A SURVEY OF HEALTH REFORM MYTHS

I have seen several references to a University of Indiana opinion study on the public's belief in health care myths. Because the study was conducted by reputable professionals, I had assumed that the study's sponsors would know more about the theory of opinion polling than they do.

Dr. Aaron Carroll, who directs the IU Center for Health Policy and Professionalism Research, commented about his center's study on MSNBC:

"More than half of Americans believe so many of these myths that it's really quite clear that the administration and Congress just aren't getting the message out about what health care reform is really going to do."

If you look at the survey, you see that most of the supposed knowledge questions do not turn completely on known facts, which can have true or false answers. The myth questions are mostly subjective — expectations or predictions about the future — which by nature have no right or wrong answers. This distinction is axiomatic in the field of survey research.

Of course, most of these predictions could at some future time be determined to be true or false by most fair-minded observers, but not now. A few of the predictions about the future strike me as being extremely likely to turn out to be correct (if Obama's plans were enacted) and a few strike me as strike me as being extremely likely to turn out to be incorrect predictions. If Obama's plans are ever enacted, time will tell. But they are not now "myths."

EXPECTATIONS OF FUTURE EVENTS IN SURVEY RESEARCH

Expectations of future events are classically understood as subjective questions. Willem E. Saris and Irmtraud Gallhofer distinguish subjective from objective survey variables:

Subjective variables include cognitions, evaluations, evaluative beliefs, feelings, preferences, values, rights, norms and policies, action tendencies, expectations. Objective variables include behavior, past events, demographic characteristics, knowledge, information about time, place, procedures and frequency. . . .

By subjective variables, as stated, we understand variables for which the information can only be obtained from a respondent because the information exists in his/her mind alone. Operationalization of Social Science Concepts by Intuition, Quality & Quantity 38: 235--258, 238, 241 (2004).

Saris and Gallhofer go on to explain Expectations of future events (at p. 246):

Expectations of future events (Graesser et al., 1996) are anticipations of events in which oneself is not involved. . . . For example:

I expect better weather in the near future

. . . The difference with the previous type of assertion [action tendencies] is that an expectation does not relate to the respondent's own action but it refers to some kind of event which is not connected with one's own behavior.

Here ends our overview of concepts by intuition that fall under the heading of subjective variables. They are all characterized by assertions based on information that can only be obtained from respondents because they represent subjective variables and these views can not be checked in any way because they are personal views.

In other words, most of the myth questions in the Indiana survey are questions about subjective views (expectations, opinions, attitudes, and beliefs), not currently knowable facts. For a social scientist reporting a survey to call them "myths" violates general principles of opinion polling.

OBAMA'S PROMISE TO MAKE COMPANIES CHANGE INSURANCE PLANS

Before getting into the survey questions themselves, people should remember what President Obama said in his first August town hall meeting on health care in New Hampshire:

Under the reform we're proposing, insurance companies will be prohibited from denying coverage because of a person's medical history. Period. . . .

Now, when we pass health insurance reform, insurance companies will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. And we will place a limit on how much you can be charged for out-of-pocket expenses, because no one in America should go broke because they get sick. (Applause.)

And finally — this is important — we will require insurance companies to cover routine checkups and preventive care, like mammograms and colonoscopies — (applause) — because there's no reason we shouldn't be catching diseases like breast cancer and prostate cancer on the front end. . . .

So this is what reform is about.

I quote this to remind skeptics that President Obama is promising to prohibit insurance companies from offering lower cost plans with high deductibles, which some younger people in good health currently prefer. In other words, some of you who like your current health plans will not be allowed to keep them.

Next: Answering the Questions in the Indiana Health Care Myth Survey.