Helping the Public Sort Through Health Care

Health care is the most talked-about topic in Washington this week, but is all the talk actually helping people come to grips with this issue?

There are a lot of surveys out about health care, and the word that most commonly comes up in the media coverage of public attitudes is "skeptical." That's fair. "Confused" might work as well. More than six in 10 Americans admit they find the debate hard to understand.The survey released by Kaiser today is one of the most helpful, pointing out that overall support for change remains strong even as many voice doubts about the specifics.

What a lot of the coverage lacks, however, is a sense of how the public grapples with issues and what they need to know to make choices. Public Agenda founder Daniel Yankelovich calls this the "Learning Curve™" and it has several distinct stages. First there's "consciousness raising," where people first learn about a problem. Then there's a period of "working through," where people start actually thinking about the choices required for a solution, and have to overcome problems like wishful thinking. Finally, there's "resolution," the point at which the public has weighed the options and reached firm conclusions. Surveys at the point of resolution are actually very stable, because people have made up their minds.

Right now, the surveys suggest people are past the consciousness-raising stage: they certainly believe the current system has problems. Too many people are uninsured, too many others pay too much for the insurance they have. But most Americans are just starting to work through the options for change. It isn't at all clear, for example, whether most people understand how crushing health care costs will be for the federal budget, or for society in general. People need a few key facts to make sense of this debate, but what they're mostly getting is spin from advocates on both sides.

President Obama used his news conference last night to adopt the role of "explainer in chief," and despite his fondness for words like "incentivize," that's probably a helpful strategy. But both leaders and the media have to go further and start preparing the public for the difficult decisions ahead. The stakes are very high in this debate. Both the nation's medical and financial health are at risk. The public needs real options, candidly presented, and a clear sense of the tradeoffs now and in the future.

Because it's the public who will be living with the results.