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%