Americans Prefer Having Cake, Eating It

The wise Harold Pollack has argued that health care reform is in some ways the best covered social policy story in the history of American journalism. That isn't to say there hasn't been plenty of crappy coverage, but there has never been the same volume of informed and insightful reporting and analysis available in so many places on a pressing policy debate.

And yet it's easy to get depressed about the impact all that good work didn't have. From our perspective over here on the left, the arguments offered by reform's opponents are a collection of hypocrisy, faulty analysis, and outright lies. The public, unfortunately, hasn't really been persuaded. In the broadest terms, they mostly see health care reform through partisan lenses. In the particular, they want all the benefits without any of the responsibilities.

I'm painting with a broad brush here, of course. But this morning the New York Times is out with a new poll on the Affordable Care Act that doesn't really show much that's new, but does reinforce what's been apparent all along. Take a look:

So 85 percent of the public—in other words, basically everyone—thinks we all ought to get coverage no matter our pre-existing conditions. Even Republicans think that. But over half of the public doesn't think we ought to be required to get insurance, despite the fact that universal participation in the insurance pool is precisely the thing—and the only thing—that makes it possible to do away with exclusions for pre-existing conditions and get closer to a system that operates the way it should, i.e. that you have insurance, and that insurance pays for whatever medical needs you have, full stop.

I know this is going to sound elitist, but there are times when a country's leaders need to accept that the public is never going to fully understand the critical details of a policy debate, and it's up to them to just figure out what the right thing to do is, and do it. The people who have done such extraordinary journalism over the last few years on health care can keep pumping out those articles, but the impact is going to be marginal at best, while Sean Hannity can go on the radio and shout "death panels!" to his millions of listeners (which he still does regularly, by the way), and they'll nod their heads and grumble about big government. If you believe that the policy is a necessary one, you have to just forge ahead, even if it means a majority of the public won't come around to support it for a long time.

In the end, the law will succeed or fail on its own substantive merits, and no matter how well it works it won't ever be completely immune from attack. Medicare has been a smashing success, and the conservatives who fought its creation half a century ago are still trying to destroy it. The only comfort is that they never get very far, if only because the program's defenders aren't above a little demagoguery now and then when it's under genuine assault. If you were hoping that a high-minded, comprehensive debate could build deep and wide support for a worthy policy change, well, the people had their chance with the ACA. They didn't completely fail (the public is basically split down the middle and always has been), but nor did they get to a place where most of them actually grasp how this thing works and what's at stake.

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