Larry Jacobs has come to a somber conclusion about the prospects for health care reform after reviewing dozens of public opinion polls.
In an article published in the current edition of the New England Journal of Medicine, the University of Minnesota political scientist reports that while Americans have broadly agreed on the need for health care reform for nearly two decades, public opinion has made little difference in the outcome of past reform efforts.
Jacobs doesn't think public opinion will matter much during the current reform debate.
"We've got a public that is very dissatisfied with the health care system," said Jacobs. "They want to see change. But on the other hand, they're deeply ambivalent about what that change looks like. And the various factions are able to mine and exploit that ambivalence and those divisions."
“I think that the key interest groups are much more interested in getting to yes than they have before, because they've seen the health care system deteriorate.”Ron Pollack, executive director of Families USA
Based on his research, Americans, for the most part, are torn between a market approach to controlling costs or a government-led effort to make sure everyone gets care.
It's easy to stoke Americans' fears about either of these approaches -- even the one they support, Jacobs says.
"When you ask people straight out, 'Do you think the problems today are severe enough that you would support national health insurance financed by taxes?' you will often find majorities in the 55 to 60 percent range. Very impressive."
That is, until you probe a little deeper.
"When you follow up and you say, 'Would you support reform if you knew that it might reduce your access to specialists, or waiting lines might go up, or cost-sharing in terms of premiums and deductibles might go up?' you see that support plummet," said Jacobs.
It's debatable whether there would be long waits or limited access to specialists. But as long as there's doubt in voters' minds, the damage is done, Jacobs says.
Special interest groups know these poll results inside and out, and use them to their advantage when lobbying against a proposal they don't like, Jacobs says. That makes him very skeptical of claims that health care reform is likely anytime soon.
The polls don't reflect how the mood in Washington has changed recently, says Ron Pollack, executive director of Families USA, a consumer lobby.
"I think that the key interest groups are much more interested in getting to yes than they have before, because they've seen the health care system deteriorate," said Pollack.
Pollack says he believes the prospects for health care reform are better than they have been in years.
"Health care costs, premiums are rising much, much faster than people's wages. Businesses are saying health care costs are unsustainable. More and more people have joined the ranks of the uninsured," said Pollack. "Governors across the country are saying that health care reform is a real necessity. So I do think the climate is right to actually get this accomplished this time."
The three major party candidates for president haven't been talking about health care as much lately as the economy and the war in Iraq. But they all have proposals to reform the health care system.
Democrats Hillary Clinton and Barack Obama would create more public insurance options and offer subsidies to uninsured Americans. Republican John McCain would rely on tax cuts and the free market to make health insurance more affordable.
Whoever wins the presidential election likely will have to compromise on health care reform, according to Pollack, but that's not necessarily bad.
"We've got to find virtue in achieving a second favorite choice that moves us forward, even if it isn't the exact perfect solution that any particular group might wish to promote," said Pollack.
Political scientist Larry Jacobs says compromise will be challenging, but he also agrees with Pollack that it's essential to any successful reform effort.
Lawmakers might be better off if they spent less time worrying about public opinion and more time talking to each other, Jacobs says.
"If you look back to 1965 when Medicare was passed, and to other important moments of reform, you see that it was the policymakers that first got their act together. And then they came to the public and said, here's what we think will work," Jacobs said.
That approach wasn't too popular with voters at the time. But within a few years, Jacobs says, the Medicare program was widely considered a success in America.