October 27, 2009|By Clay Ramsay
Last week's health care reform vote in the Senate Finance Committee brought Republican Sen. Olympia Snowe on board - even if she only stays on the boat until the next bend in the river. Ms. Snowe opposes the public option but expresses strong interest in a "trigger" that would allow for such a government-run option if the health insurance industry does not change in response to reform legislation. In that case, she said, "you could have the public option kick in immediately."
In short, Ms. Snowe supports the country having a Plan B.
The loudest advocates of the public option usually present it as a health plan that would be available to any American, any time. This has proved to be a polarizing idea. Opponents of the public option see a government insurance plan that would go head to head with for-profit companies that are fully subject to market discipline, including the demands of Wall Street, and have to make serious money. To many people, this looks like unfair competition. When poll questions describe the public option only as something that will compete with private insurance companies, the public is typically divided between support and opposition.
But what if individual Americans could have a Plan B - rather than the whole country having one, as Ms. Snowe proposes? What if a public insurance option were available just to those who cannot get health insurance through their employer?
In a new poll conducted by WorldPublicOpinion.org together with the Brookings Institution, we tested the idea of a public option structured this way: as each person's Plan B, to fall back on if they lose their job or have to work without health benefits. Three in four Americans - 75 percent - support this limited public option, including majorities of Republicans, Democrats and independents.
We also presented arguments both for and against a broader public option, and the results show how far most Americans are from an advocacy-oriented, "bumper sticker" mindset on this issue. When they evaluated the argument in favor - that "if people cannot find affordable coverage, the government needs to provide them with an option," and "the competition provided by a public option would force private insurers to lower their overhead costs, making insurance cheaper for everyone" - 68 percent found this convincing, including a modest majority of Republicans.
A modest overall majority, including many independents, also found convincing the opposing argument: "Because the government would not need to make profits, a government-run health insurance program would unfairly undercut private insurance companies. This would inevitably lead to a government takeover of health care."
So majorities saw merit in each argument, and 3 in 10 found both convincing. But when respondents were asked to decide about "a government-administered health insurance option that anyone can purchase," a clear majority favored it. Fifty-seven percent supported it overall (though Republicans were against it by 2 to 1).
Those who opposed the broad public option were asked about a Plan B version: "What if [it] were offered as an option only to people who cannot get insurance through their employers?" Another 18 percent of the full sample supported this idea - making 75 percent in all who would support a public option as a choice for those who cannot get employer-based health insurance. And among Republicans, 59 percent supported this approach.
As Congress churns through its process, discarding and sometimes retrieving ideas for greater consensus on health care reform, it may well arrive at this Plan B by a process of elimination. But the public is already there.
Clay Ramsay is director of research at the Program on International Policy Attitudes at the University of Maryland and a faculty member of UM's School of Public Policy. His e-mail is cramsay@pipa.org.
