How do you sell something to someone who doesn't know they need it? That, in a nutshell, is the biggest hurdle President Obama and Congressional leaders face in trying to push a health care overhaul to the roughly 180 million Americans who have private health insurance coverage.
The president previewed some of the themes he's likely to use in his address to a joint session of Congress Wednesday at a Labor Day picnic in Cincinnati. "I see reform where we bring stability and security to folks who have insurance today," he said, "where you never again have to worry about going without coverage if you lose your job or you change your job or you get sick."
But the sagging poll numbers, both for Obama and his top domestic priority, show that so far, the public isn't buy what he's selling. Robert Blendon, a public opinion expert at the Harvard School of Public Health, says he's not that surprised. "This recession... has not left Main Street people's lives," he said.
"And for them to really sign onto these bills they have to feel that their insurance premiums will be lower in the future and their out-of-pocket costs. And they just don't see that."
Karen Pollitz, an insurance expert at Georgetown University, says the problem is actually even bigger: Most people who have insurance don't realize that they might not have as much protection as they think.
The reason most people say they're satisfied with their health insurance? They don't use it very much. "The majority of Americans who are healthy account for only about 3 percent of total medical spending," Pollitz said. "It's kind of like hearing that most people are satisfied with their new car before they drive it off the dealer's lot."
On the other hand, those who do run up big bills often experience problems. One survey, Pollitz said, "found...that more than one in five cancer patients who had health insurance the whole time they were in treatment, nonetheless, ended up using up all or most of their savings on medical bills."
Pollitz says that because most people are healthy, insurance companies have tried to attract their business by holding down premiums. But what many people don't realize is that those lower premiums often mean less coverage when you really need it.
For example, she says, "you might be paying a lower premium because the drug benefit in your policy only covers generic drugs."
That's no problem if you have a common ailment like high blood pressure or only require the occasional antibiotic. But if you're diagnosed with a serious illness for which there are no generic medications, like multiple sclerosis, "you need very very expensive name brand drugs that cost thousands of dollars every month," Pollitz said.
Harvard's Robert Blendon says the Obama administration, like the Clinton administration 16 years ago, may have misstepped in trying mount a campaign for changes to the health care system that's too similar to the one it mounted to get its candidate elected president.
"People's investing in a president is different from having their health care changed," Blendon said. In getting people to vote for a candidate, he says, "they don't have a lot to lose. They like the candidate; they want something called change. And so you may get audiences excited for Obama or Clinton when they're running for office, that don't get excited at all about their health care getting changed."
Instead, Blendon says, what backers of health care overhaul should be doing is running a campaign like people do for local school bond referenda, where voters must raise their own taxes for the greater good. In those cases and this one, he says, "You really have to convince people that if their taxes go up their schools will be better; it won't be a waste of money."
That convincing starts with the president's speech Wednesday night.