A flood of national surveys show that Americans are divided about health care reform. Why?

Moving beyond vague, binary polling questions ("for or against reform"), Gallup’s latest survey actually asked people to back up their health care position with the reasons, in their own words, that they favor or oppose reform. The results are telling.

With a little data alchemy, statistician Nate Silver created a word cloud based on the "words that were used most frequently by the 45 percent of the country who would tell their Congressman to vote for the health care bill." The animating arguments are clear:

Silver explains:

The message that the pro-reform voters have taken away comes through loudly and clearly: ‘PEOPLE … NEED … INSURANCE’… the moral arguments [] seem to have broken through… Very few people have been persuaded by the discussions about bending the cost curve, on the other hand. Although the word ‘AFFORD’ is used more often by proponents of the legislation, terms like ‘COST’ and ‘MONEY’ are used far more often by those opposed to it.


The White House has focused far more on affordability and pre-existing conditions, however, to target audiences that have insurance. And Obama officials used to downplay overt moral appeals. That strategy might have been logical, given the districts and communities that were skeptical of reform. Yet Gallup’s findings suggest those arguments are not even sustaining the current reform constituency, let alone pushing it over 50 percent. "Supporters of healthcare legislation commonly cite a moral imperative as a reason for their support," explains Gallup’s report.

The most common "main reasons" – again, drawing on supporters’ own words – were concern for the uninsured and fixing a broken system, followed by controlling costs and a general "moral obligation" to provide health care. (Those three moral rationales, plus helping the poor, are driving 62 million people to support reform, while the cost constituency runs to another 17 million people.) And in the single instance when Obama’s team crowdsourced its health care message, in an online video contest, the winning submission was a moral plea about health care for children:


The winning ad was a definite departure from the administration’s [traditional health care] messaging. Administration officials routinely pressed reform based on practical considerations and self-interest – lowering costs for all, improving access, avoiding deficit spending – the winning video hammered the moral imperative of caring for the most vulnerable members of society.


On Monday, Obama struck an impassioned, moral tone in his address, "Health Insurance Reform Right Now." He recounted the story of Natoma Canfield, an Ohio woman who survived cancer, then lost her insurance this year after premiums spiked 40 percent. She is currently battling Leukemia. "I’m here because of Natoma!" Obama said, flanked by her sister.

Opponents of the health care bill would counter, of course, that they are also here for Natoma. They just don’t think the federal government can help her effectively. Returning to the public’s own words, Gallup found it’s all about government for reform opponents:

Three dynamics jump out here.

There is a remarkable public fixation on "government" for a bill that has been stripped of any government expansion – no public option, no Medicare buy-in, no major federal program beyond the budgeting process. But many people just don’t know what’s in the bill.

Then, on the politics, the Democrats are clearly carrying the costs of "Big Government" – but without netting the benefits (like rallying the base with a public option, or wooing 60-somethings with a lower Medicare age). The predicament evokes Obama’s odd reluctance to capitalize on the exaggerations of his opponents – if they’re going to call you a socialist anyway, you might as well take the political space and run with it. You’re already paying for it. The satirist Alex Pareene recently captured this dynamic:


If you’re going to be painted as a socialist for expanding Romneycare nationwide, and you’re not going to win Olympia Snowe’s vote even by giving her everything she wants, why not push for even better subsidies, a national exchange, and a public option? Because you’re scared they’ll call you a double socialist?


And finally, there’s the Big Issue that still threatens the entire health care bill. Except, you know, you can barely find it registering among opponents. In their own words, abortion is a blip. Gallup found that two percent of opponents cited abortion as the main reason to spike health care reform.

Images courtesy of www.wordle.net.