Understanding the Public on the Health
Care Costs/Uninsured Issue:
Implications for the Next Debate
Surveys developed in collaboration with the
Kaiser Family Foundation
Robert J. Blendon, Sc.D.
Kennedy School of Government
Harvard School of Public Health
Most Important Issues for
Government to Address
Percent saying issue is one of two most important:
1993
1. Economy/Jobs
November 2005
45%
2. Health care
31%
(excluding Medicare)
3. Federal deficit
19%
4. Education
10%
5. Abortion
9%
6(t). Taxes
7%
6(t). Programs
for the poor
7%
1. War/Defense
52%
2. Economy/Jobs
17%
3. Health care
12%
(excluding Medicare)
4(t). Gas & oil prices
Energy
11%
4(t). Education
11%
6(t). Terrorism
9%
6(t). Taxes
9%
Note: May sum to more than 100% because each respondent was asked to give up to two
different answers.
Harris Interactive polls, 1993, 2005.
Public Views of the Bush Administration’s
Health Care Policies
Handling of Health Care1
37%
Approve
60%
Disapprove
Country’s Health Care System at End of Bush’s Second Term2
Will be better
Will be worse
Will be about same
9%
40%
50%
1 ABC/Washington Post poll, January 29, 2006. 2 NYT/CBS poll, January 20-25, 2006.
Key Points
•
A principle – policy gap exists in health care
•
Public concerned about health care problems and
supports the principles that:
– There needs to be fundamental change from
status quo in health system
– Government should guarantee health
insurance for all
– Government should address costs/uninsured
problems
Key Points
•
But, public will oppose policies reflecting principles if the
trade-offs include:
– A major negative change in their care arrangements or
premiums
– A substantial tax increase
– Substantially hurting the economy
•
Media/expert role is critical here
– Public does not understand the magnitude of tradeoffs
– Public differs with many researchers over causes of
high costs and is confused by their proposals
•
Trusted independent sources of information can be
important to outcome of debate
Public Attitudes Toward
U.S. Health Care System
47% 50% 47%
42%
35%
28%
19%
16%
6%
Works pretty well/only
minor changes needed
Some good
things/fundamental
changes needed
1982
Source: Harris Interactive surveys, 1982-2005.
1991
2005
So much wrong/Needs
to be completely rebuilt
Public Support for Federal Government Guaranteeing
Health Insurance for All Its Citizens
Favor
64%
Oppose
Don't know
Pew Center Poll, July 2005.
30%
6%
Most Important Health Care Issue for
Government to Address
% saying issue is one of two most important
39%
Health care costs
Uninsured/access to
care
23%
Senior/Medicare
issues
Quality of care
13%
1%
Source: Kaiser Family Foundation/Harvard School of Public Health/ICR poll, August 2005.
Public Support for Truman Health Plan
(1949) Support Social Security covering MD and hospital bills
68%
(1949) Oppose Truman Health Plan
38%
(1950) Oppose Truman Health Plan
61%
Health Affairs (March/April 2001)
Public Support For the Clinton Health Plan
% approving
71%
59%
43%
April
1993
US News and World Report poll, 1993.
USA Today/CNN polls, 1993, 1994.
September
1993
April
1994
Insured Americans’ Satisfaction with Their
Own Health Care
% satisfied
Health plan
performance (A or B
rating)1
Quality of health
care received2
Ability to get most
sophisticated treatment2
72%
88%
81%
Source: 1Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll (December 2003); 2Washington
Post/ABC News poll (October 2003).
The Uninsured Vs. Insured in America
Put off Treatment for Serious Illness Last Year
38%
Uninsured
Insured
12%
Dissatisfied with quality of care received
Uninsured
Insured
33%
11%
Dissatisfied with ability to get latest treatments
Uninsured
Insured
41%
15%
Source: Washington Post/ABC News poll (October 2003).
Public Worries about the Future
Worried your health insurance will be too
expensive1
65%
Think there will be rationing2
64%
Sources:1 Kaiser Family Foundation/Harvard School of Public Health poll (June 2005); 2 Washington Post/ABC News poll
(October 2003).
Public Support for Federal Government
Guaranteeing Health Insurance
for All Its Citizens
Favor if it means raising taxes1
64%
Favor if substantial tax increase required2
35%
Sources:1 Pew Center poll (2005);
2
Harris Interactive poll (2000), involves slightly different question wording.
How negative arguments affect support for proposals to
cover the uninsured (1)
Expanding existing state programs
What if you heard that expanding
these programs would require
raising taxes to pay for the cost?
82%
55%
Employer mandate
What if you heard that it would be
so expensive that employers would
be forced to lay off workers?
76%
35%
Tax credits and deductions
for the uninsured
What if you heard that the amount
of tax relief would not be enough to
cover the cost of a private plan?
70%
36%
Initially favors
Favors after challenge
Note: Responses of Massachusetts adults
Source: Harvard School of Public Health/BCBS Foundation/Cogent Research poll (2003).
How negative arguments affect support for proposals to
cover the uninsured (2)
Legally requiring all residents
to have health insurance
56%
What if you heard that even with
the government’s help, people
won’t be able to afford insurance
and the law will cause financial
hardship?
22%
Single payer government plan
50%
What if you heard that you would
have to wait longer for some
hospital and specialty care?
30%
Initially favors
Favors after challenge
Note: Responses of Massachusetts adults
Source: Harvard School of Public Health/BCBS Foundation/Cogent Research poll (2003).
Public Preference:
Current System or Universal Coverage?
62%
38%
33%
Current system
Universal
coverage
Source: Washington Post/ABC News Poll (October 2003).
Universal
coverage, with
waiting lists for
non-emergency
treatment
35%
Universal
coverage, with
limited choice of
doctors
Americans’ Views About National
Spending on Health
% saying
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
77%
14%
7%
Too much
General Social Survey (2004)
About right
Too little
Public’s Perception of Reasonableness of
Prices of Selected Products and Services
% saying unreasonable
57%
Prescription drugs
54%
Hospital charges
43%
Doctors bills
Automobiles
36%
Clothing
Packaged foods
Harris Interactive poll, April 2003.
16%
10%
Perceived Reasons For Rising Health Care Costs
Percent who say each is a “very important” factor in causing higher health care costs…
High profits made by drug
and insurance companies
71%
Number of malpractice lawsuits
58%
Amount of greed and waste that
occurs in the health care system
59%
Use of expensive, high-tech
medical equipment and drugs
Doctors making too much money
People having little incentive to
look for lower cost doctors and
services
46%
31%
34%
Source: USA Today/Kaiser Family Foundation/ Harvard School of Public Health Health Care Costs Survey
(conducted April 25 – June 9, 2005)
What Do Researchers and the Press
Need to Tell the Public About the Trade-Offs in the
Next Health Care Debate?
•
What happens to people with the problems?
•
What happens to the insured middle-class
taxpayer?
•
What happens to others?
– Business, insurers
– MDs, hospitals, Rx companies
How Does the Public Learn the Health Policy
Answers from the Media?
•
Presentation of objective facts and descriptions
•
Portrayal of views of leading partisan (political)
figures
•
Portrayal of views of trusted independent figures
•
Reports of interest group advertising
Who Will be Helped or Hurt by the Clinton Health Plan?
Hurt
Helped
Uninsured
73%
Poor people
64%
50%
Middle class
0%
Washington Post poll, October, 1993.
20%
40%
60%
80%
100%