America’s legislative struggle over healthcare is approaching its climactic battle, with Republicans dug in and Democrats amassing their forces for a final assault, though worried about defections. The debate is now between Democratic leaders and conservative Democrats who fear that the bill could cost them their jobs, or that it does not fully preclude federal funding of elective abortions.

Gone are the fundamental debates over whether healthcare is a right that government should guarantee or a service to be purchased in a free market (and, if the latter, whether Republican ideas on how to make it competitive and transparent would work). Gone, in particular, is the Republican proposal to go “back to the drawing board”. Or is it?

In surveying American opinion just before and a week after President Barack Obama’s healthcare summit, we found a third of respondents more supportive of his plan, a third less so and a third unchanged. This would seem to confirm that the summit achieved nothing. Also taking into account our findings in December and January that most Americans want incremental, bipartisan health legislation and believe the Democratic leadership is (at least on health reform) not “out in front” but “out of touch”, there does not seem to be much good news for advocates of reform.

But looking deeper into our March 3 data reveals some surprises. These may give second thoughts to those Republicans who want some type of health reform but are under orders to vote no on Obamacare.

First, we were surprised to find Americans exactly evenly split between Mr Obama’s plan and that of the Republicans. Well aware that the way the question is asked can determine the result, in our surveys just before and after the summit, we used Mr Obama’s name and listed the main provisions of both plans. In previous surveys we had asked respondents to choose between the House or Senate Democrats’ plan and no bill, or starting over, and they always preferred no bill, or starting over.

Still, almost all Republicans and most independents oppose Mr Obama’s plan. The summit did not change their views, but it did change their prediction of the outcome: a slim majority of Americans now predict health reform will pass, whereas just before the summit the majority predicted no bill would pass.

And whereas in December and January a large majority of Americans agreed with Republican calls for a fresh start – for going, as senators Olympia Snowe, Susan Collins and Scott Brown put it, “back to the drawing board” – now it is a very slim majority. This is an option that Mr Obama, Nancy Pelosi, House speaker, and Harry Reid, Senate majority leader, have rejected. Democratic leaders fear – according to David Axelrod, an adviser to Mr Obama, and others – that “back to the drawing board” is just a ruse to delay or kill the bill.

When we asked who was putting the nation’s interest ahead of political gain, we got a surprise: most independents – and almost half of Republicans – chose the Democrats.

So, while independents and Republicans prefer the Republican plan to Obamacare, they think the Democrats’ hearts are in the right place. This should worry Republicans on two counts: on this issue, Americans suspect their motives, and people vote with their hearts more than their heads. As the saying goes: “They don’t care that you know ’til they know that you care.”

It is possible a Republican leader could yet emerge and resolve the healthcare impasse, but that would require breaking with the party leadership. Here is how: persuade a group of Republican moderates to say that, if the Democrats are willing to go back to the drawing board, they can have a bipartisan bill by a certain date, say May 15.

This offers the prospect of a bipartisan bill with better cost controls, taking advantage of free markets with the right amount of state and federal oversight. The alternative is a bitter defeat for one party or the other and a bill that only half of Americans want, or no reform at all.

Dr Casscells, who was US assistant secretary of defence (health affairs) from 2007-09, is a professor of medicine and public health and vice-president for public policy at the University of Texas at Houston. Mr Zogby, the founder and chairman of Zogby International, is a pollster and the author of the ‘The Way We’ll Be’

Get alerts on US downturn when a new story is published

Copyright The Financial Times Limited 2019. All rights reserved.
Reuse this content (opens in new window)

Follow the topics in this article