The big story in that ABC/Washington Post poll released yesterday is that big margins support a public insurance option in health care reform, and prefer a bill with that element over a bill that is bipartisan and can attract Republican votes. In addition, the only slippage on health care in the poll for Obama comes among Democrats.

Those are important data points. But as long as those are covered, I will highlight another one from the poll:

14. One idea would put a tax on the most expensive health insurance policies. (Supporters say this would help pay for health care reform, and encourage insurers to offer cheaper policies.) (Opponents say this would make these policies too expensive for people who want them.) Would you yourself support or oppose this tax?

Support: 35
Oppose: 61
No opinion: 4

The excise tax is difficult to summarize, but that’s pretty decent language. And it gets hammered. The 61% opposition is as high as any opposition in the entire poll.

The reasons given by reformers for including an excise tax on high-end insurance plans include the idea that it only affects the top-level plans and is therefore progressive, and the revenue outstrips health inflation over time, making the tax a deficit reduction strategy. Some have argued that the tax is actually regressive, but clearly, within 10 years, it would encompass far more than only the highest-end plans. In fact it’s designed that way. If the virtue is that the revenue outstrips health inflation, then the virtue is that the tax would impact more and more plans over time.

The expected policy fix to that outcome, hitting more and more insurance plans with a tax that the insurance companies will try to pass on to their customers, would mirror the annual fixes to the alternative minimum tax. In that case, the AMT, which was supposed to force the wealthy into paying some tax every year instead of them writing all of it off through deductions, started to hit the upper-middle class, and so every year, Congress passes a patch, a fix that shields the middle class from this tax burden. And every year, this patch is not offset, adding $70-$80 billion to the deficit. It was included in the stimulus package early this year.

Therefore, we have to clarify something. If the Congress will likely just patch the excise tax every year so that the working class gets shielded from being impacted, then you cannot say that the revenue from an excise tax would reduce the deficit. You can’t have it both ways. Either the tax will eventually, under current health inflation, hit 40% of all policyholders within 10 years, or it will be confined to the top 2-4%, in which case it acts pretty much the same as a wealth surtax anyway, making the surtax much simpler. The original financing from the Obama Administration, to reduce charitable deductions to where they were in the Reagan years, was preferable to all of these options.

Now, reformers have charged that the threat of a tax would change health care buying habits and lead employers to purchase less expensive health care for their workers, saving the government money from the business deductions going to health care benefits. (This is one of those educated guesses that the CBO always trots out, a wishful examination of American behavior instead of hard data). Again, this makes a virtue out of something curious – working people getting objectively worse health care.

The one point where excise tax supporters have something is when they offer that it would trend us away from the employer-based health care system, which is inefficient to deliver health care and places an unnecessary burden on businesses. I don’t disagree with that, but of course, then you would need to replace it with something substantial, like a public insurance option.

UPDATE: More from In These Times.