The Health Care Debate: Witness The “NIMBY” Effect In Action

This article was co-authored by Bill McInturff and Alex Bratty.

If you’ve been following the ins-and-outs of the health care debate and reading some of the recent articles regarding public attitudes towards the proposal for a public plan you might be a little confused about what it is people really want. And rightly so, for there are many numbers floating around out there and some fail to capture the complexity of the issue.

In our recent NBC/WSJ poll* we asked a series of questions on the issue of health care, specifically designed to cover the various angles of the debate.

Sure, when asked the importance of having the choice of both a public plan and a private plan for their health insurance three-quarters (76%) of Americans say this is “extremely” or “quite important.” But, pause for a moment and ask yourself this question: Is this a surprising answer for a country that prides itself on wanting more choices? Of course not. Whether it’s health care or some other issue, in general, Americans favor choice every time.

The point is you have to dig a little deeper to find out what people worry about. As with many public policy issues, the rub comes when people feel it might personally impact them in an adverse way – yes, that familiar “Not-In-My-Backyard” or “NIMBY” effect.

First, consider the concern among Americans who already have private health insurance (59% of our survey respondents). Asked if a public plan administered by the federal government was created and available to all Americans, how likely they think it is their employer would drop their current health coverage, almost half (47%) of these privately insured adults said they thought it would be “very” or “somewhat” likely. (32% think it is “not too” or “not at all” likely.)

Next, consider the concern about how we’re going to pay for the trillion dollar health plan Obama is proposing. Not surprisingly, a majority can live with the options that don’t seem to directly affect them: Requiring everyone to have health insurance – those who can afford it buy their own, those who can’t get government assistance (62% acceptable); raising taxes on people who earn more than $250,000 per year (62% acceptable).

The margins get smaller at the thought of requiring all small businesses to offer coverage or pay a percentage of their payroll to the government (55% acceptable, 37% unacceptable); and things get shaky at the suggestion of reducing Medicare and Medicaid reimbursements to doctors (47% acceptable, 46% unacceptable). But, the rubber really hits the road when Americans see a potential direct impact. The idea of requiring people to pay taxes on their benefits is roundly rejected, whether those taxes are on a portion of only the most generous plans (59% unacceptable) or for everyone to pay on all private plans (70% unacceptable).

So you see, while Obama’s proposed plan has initial support (55%), once we get into the details and how it might personally impact people – especially the majority who currently have private health insurance – the picture changes dramatically. Americans become less certain about their options if it could mean potentially losing their existing coverage, or taxing their benefits.

*National survey of 1,008 adults conducted June 12-15, 2009
(Public Opinion Strategies partners with Peter D. Hart Research Associates to conduct the NBC/WSJ polls. Neither Peter D. Hart Research Associates nor NBC/WSJ are responsible for these conclusions.)

Public Opinion Strategies