Skip to main content Accessibility help

Questioning the Conventional Wisdom on Public Opinion Toward Health Reform*

  • Lawrence R. Jacobs (a1) and Robert Y. Shapiro (a2)

Ample evidence confirms that public opinion influences the policy-making process. Research suggests that public preferences are not simply translated into government policy; rather, policymakers' response to public opinion is conditioned or mediated by political and institutional processes (Jacobs, 1993a, 1993b, 1992a, 1992b; Jacobs and Shapiro, 1994a, 1994b; for discussion of this research see PS, March 1994, 9–38).

The passage and designing of health reform will depend in important respects on public attitudes toward health care and health reform. The interpretation of public opinion by the media and other political observers, however, is not a neutral process dictated by scientific methods; it is the product of institutional and political struggles for position and power.

Conventional wisdom regarding the public's health reform attitudes holds that Americans are narrowly self-interested, unambiguously antitax, and unwavering opponents of government regulation. Are these three sets of assumed attitudes supported by the available empirical evidence?

Here we take an historical approach to studying public opinion—one that identifies the patterns and trends of Americans' responses to identically worded questions asked in national opinion surveys.

Hide All
Blendon, Robert, Maritila, John, Benson, John, Shlter, Matthew, Connolly, Francis, and Kiley, Tim. 1994. “The Beliefs and Values Shaping Today's Health Reform Debate.” Health Affairs 13 (Spring): 274–84.
Citrin, Jack, and Green, Donald. 1990. “The Self-interest Motive in American Public Opinion.” In Research in Micropolitics: A Research Annual, ed. Long, Samuel. Greenwich, CT:JAI.
Cook, Fay Lomax, and Barrett, Edith J. 1992. Support for the American Welfare State: The Views of Congress and the Public. New York: Columbia University Press.
Free, Lloyd, and Cantril, Hadley. 1967. The Political Beliefs of Americans: A Study of Public Opinion. New Brunswick: Rutgers University Press.
Jacobs, Lawrence. 1993a. The Health of Nations: Public Opinion and the Making of American and British Health Policy. Ithaca, NY: Cornell University Press.
Jacobs, Lawrence. 1993b. “Health Reform Impasse: The Politics of American Ambivalence Toward Government.” Journal of Health Politics, Policy, and Law 18(Fall):629–56.
Jacobs, Lawrence. 1992a. “Institutions and Culture: Health Policy and Public Opinion in the U.S. and Britain.” World Politics 44 (January): 179209.
Jacobs, Lawrence. 1992b. “The Recoil Effect: Public Opinion and Policy Making in the United States and Britain.” Comparative Politics 24 (January):199217.
Jacobs, Lawrence, and Shapiro, Robert Y. 1994a. “Issues, Candidate Image, and Priming: The Use of Private Polls in Kennedy's 1960 Presidential Campaign.” American Political Science Review (September).
Jacobs, Lawrence, and Shapiro, Robert Y.. 1994b. “Studying Substantive Democracy.” PS: Political Science & Politics 27(1):917 (March).
Jacobs, Lawrence, and Shapiro, Robert Y. 1994c. “Public Opinion's Tilt Against Private Enterprise.” Health Affairs 13 (Spring):285–98.
Jacobs, Lawrence, Shapiro, Robert, Schulman, Eli. 1993. “Poll Trends: Medical Care in the United States—An Update.” Public Opinion Quarterly 57 (Fall):394427.
Jajich-Toth, Cindy, and Roper, Burns. 1990. “Americans’ Views on Health Care: A Study in Contradictions.” Health Affairs (Winter): 149–57.
Kiewiet, D. Roderick. 1983. Macroeconomics and Micropolitics: The Electoral Effects of Economic Issues. Chicago: University of Chicago Press.
Kinder, Donald, and Kiewiet, D. Roderick. 1979. “Economic Discontent and Political Behavior.” American Journal of Political Science 23:495527.
Kosterlitz, Julie. 1993. “Dangerous Diagnosis.” National Journal 16 January:127–30.
Ladd, Carl Everett. 1985. The American Polity: The People and Their Government. New York: W.W. Norton & Co.
McClosky, Herbert, and Zaller, John. 1984. The American Ethos: Public Attitudes toward Capitalism and Democracy. Cambridge, MA: Harvard University Press.
Page, Benjamin, and Shapiro, Robert. 1992. The Rational Public: Fifty Years of Trends in Americans' Policy Preferences. Chicago: University of Chicago Press.
Roper Center. The American Enterprise. 1992. (March/April). Roper Center for Public Opinion Research, Storrs, CT.
Sears, David, Lau, Richard, Tyler, Tom, Allen, Harris. 1980. “Self-Interest vs. Symbolic Politics in Policy Attitudes and Presidential Voting.” American Political Science Review 74 (September):670–84.
Sears, David, and Funk, Carolyn. 1990. “Self-Interest in Americans' Political Opinions.” In Beyond Self Interest, ed. Mansbridge, Jane, Chicago: University of Chicago Press.
Shapiro, Robert, and Gillroy, John. 1984a. “The Polls: Regulation—Part I.” Public Opinion Quarterly 48(Fall):531–42.
Shapiro, Robert, and Gillroy, John. 1984b. “The Polls: Regulation—Part II.” Public Opinion Quarterly 48(Winter):666–77.
Shapiro, Robert, and Young, John. 1986. “The Polls: Medical Care in the United States.” Public Opinion Quarterly 50(Fall):418–28.
Staub, Ervin. 1989. “Individual and Societal (Group) Values in a Motivational Perspective and their Role in Benevolence and Harmdoing.” In Social and Moral Values: Individual and Societal Perspectives. eds. Eisenberg, N., Reykowski, J., and Staub, E., Hillsdale, NJ: Erlbaum.
Tocqueville, Alexis de. 1969. Democracy in America, ed. Mayer, J.P., Garden City, NJ: Anchor.
Welch, Susan. 1985. “The ‘More for Less’ Paradox: Public Attitudes on Taxing and Spending.” Public Opinion Quarterly 49(Summer):310–16.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

PS: Political Science & Politics
  • ISSN: 1049-0965
  • EISSN: 1537-5935
  • URL: /core/journals/ps-political-science-and-politics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed