THE TIMES POLL : By 2-1 Margin, Public Backs Health Care Plan

With his all-points sales pitch, President Clinton has won broad initial support from the public for his sweeping health care plan, a Times Poll has found.

In their preliminary reaction, the survey shows, Americans support Clinton’s health care plan by a greater than 2 to 1 margin. They overwhelmingly endorse his argument that maintaining the status quo would be more risky than dramatic change. And they decisively reject the contention by critics that the Administration proposal constitutes “excessive government intrusion” into the private marketplace.

But public opinion about the numbingly complex proposal remains extremely tentative.

Clinton has not yet convinced most Americans that it will improve the quality of care they receive. Nor are they convinced that the plan will reduce their medical costs--the concern those polled cited most often about their own health care. Public fears about potential job losses also loom as a potential vulnerability as the debate over the plan sharpens.

Heading into the long congressional struggle over health care, Clinton’s overall political position is strengthening. Americans now approve of his job performance by 53% to 38%, a significant increase from June, when a plurality of those polled gave him failing marks. Similarly, nearly 7 in 10 Americans now say that Clinton is “working hard to bring fundamental change to the way government is run.”

The Times Poll, supervised by John Brennan, surveyed 1,491 adults from Sept. 25 to 28. It has a margin of error of plus or minus three percentage points.

At the most basic level, Americans are not yet convinced that the sweeping changes Clinton has proposed would improve their own health care situation. Just 24% of those polled said that the plan is likely to improve their family’s health care coverage, while 17% said that it is likely to weaken their coverage and 46% said they expect no change.

On costs, assessments of the plan’s likely impact are even less optimistic. Only 10% of those surveyed said that they expect to spend less for health care under the plan; 30% said that they do not expect their bills to change. And fully half said they expect their costs to rise.

But such personal calculations appear to be less important in guiding reaction to the proposals than broader considerations like partisanship, ideological views about government’s role in the economy and the degree of urgency Americans feel about reforming the health care system. So far, the poll suggests, Americans seem to be asking not what the plan will do for them but what it will do for the country--and, largely, if tentatively, answering that it will do more than the status quo.

“Here’s the issue: As they fill in details on how it will affect them personally will that become a larger determination for people or will they continue to judge it on how it affects the nation?” Brennan said.

On other issues, the poll found Americans still divided over--and uncertain about--the North American Free Trade Agreement that Clinton is urging Congress to approve this fall. In the survey, 31% of those polled said they oppose the plan, 26% expressed support for it and 37% said they were unaware of it. Despite intensifying public debate in the last several weeks, those numbers are little changed since June--or, for that matter, last fall.

Some demographic divides are emerging in consideration of the agreement, though. While whites generally oppose the agreement and blacks split evenly on it, Latinos now support it by more than 3 to 1. Among college graduates, support is twice as great as among those Americans with a high school education or less. Union members oppose it by 2 to 1. Non-union members essentially split over the question.

Perhaps more tellingly, almost half of those surveyed said that they expect the treaty to cost American jobs, while just 1 in 7 respondents accepted Clinton’s contention that it will produce net employment gains. Those sentiments vary little by partisan or ideological affiliation--which suggests that the Administration still has an uphill struggle ahead to build a base of public support for the agreement.

On health care, those who think that the plan will diminish their own care now overwhelmingly oppose it, while those who expect it to improve their personal coverage support it by lopsided numbers. But the large group that expects to pay more actually supports the plan by 45% to 36%. And those uncertain whether their coverage will improve or their costs will rise are now inclined to give Clinton the benefit of the doubt: at least three-fifths of both groups support the plan.

Likewise, opinion on the plan varies little between those who said that their health care coverage has changed substantially in the last five years and those who reported little change, among those who consider their finances shaky and secure, those who work for large employers and small employers and among those who consider their own health good or poor.

The plan has support from those on Medicare and Medicaid, those who receive health insurance from their employer, those who lack health insurance and those who buy it themselves.

Nor are many of the demographic distinctions that often guide public opinion playing much of a role. Support for the plan varies little by income or education; single women and married men--two groups typically at opposite poles on most issues--expressed virtually identical degrees of support for the package. To the extent a demographic disparity emerges, it is concentrated on race (57% of Latinos and 67% of blacks expressed support for the plan, compared to only 52% of whites) and on age (those over 45 are somewhat more supportive than younger Americans).

More decisive, for now, are traditional partisan divisions. Among Democrats, 64% said that they support the plan and only 12% said they oppose it. Republicans oppose it by 38% to 45%. Liberals endorse the plan, 62% to 15%; conservatives by a more equivocal 46% to 36%.

Asked in an open-ended question why they dislike the plan, opponents cited ideological concerns as often as practical ones: 22% raised “big government” as their objection, while another 12% derided the idea as socialized medicine. As GOP pollster Glen Bolger put it, opposition now is centered on those who believe “if Clinton says it, it must be bad.”

But in this first round of debate, Clinton is holding the independents who provide the critical swing margin in public opinion. Independents expressed support for the plan, 55% to 21%. By 73% to 17%, they said that inaction poses a greater danger than Clinton’s plan. And by 57% to 29% they rejected the idea that the plan is an excessive intrusion of government power into the private sector.

With independents and Democrats on board, and Republicans divided in their opinions, Clinton now has strong public support both for key elements of the plan and for the broad philosophical arguments underpinning it.

Three-fourths of those polled agreed that business should “be required to contribute to their employees’ health care coverage.” Just 1 in 5 respondents disagreed. By virtually the same split, Americans said that they support a new tax on cigarettes to help pay for the plan. A little more than two-thirds of those surveyed said that they support the establishment of a National Health Board “to monitor and regulate health care benefits and costs.”

And the call to extend universal coverage to all Americans--which Clinton has portrayed as the plan’s non-negotiable core--was supported by a 78% to 17% margin. When supporters were asked in an open-ended question why they back the plan, by far the most common response was that it provides universal coverage.

At first hearing, the public also largely endorsed the fundamental arguments on which Clinton constructed his proposals. Just under three-fifths of those surveyed said that “health care is a right all Americans are entitled to receive from the government,” while only 36% described it as “a privilege.”

But these opinions do not appear set in stone: not surprisingly, only 21% of those surveyed said they know a great deal or a good amount about the proposal, while 39% know only some and an equal number “not much.”

Even within that framework of uncertainty, the poll pinpoints areas of vulnerability that critics will surely seek to exploit in the weeks ahead.

Already, many Americans worry that the plan will cost jobs and hurt small business. About 1 in 3 of those polled said that the plan is likely to reduce employment, while only 1 in 6 said they believe it will add jobs.

There also is only limited willingness to pay increased taxes to expand health care coverage if Congress rejects Clinton’s claim that the reforms can be financed primarily through savings in the existing system. About one-fourth of those polled said that they would be unwilling to pay any new taxes to fund universal coverage; another fourth said that they would be willing to spend less than $200. Just one-fifth of those surveyed said that they would accept $200 or more in new taxes to expand care, while 28% said they did not know.

Taxes remain a particularly vulnerable issue for Clinton: 51% of those surveyed said they considered the President a “tax and spend” Democrat, while only 33% rejected that characterization.

Americans are also leery of granting government too much control over the system: by a 51%-33% count those polled said they believe that private industry would do a better job than government of managing the health care system.

Abortion promises to be another stumbling block: Clinton’s plan would include abortion in the standard package of benefits but, by 54% to 40%, those polled--including those who support the overall plan and those who do not--said they oppose “including funding for abortions in health care reform.” Nearly twice as many Americans strongly oppose covering abortion as strongly favor its inclusion. Even those who support the plan split only 49% to 46% in favor of covering abortion.

Overall, when asked which party would do a better job of handling the nation’s most important problem, those polled gave Democrats a narrow 35%-32% edge--virtually unchanged since June.

* AMA NEUTRAL ON PLAN: Largest doctors group does say it will lobby for changes. A22

Reaction to the Clinton Plan

Initial support for the Clinton health care proposals is broad but tentative. A majority backs the plan, mostly because it will offer universal coverage. But most doubt their own health care will improve and half expect to pay more.

Do you approve or disapprove of the health care reform proposals Clinton has presented to Congress? Approve: 54% Disapprove: 24% Don’t know: 22% +

Approval of the plan varies by group

Approve Disapprove Don’t know The elderly 61% 18% 21% Anglos 52% 29% 19% Blacks 67% 8% 25% Latinos 57% 9% 34% The uninsured 64% 20% 16% Those whose companies offer insurance 53% 26% 21% Those who buy on their own 49% 27% 24% Democrats 64% 12% 24% Republicans 38% 45% 17% Independents 55% 21% 24%

+

Knowledge of the plan is limited

How much do you know about the details of President Clinton’s health care proposals? A great deal: 6% A good amount: 15% Some: 39% Not much: 39% Don’t know: 1% +

No change expected by almost half

Do you think you and your immediate family are likely to end up with better health care coverage than you have right now, or worse, or don’t you think your health coverage will change? Better: 24% Worse: 17% No change: 46% Too early to say: 4% Don’t know: 9% +

Fears of paying more are high

Do you think you and your immediate family are likely to pay more or less? More: 50% Less: 10% No change: 30% Too early to say: 4% Don’t know: 6% +

Many say change is needed

What is the greater danger: that Clinton’s proposals will hurt the country or that doing nothing at all will hurt the country? Clinton plan will hurt: 18% Doing nothing will hurt: 71% Neither: 3% Don’t know: 8% +

Most wary of quick change

Do we need to effect changes in the American health care system as quickly as possible or would it be better to phase in the changes over time? As quickly as possible: 44% Phase changes in over time: 51% Don’t know: 5% +

Why they approve of the plan (up to two responses accepted*) Provides care for everyone: 66% System needs to change: 13% Can never lose health care: 9% Will hold down costs: 9% Will be cheaper for me: 5% +

What they disapprove of the plan (up to two responses accepted*) Government bureaucracy: 22% Won’t work/badly thought out: 21% Socialized medicine: 12% It will hurt businesses: 10% No explanation on funding: 9% * Top five items mentioned

HOW THE POLL WAS CONDUCTED: The Times Poll interviewed 1,491 adult Americans nationwide, by telephone, from Sept. 25 to 28. Telephone numbers were chosen from a list of all exchanges in the nation. Random-digit dialing techniques were used so that listed and non-listed numbers could be contacted. Interviewing was conducted in English and Spanish. Results were weighted slightly to conform with census figures for sex, race, age, education and labor force participation. The margin of sampling error is 3 percentage points for the total sample; for other sub-groups it may be somewhat higher. Poll results can also be affected by other factors such as question wording and the order in which questions are presented.