion to policy, though, Shapiro and Arrow seem to have a good point when they write:
While the reports in the press of public support for major changes have been accurate (though varying from opinion poll to opinion poll, depending on how the survey questions were asked), they did not examine fully how current public opinion compares to what Bill Clinton faced in 1993-1994.