We are often told (incorrectly) that pollsters can generate whatever results they want. Just word the question a certain way and the findings will follow. Question wording is undoubtedly important and unethical researchers can play on well-known cognitive biases to produce misleading results, but the goal of polling is to understand public opinion and not to create a false impression of opinion for political purposes. Contrary to popular belief, legitimate pollsters are far more interested in understanding the contours of public opinion than arriving at some preordained result. Credibility is far more important than jacked-up numbers.
With this mind, consider the health care results from the 2013 Louisiana Survey. We asked respondents a relatively simple question: Do you think the Louisiana state government should accept or reject federal money to expand the Medicaid program for uninsured adults? An overwhelming majority – 70 percent – said the state should accept the federal money; only 24 percent said the state should reject the money.
Before we fielded the survey, we had several conversations about question wording. We opted for this version over more complicated and potentially “biasing” versions because of its simplicity. “Let’s just ask whether people think we should accept the federal money or not.” In retrospect, I am not convinced that respondents had enough information to weigh the consequences of accepting the federal dollars. There is no costs to the decision to accept. [I should note there is a debate about what the actual costs are].
Our results differed in important ways from early polls that asked more complicated questions.
Voter Consumer Research asked the question this way:
One of the features of the federal health care law is that it increases the number of people covered by Medicaid, the program that is run jointly by the federal and state government to provide health care for low income and disabled residents. If states agree to increase the number of people covered, the federal government would pay 100% of the cost for the first four years, and 90% of the cost in the future. If Louisiana participates more Louisianans would receive health coverage, but some critics argue that the state cannot afford future costs of expanding health coverage under Medicaid. First, do you think Louisiana should participate in the expansion of Medicaid or should it not participate?
VCR found that 51 percent of Louisiana residents though Louisiana should participate in the expansion of Medicaid, while 43 percent said the state should not participate.
Southern Media & Opinion Research structured the choice in terms of the competing political perspectives of Governor Bobby Jindal (to reject the federal money) and Democratic Senator Mary Landrieu (to accept the federal money). The specific question is list below:
The Affordable Care Act, also known as Obamacare, provides for an expansion of Medicaid which would help as many as 400,000 people in Louisiana to get health coverage. The federal government will cover the full costs the first three years, after that the state cost share would gradually rise to a maximum of 10 percent. Governor Bobby Jindal says he will not implement the expansion of Medicaid in Louisiana because it could ultimately cost Louisiana taxpayers too much money. Senator Mary Landrieu says Governor Jindal is putting his political ambitions ahead of the health and economic interests of Louisiana. Who’s position do you agree with more: Governor Bobby Jindal or Senator Mary Landrieu?
The find an even narrower divide: 49 percent agreed with Mary Landrieu while 46 percent agreed with Bobby Jindal.
The differences here are telling. Our result tells us respondents immediate gut reaction is to accept the federal money to cover uninsured adults. Think of this as a baseline response. The Voter Consumer Research and Southern Media polls, alternatively, give us more insight into what “informed” opinion might look like. Support predictably declines when people consider the reasons for not accepting the money. The balance is still tilts toward accepting federal money and Medicaid, but the narrow division means this is not as easy of an issue as it might appear at first glance.
Perhaps the more telling takeaway from our survey relates to public perceptions of health-related budget cuts. Sixty-five percent of Louisiana residents said cuts to the public health care system were “unnecessary.” In contrast, only 17 percent said the cuts were necessary given tight budgets and only 15 percent said the cuts were necessary to achieve greater efficiency. The specific question wording is as follows:
Over the past several budget cycles, state government has cut spending on the public health care system. This
includes state run hospitals which provide health care services for the poor and uninsured. Which of the
following best describes your view of these cuts?
a) Cuts were unfortunate but necessary given tight budgets
b) Cuts were needed to achieve greater efficiency in providing health care services
c) Cuts were unnecessary and make it more difficult for the poor and uninsured to find quality care
We are often told that Louisiana residents are anti-tax. Other than sin taxes (on smoking, drinking and gambling), this is generally and unquestionably true. But at some point the knife hits the bone and residents begin to recoil at spending cuts.
The larger point is this: Public opinion is generally fiscally irresponsible. Louisiana isn’t unique in this respect as this is also true of national public opinion as well. Our elected representatives aren’t solely to blame for our ongoing national budget woes, voters bear responsibility as well. At the end of the day, we want more from government than we are willing to pay for.