Contentious health care debate opens in the Senate, public approval in the dumps

Gallup released a poll today, November 30th, 2009, indicating that Americans are leaning against health care reform, and a majority disapprove of President Obama's handling of the reform issue. Their research indicates that 49% of Americans would vote against health care reform, with only 44% approving. Broken down by political party, 76% of Democrats still support the legislation, although this is a 6-point drop from October 2009. Republicans still uniformly oppose the legislation at 88% against. The most dramatic drop in support is among Independents who have dropped 11-points in a month to a paltry 37% approval (or, 63% opposed.) And the president gets the worst report card, with only 40% approving of his handling of health care reform, and 53% indicating a negative feeling, a 13-point net negative, and a 7-point negative slide since October. Broken down by party, and compared to general approval ratings, the president fares even worse. Read the entire poll analysis here. Gallup describes the "bottom line" as, "Despite the considerable efforts of Congress and the president to pass health insurance reform, the public remains reluctant to endorse that goal. Over the past month, Gallup has found more Americans opposed to than in favor of healthcare legislation, though at least one in five say they have not made up their minds. Proportionately more independents (27%) and Democrats (24%) than Republicans (14%) are undecided, which at least improves the odds that legislation could wind up getting majority public backing. But the recent trend has been in the opposite direction, with opposition growing."

Interestingly, Gallup did not poll on a key issue polarizing the debate: the public option, which has both parties impassioned, and is threatening to divide the Democratic party. The GOP almost uniformly opposes the public option, and moderate Democrats, as well as freshmen Democrats in heavily Republican districts, are vulnerable. While the Republican party at large gained little in the 2009 off-cycle elections, the gains they did make exposed this vulnerability like a raw nerve. Now, much more critical races are on the table for 2010, and particularly Conservatives have sunk their claws into health care reform as a referendum on the new administration, as a mirror of government spending which has exploded under Obama's watch.

Regardless of the arguments that programs like the stimulus spending and the bank bailouts were necessary to protect the global economy, Democrats used their majority to usher these programs through. There was little true worry they would not pass, and the urgency they were presented with served as a political steam roller. Now, with tangible results slow to come, lagging by most estimates, and the national debt spiraling upward with each new bill passed, economic burden colors every debate, and Democrats, and the president, will be held accountable. Seniors are also skeptical of the public option and of Medicare-related changes in the legislation, and rightfully so. Many are being told by their elected Congressmen and by aggressive ad campaigns that they are going to lose benefits, particularly Medicare Part B, which covers the bulk of their care. Senior citizens comprise a formidable voting bloc.

A new Kaiser Family Foundation poll indicates that 58% of American want elected officials to take on the cause of health care reform, but half of those who support reform, oppose what is currently being debated. It is an unusual dissonance, but one lawmakers should be paying close attention to. The New York Times cites several surveys claiming that Americans in general support the public option, saying "Surveys show that a majority of the public supports it. But a deeper look at the polls show that support is soft and that it is not viewed as important as other perceived goals of the bills, like lowering costs." They also note that when the poll described the public option as, "similar to Medicare," approval jumped by 7 points. Additionally, the eternally divisive issue of abortion and sexual health has further escalated the debate, causing an uproar in liberal-leaning groups who oppose the legislation because of its lack of progressive language on abortion, reproductive health, and gender-related medical care. Health care reform is not simply a party-line issue. Both parties have unique issues within the debate. Republicans left the negotiating table for the most part over fiscal concerns and because of their failure to include meaningful tort reform in the final package.

Critical voices in the Senate are now saying they will oppose the bill for a cornucopia of reasons. Senate majority Leader Harry Reid, who has vigorously defended the public option, wants a final bill voted on by Christmas, an ambitious goal. Sen. Blanche Lincoln (D-Arkansas), who has been quoting Bill Clinton's campaign logo, "It's the economy, stupid," recently joined Democrats and voted to allow debate on the bill. In Little Rock on Monday she said, "Making sure we can keep debate alive in this country is what we're founded on, and I think that's an important thing." But, she still opposes the public option, and her vote on the final bill is not assured. Lincoln said, "I have said I don't support a government-funded, government-run public option. I just don't think it's fair in these economic times to put at risk taxpayers and the treasury, which if in fact the premiums don't cover the program that's what's probably going to happen." Sen. Joe Lieberman (I-CT) has also said he will "be stubborn" in his opposition to the public option, elaborating on a similar note to Lincoln, "Once the government creates an insurance company or plan, the government or the taxpayers are liable for any deficit that government plan runs, really without limit." Lieberman said he would support an alternative "trigger method," such as the one proposed early on by Sen. Olympia Snowe (R-ME).

Snowe is also a key Senator in the debate, being one of the few Republicans who has been willing to work with Obama and Congressional Democrats on crafting a passable bill that pleases the greatest majority possible. Over the weekend, Snowe said, "No one has a monopoly on good ideas," and made another plea for bipartisan cooperation, she told WCSH, the local NBC broadcaster in Portland, Maine, "I hope they will be willing to come together and...be willing to work in a constructive, bipartisan fashion to get it done and to get it done right." Snowe's concerns with the bill overall are largely fiscal.

Sen. Ben Nelson (D-NE) has also taken up the abortion issue, saying the language of the bill is to vague in this area. Nelson is opposed to federal dollars going to fund abortions, and told The Hill, "I think you need to have it eminently clear that no dollars that are federal tax dollars, directly or indirectly, are used to pay for abortions."

Democrats need 60 votes to pass their bill and overcome Republican opposition. Vice President Biden appeared in a video on the White House website, with a rallying call for reform. Biden asked if we should trust "...the people who say you’d be better off if you just left things the way they are,” or “the folks who actually know something about what’s happening in our health care system.”