Public support and opposition to public plans can be similarly swayed. When the 67 percent who initially supported public plans are told that they could give the government an unfair advantage over private plans, overall support drops to roughly three in ten (32% favor, 59% oppose). When supporters were offered a different argument, that public plans would be the first step toward single-payer, government-run health care, overall support again eroded, but not as much (41% favor, 50% oppose).

As discussed earlier, there is initial majority (61%) support for "sin" taxes to finance health reform. While this idea hasn't been broadly debated publicly this year, some arguments for and against the approach were tested. Support for the approach declines overall (39% favor, 57% oppose) when supporters are told that the tax increase would hit low-income people the hardest. When initial opponents are told that the tax increase would raise money for reform and improve health by encouraging healthier habits, overall support increases moderately (70% favor, 27% oppose).

The survey cannot gauge in advance what arguments will be used in the health reform debate, who will make them and how well the arguments will be heard and absorbed by the public. And the fact that arguments are made does not make them accurate. What the simulations can tell us, however, are how possible arguments can alter potential public support.

Public Realizes Medicare Faces Challenges, But Most Uninterested in Personal Sacrifices

Roughly three-quarters (77%) of the public view Medicare as "very important" for the country, and just over half (53%) say the same for their own family. As might be expected, an even larger share of seniors (78%) and those living in households making less than $30,000 per year (68%) say that Medicare is very important to them personally.

While Medicare is valued by the public, many Americans under age 65 are concerned that the program will not be there for them when they need it. More than eight in ten (85%) are "very" or "somewhat" concerned that the program benefits available to seniors today will not be available when they retire. Three in four Americans say either the program is already in financial crisis (30%) or is facing major financial problems (44%). At the same time, though, more incorrectly believe that Social Security will be first to face a major financial shortfall (52%, compared to 39% who correctly named Medicare).

The survey suggests the public recognizes that rising health care costs are a primary culprit in Medicare's financial troubles: eight in ten cite this as a "major reason" for the program's difficulties, putting it at the top of a list of seven possible causes. But at the same time, roughly seven in ten say that "doctors and hospitals charge too much" and "too much fraud in the program" are also major reasons for the impending financial problems, causes which are seen as secondary by many experts.

Despite widespread concern about Medicare's solvency, most Americans are not interested in reform proposals that require personal sacrifice. The most popular option is to allow the government "to negotiate with drug companies for lower drug prices" (86% favor), followed by having the program pay for new treatments and technologies only if they provide better results (75%). The Medicare changes detailed earlier as possible revenue raisers are next in popularity, but it should be noted that seniors are less supportive-only half favor reducing payments to insurer plans or providers. About half the public (53%) would support requiring higher income seniors to pay higher Medicare premiums. Proposals that would more broadly impact individuals - such as raising payroll taxes, raising the age of eligibility for Medicare or requiring all seniors to pay a larger share of costs -- all received less than majority support.


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