Journal Issue: Health Care Reform Volume 3 Number 2 Summer/Fall 1993
Public opinion will play an important role in shaping health care reform in this country. Thus polls that attempt to measure the strength and direction of public opinion have become one focus of the debate over health care reform. Until very recently, however, children were not the focus of much public opinion research. While a great deal of polling has been done to test the popularity of various approaches to health care reform, few of these polls specifically address children's health.
Despite this historic oversight of children's issues, in this article Susan Nall Bales of the Benton Foundation reviews recent polling data from which some areas of consensus on health care reform for children can be identified. Her analysis draws on a seminar presented for U.S. congressional staff during the summer of 1992. At this seminar, four political pollsters, each involved in advising candidates during the presidential and congressional election campaigns, were asked to assess whether a children-first approach to health care reform would be able to motivate public support for health care reform. Representing the Republicans were Gary Ferguson of American Viewpoint and David Sackett of the Tarrance Group. For the Democrats were Robert Green of Penn + Schoen and Celinda Lake of Mellman-Lazarus-Lake.
The analyses of the pollsters strongly suggest that children's health care is a prime concern among a diverse public, that Americans want to see children accorded priority among competing "groups claims on government," that they view political candidates' attention needs as touchstone their responsiveness. While is divided regarding how pay expanded access health care—whether enacting personal corporate taxes or by reallocating current revenues—the polls strongly suggest a new realism respect to children and increased public support candidates who come forward with proposals for improving children's status, regardless of the tax liability.
This emerging public mandate to do more for children is tempered, however, by an ambivalence regarding the private nature of family concerns. The public still holds parents primarily accountable for their children's condition; at the same time, the public wants more help from government for families with children, and not just poor families. But children's health is often overlooked by the public and, therefore, by pollsters and policymakers because the public does not automatically link these issues to the political arena. This suggests that these issues are just emerging in the minds of American voters as legitimate political concerns.
An important issue revealed in the polls is that the public is often unable to speak out in support of children's services because it lacks understanding of the specific programs—from Medicaid to the Special Supplemental Food Program for Women, Infants and Children (WIC)—under which children are covered. The fact that Medicaid has been linked to welfare is a prime disadvantage for children. However, while public support for any government program directed to the poor will drop automatically when the word "welfare" is used explicitly, the public does not confuse children's programs with welfare. But neither does it understand where to find programs that serve children within the government bureaucracy or how to protect children's services.
It remains to be seen how children fare in the current health care reform debate, which is rapidly turning into a directive for cost containment first, as a precursor to eventually expanded access. While cost concerns are widely documented among the public, no data currently exist to show whether the public wants cost containment principles applied to children, whether the public is willing to trade some aspect of children's quality of care for cost containment, or whether children should suffer equally in any new rationing system.
More research on specific questions is needed to better understand the public's concerns, and an educational effort to inform the public of the stake of children in health care reform may also be appropriate. Ultimately, however, in what form and how quickly health care reform advances will depend on a number of critical political decisions which will be guided by public opinion.