How Polls Divided Americans on Obama’s Health Care Reforms

In theory, polls on the Obama health care reforms were supposed to measure public attitudes.

In fact, they helped create them.

How did this happen? What were these polling fictions? How did the tail end up wagging the dog?

The answers can be found by examining the design and impact of the many polls commissioned by the nation’s most influential media organs including The New York Times, The Wall Street Journal, The Washington Post, CBS, NBC, ABC and CNN among others, over the past year and a half.

If you believe the polls, Obama’s health care reform legislation is a disaster. With the ink barely dry from the legislation signed into law last March, the polls are reporting that large numbers of Americans are in favor of its repeal.

But is it the public that has soured? Or did the polling process fail the public?

Confused public

The health care reform legislation is quite complex. The bill the President signed totals about 2400 pages. In comparison the Civil Rights Act needed only 8 pages. Many Americans quite understandably have had a hard time imagining how all the different parts worked. The task was made more difficult by the avalanche of ideological propaganda from both sides but particularly from the GOP. Confidence in the legislation was also damaged by the behind the scene deals made by the Administration in order to gain sufficient votes for its passage in Congress. One such deal resulted in the popular “public option” being cut from the legislation.

In the end, Americans were left in a high state of confusion as to whether these reforms would benefit them personally and the country as a whole. Numerous polls have attested to this high degree of public confusion.

  • 59%-67% indicate that health care proposals are “confusing” – CBS News/New York Times
  • 63%-69% say the debate is “hard to understand” — Pew
  • 75% agree that the proposals are “so complicated it is hard for the average American to understand [them]” — Bloomberg

Most Americans learned about the particulars of this legislation from the media. The media focus was on the rancorous and often not very educating congressional debate between Republicans and Democrats. Ideological, simplistic, often resorting to half-truths and even outright lies, the primary purpose of these debates was to score political points. This became the substance of the public’s education on these complex reforms.

Conditioning the public

Saturated by propaganda from every conceivable media source, the public responded in an entirely predictable way. If a person was a Democrat-leaning voter they would see virtue in the legislation by having it associated with phraseology like “health insurance for all Americans”, “no insurance restrictions on pre-existing medical conditions”, “coverage for children up to 25 years” and so on. If a person was a Republican-leaning voter they would see the legislation as anathema by having it associated with phraseology like “job killer”, “socialized medicine”, “big government control over individual Americans”, and so on.

On the important issue of economic consequences, Democrat-leaning voters were told by President Obama that if this legislation were not adopted, the country would soon go broke due to runaway medical costs. Republican-leaning voters were told the opposite by their leaders — that the country would go broke if the legislation were to become law.

This partisan labeling process initiated by the opposing parties but reinforced by massive media indoctrination,  conditioned the American public to accept or reject specific reforms on a most superficial level of understanding. Sadly this was as close as most Americans ever got to understanding the complexities of Mr. Obama’s health care reforms.

Partisan polling

Polls conducted to measure public attitudes to the reforms confirmed this polarization. They did so by capitalizing on the partisan, media driven conditioning process. The preformatted questions employed in the surveys often used phraseology or labels that came straight out of the polarizing congressional debate. These labels prompted respondents to answer survey questions in a predictably partisan way as conditioned by mass media indoctrination. This is apparent when analyzing the response to the questions. Most are highly correlated to respondents’ political affiliation (Republican, Democrat, or Independent). Few Americans had a depth of understanding of the specifics of health care reform to respond to the questions in a personal way, independent of political influences.

Perception of a divided public

Not only did polling do little to further our understanding of what health care reform meant to individual Americans, the polling results were used by media to strengthen the perception that the American public was bitterly divided in their support of this legislation. Most polls showed a plurality of Americans disapproved of Mr. Obama’s handling of health care reform legislation, and about half were in favor of its repeal. However to suggest as some media reports have done, that this reaction means half of America is against health care reform is completely unwarranted.

The evidence comes from the polls themselves.

Public support for health care reform

When asked about what should be the goals of health care reform, about 90% of all Americans indicated that it was important to find a way to get health insurance for those who are uninsured, to prevent insurance companies from refusing to ensure people with pre-existing conditions, and to prevent insurance companies from dropping persons due to illness. About six out of every 10 said these goals were “critically important”. Only one of every 10 said they were not important. These goals remain at the core of Mr. Obama’s health care reforms. Other goals were less popular but still had the support of a majority of Americans.

Secondly, Pew Research polls reported that 71% to 76% of Americans felt that the US health care system needed to be completely rebuilt or fundamentally changed. The status quo was unacceptable. One would conclude that if Obamacare was to be faulted, it would be because the changes it proposed were not fundamental enough.

The divide revealed

So what is really behind this great divide? Apart from the media driven partisan conditioning process, the complexity of the legislation itself helped to create this polarization. Even if respondents supported most elements of the reforms, one or two provisions that they strongly resisted e.g., 60% oppose the legal requirement that everyone buy health insurance, may have been enough to pull the plug on their overall support for the reforms. Similarly, repeal could relate to all of the legislation or specific provisions. Secondly, opposition to reforms could exist because a) the legislation went too far, or b) it didn’t go far enough. While polls show that more feel it went too far, the numbers saying it didn’t go far enough is significant.

Interpreting public support for health care reform (or lack of it) from the above questions is not at all obvious. While the press is attracted to these questions because of their combative, adversarial overtones, their meaning is steeped in ambiguity. If anything, they seem to represent some vague, symbolic notion of how displeased Americans are with all the political theatrics surrounding something they sense is really important rather than opposition to health care reform.

Sensitivity to question wording

Public unfamiliarity with the reform proposals was also evident in how much attitudes towards health reform shifted when a poll question included a preamble that explained some specifics of the reforms. For example, an NBC/Wall Street Journal poll found that the 36% saying that Obama’s health care reform plan was a “good idea” jumps to 56% favorable rating in a follow-up question that briefly describes the plan. Without a developed point of view, responses are easily influenced by question wording and question order in addition to the influences noted above.

Sensitivity to question wording is but one of a number of ways the polls revealed how badly the American public misunderstands (or was led to misunderstand) the health care reforms. The polls also revealed monumental misapprehensions, contradictions, and irrational adherence to political propaganda.

Public misapprehensions

Polls have reported that large numbers of Americans are concerned that reforms will lead to government money being used to pay for:

  • health care for illegal immigrants (37%),
  • abortions (33%),
  • rationing of health care (35%), or
  • death panels in which government officials will determine how much health care ailing Americans are to receive (30%)

These are obvious fabrications probably disseminated by enemies of Mr. Obama’s health care reforms. Public response to these issues reveals not only how little Americans know about the reforms, but also on the effectiveness of mass media to condition the American public to political messages regardless of whether these messages are truthful or not. In this context, the polls performed a useful function in revealing this susceptibility.


While the majority of Americans seem to support the idea of universal coverage, the majority also is opposed to forcing Americans to buy health insurance. Requiring by law that everyone has health insurance is the mechanism by which universal coverage is achieved in Obamacare. By that logic, if you oppose one you also oppose the other. Again, this reveals insufficient public understanding of this complex piece of legislation.

On an interesting side note, forcing those without health insurance to buy it was a method pioneered by the Republican state administration of Mitt Romney. The irony for President Obama is that even when borrowing a health care reform idea inspired by Republicans, he still gets no respect from Republicans.

Blind adherence

Then there are results that can only be explained by blind political, ideological adherence, such as the reported 35% of Americans who say they oppose Obamacare reforms because they make it illegal for private medical insurance companies to reject clients with pre-existing conditions. Unless this was a survey conducted solely amongst private health insurers, this doesn’t make any sense at all. Why would any respondent, be they Republican or Democrat, want an insurance company to reject them for a pre-existing condition?


Using pre-formatted questions with hot button phraseology straight from Congress, all the polls could do was mirror the confusion and social conditioning of Americans and, as interpreted by the press, reinforce the mistaken perception that half of America was opposed to health care reform. Instead of reporting what the polls were certain of — that the American public was confused about this truly complex piece of legislation — the media focused on what polls weren’t sure of — where the American public stood on the merits of the legislation.

The reason for this choice was obvious. A headline proclaiming “Americans Divided on Health Care Reform” gets the public’s attention. The headline “Americans Confused on Health Care Reform” gets… well, a stifled yawn at best.

Unfortunately, the former is an illusion and the latter the reality.

About Oleh Iwanyshyn

Oleh Iwanyshyn has been involved professionally with surveys from the mid-70s when he started as a methodologist at the Institute for Behavioral Research at York University. Later, while at the Canadian Broadcasting Corporation his focus shifted to media and election surveys. He now runs his own survey research company, ViewStats Research, established in 1997 and specializing in online surveys. Public opinion surveys is an essential communication tool between a democratic society and its leaders. Unfortunately, surveys can be very easily manipulated. Revealing such manipulations and their consequences is the raison d'être of the poll stuff blog.
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