One other potential area of revenue discussed by policymakers for health reform comes from changes to the Medicare program. When asked about making changes to the program as a way to keep Medicare financially sound, reducing payments to managed care plans and other private insurers is "strongly" or "somewhat" supported by two-thirds (66%) of the public. Two-thirds (65%) also support reducing Medicare payments to doctors and hospitals.

Ideological Divide in Support for Public Plan

There has already been an ongoing debate about whether a public plan option should be included in health reform. Generally, two-thirds of the public (67%) "strongly" or "somewhat" favor creating a public option "similar to Medicare." More than eight in ten Democrats and six in ten political independents "strongly" or "somewhat" favor having a public plan, but just about half (49%) of Republicans agree.

Another way to measure Americans' views on the public plan debate is giving the public a choice of two methods and asking which would better encourage price competition among health plans. When asked whether private plans competing with just each other or with a government-administered public insurance plan similar to Medicare would do a better job of lowering costs and improving quality, Democrats favor including a public plan by more than 3 to 1 (71% to 19%), and political independents back this approach 53 percent to 40 percent. A majority of Republicans, on the other hand, prefer having private plans compete without a public plan (54% to 39%).

Simulating a Public Debate with Potential Arguments Shows Malleability of Opinion

In an attempt to measure the firmness of public support for key policy approaches in health reform, a handful of arguments for and against such policy options were tested on the public in preparation for what could be a robust, fast-moving debate.

Employer mandates have been a staple of previous reform debates and are likely to be considered this year as well. When the public is initially asked if they support "requiring employers to offer health insurance to their workers or pay money into a government fund," seven in ten (71%) support the concept. When the supporters are exposed to a one-sided argument stating that the approach may mean some job loss, overall support for mandates drops dramatically (to 27% for and 65% against). When the initial opponents of employer mandates are told that mandates are "more fair because today some employers pay for health insurance and some do not," then support overall rises from its initial level to 78 percent for and 17 percent against.

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