Questioning the Conventional Wisdom on Public Opinion Toward Health Reform

Abstract

Ample evidence confirms that public opinion influences the policy-making process. Research suggests that public preferences are not simply translated into government policy; rather, policymakers' response to public opinion is conditioned or mediated by political and institutional processes (Jacobs, 1993a, 1993b, 1992a, 1992b; Jacobs and Shapiro, 1994a, 1994b; for discussion of this research see PS, March 1994, 9–38).The passage and designing of health reform will depend in important respects on public attitudes toward health care and health reform. The interpretation of public opinion by the media and other political observers, however, is not a neutral process dictated by scientific methods; it is the product of institutional and political struggles for position and power.Conventional wisdom regarding the public's health reform attitudes holds that Americans are narrowly self-interested, unambiguously antitax, and unwavering opponents of government regulation. Are these three sets of assumed attitudes supported by the available empirical evidence?Here we take an historical approach to studying public opinion—one that identifies the patterns and trends of Americans' responses to identically worded questions asked in national opinion surveys.