Put slightly differently, Americans are unhappy in their current relationship, but there are perks to being attached, and they're not quite ready to commit to someone new.

Doesn't your graph say the opposite?
It seems to me just 23% of Americans are unhappy in their current relationship.

Well, the graph shows 70 percent satisfaction, 8 percent dissatisfaction, and the rest saying their insurance is "fair." I can't imagine another issue where we'd take those results as evidence of deep seated unhappiness.

Right. That's why I don't understand your statement that "Americans are unhappy with their current relationship".
It's early here, maybe I'm not seeing clearly what you are saying. It seems that Americans are happy with their current relationship.

I think Ezra's point, of which only half shows up in the graph, is that people like what they have right now (the graph), but a large sector are afraid of losing it (not shown).

Oh, sorry, misread the post. At the same time, about 70% to 80% want the system completely rebuilt. There's a contradiction between how people feel about their personal insurance and how they feel about the health system. They're unhappy with the system they're in but not willing to give up what they have. Does that make more sense?

They're unhappy with the system they're in but not willing to give up what they have. Does that make more sense?

It does make more sense, thanks.
I think dallas's assessment is perhaps the most accurate. People are happy with the system they are in, but they are afraid of losing it. Alternatively, they are happy with the system they are in but they think other people have difficulties.
That's a pretty common American pattern, isn't it? The way people are forever unhappy with Congress but like their own Congressman, or the polls that show people are afraid the country is on the wrong path but are highly satisfied in their own life.

So from a messaging perspective, PNHP has a point: Insurers are unpopular, and reformers should exploit that unpopularity. But the intuitive conclusion -- that voters will embrace a system without private insurers -- isn't supported by either the data or the history.

That is a very good point.
The other problem is even more basic. If people are happy with their own insurance (and they seem to be), convincing them to give that up to solve other people's insurance problems becomes very difficult.

Allow me to solve your phantom paradox for you skippy;

“This is the paradox of public attitudes on health care: Voters think our system is fundamentally flawed and requires substantial reform, they hate private insurers and can't stand Big Pharma, but at the same time, they like the private insurance coverage they themselves have, and the health care they themselves receive, and they won't let you to take it away.”

80% of people like their insurance company because they deal with them on a regular basis, know that they are fair, and are happy with the product they get for the price. We would all like it to be cheaper but every satisfaction poll done shows our current system is working and we are happy with it.

Now for your make believe land. What does Ezra in NY know about the other 10,000 health plans across the country? Nothing, and he makes a living supposedly knowing about them. So what does the average person who can’t be bothered to know their own insurance policy have to base their opinion of these companies on? The MSM and clueless bloggers. All the MSM and clueless bloggers run are sob stories and hit pieces on insurance companies. How does the average person get any exposure to the normal running of the system and the insurance companies that do a good job? You know the 80% of the time you never talk about.

The real paradox is how politicized and dishonest someone needs to be to attempt to change our functioning system with 80% approval based upon polls asking opinions on matters people have no exposure or education on. By progressive logic we should poll the populous on rocket design and launch whichever one gets the highest approval rating. Hell why don’t we poll the public on where we should set interest rates, it’s the intellectual equivalent of Progressive Healthcare Reform. Who want’s free insurance that covers everything paid by the Feds surely doesn’t poll much higher then who want’s 0% interest rates on all their debt. Sure both will buy you votes but neither have any chance of sustainability. Just be honest about the snake oil your selling, Healthcare Reform is buying votes to get you elected, you and your party have no clue on how to fix the system nor do you even care to, you would need to find another gig to get elected in 4 years if you did.

Warning to the public; don’t think your 80% satisfaction and demands to not take away your current plans matter to your Liberal congressman. Just look back at how Ted Kennedy and Congress forced HMOs down our throats. Employers and the public didn’t want them so Teddy made it Federal Law, employers had to offer them and then subsidized them so they undercut the cost of other insurance. The Will of The People means nothing to Liberals when they know what’s best for you.

Ezra care to make one of your pretty charts showing the satisfaction with our insurance companies vs that of our Congress? Overwhelming majority of people are more dissatisfied with Congress then Insurance companies, maybe we should have Congressional Reform first then look at our health system?

There are strong echos of the decades-ago debate over private (electric) power versus public power. TVA, Bonneville Power Admin., etc. were bitterly opposed by the private sector, but couldn't hold out to two arguments that won for public power: (1) we need a benchmark to assess the costs and quality of private providers; (2) the private providers were not serving large swaths of the country because they didn't view it as a good investment.

As much as I'd like to see a complete switch in health insurance from mostly-private (for those under 65) to wholly public, Ezra's arguments are spot on. Fear of loss of coverage is stronger than desire for improvement.

So, TVA/BPA-like public alternatives that start out primarily serving the willing and the unserved make great psychological sense. That seems to be the thrust of the Obama plan as well.

Even if the mixed private/public alternate can come into actuality, the private folks will fight it all the way - including post-implementation. Witness the private 'alternatives' to Medicare authorized (and generously subsidized) by Congress under pressure from the private insurers in recent years.

Part of the mythology of capitalism is that providers like competition. Actually they hate competition because it checks unbrideled profits: they will buy competitors, price undercut their rivals to put them out of business, and marshall marketing to dominate brand over quality/price.

I don't mind if people want to keep their private health insurance as long as the public doesn't subsidize it and requires fair play in the market versus public offerings. That's just good politics, good psychology, and wise incremental public plan implementation (bites on the roast rather than wolfing it down).

Bottom Line: Let's put a viable public alternative in place, regulate the competition vigorously for fair play, and let the people choose over time.

"80% of people like their insurance company because they deal with them on a regular basis, know that they are fair, and are happy with the product they get for the price."

Healthy people who don't use health care much like their coverage. The more people become familiar with what it's like to deal with insurers when you're not well, the less they like their insurance. It's those who have the most contact with insurers, the ill, who most dislike insurers. And yes, there are numerous studies to back this up I could cite Nate.

Ezra,

Its funny. In my post on HCAN earlier this week, I actually typed out the same point and deleted it, namely: HCAN is campaigning on the benefits of single-payer, without actually proposing it (those were my words, but PNHP is pretty much saying the same thing). What I did say earlier still is true-- their rhetoric is not consistent with the proposals (Obama/Clinton) themselves. "Choice" is only available in a theoretical sense for many Americans and the insurance companies play a critical role in the reform proposals that they are backing. Its just not true.

Now as you've argued here, there are good political reasons for doing so. But it exposes the partisanship played by both sides. Democrats, including yourself, have argued that what was wrong about the insurance companies attacking the Clinton plan in 1993 wasn't that they opposed it per se, but that they "lied" about the implications of the plan. That was "good politics" then, as they won the battle. Of course, now that HCAN is doing the spinning, but its for a plan you like, you're willing to justify it. I think that we should let the facts speak for themselves.

Ezra, your analysis is flawed.

There's nothing in the Gallup data that says that people are not willing to transition to a national healthcare program.

The data does show that a majority of people with coverage are happy with their coverage. (Although it's strange that only 5% of their sample answered "not applicable," when around 15% of the population is consistently uninsured.)

But even those of us who are happy with our coverage are willing to "give up what we have" (your term, which begs the question) in order transistion to a more humane system. I think there are three reasons for this: 1. we think it's immoral that ours is the only industrialized country that does not provide some sort of national healthcare, 2. more and more people with insurance are facing denials and reductions of coverage, 3. insurance companies do not provide healthcare, but decide who gets it and who doesn't, and they profit from this arrangement. My coverage with Blue Cross is pretty good, yet I strongly support HR 676 and a similar effort in California, where I live.

A March 2, 2007 New York Times poll found that a majority of Americans are willing to go forward with national healthcare, even if it means some personal sacrifices (http://query.nytimes.com/gst/fullpage.html?res=9E06E7D71631F931A35750C0A9619C8B63).

And I don't think that popular attitudes toward the Clintons' bungled reform effort (which no one would characterize as single-payer) tells us much about the prospects for single-payer right now, particularly in light of the Times poll.

Folks may be happy with their care and insurance...

However, it is not paradoxical in that they are worried, if not terrorfied, of costs, dropped coverage, "what if tomorrow I lose my job," etc. That is the kicker.

I believe that is the primary driver for much of the angst of the electorate, especially in the economic downturn.

In general, voters don't like private insurance, except for the private insurance that they themselves have. And though they may not even like that very much, they're not letting you take it until someone else has jumped into the deep end of your brilliant new idea and assured them that the water is fine.

But wait... if the easiest transition to single payer is to remove the age requirement from the Medicare statute, don't we already have a whole bunch of people in the pool? And if the water isn't fine, isn't it because the insurance companies are pissing in it?

ryaison,

if you opened up medicare to all we would be bankrupt in a year. The 10% increase from fraud alone would be unaffordable not to mention increased utilization and the general inefficiency of the plan design