Figure 1. Three of Five Health Care Opinion Leaders
Feel that Mixed Private-Public Group Insurance Is an
Effective Approach to Achieving Universal Health Coverage
Tax incentives for
individual insurance market
Very
effective
2%
Effective
5%
Somewhat
effective
32%
Mixed private-public
group insurance system
Not sure
1%
Not sure
1%
Very
effective
29%
Not
effective
59%
Effective
32%
Source: Commonwealth Fund Health Care Opinion Leaders Survey, January 2008.
Not
effective
8%
Somewhat
effective
30%
THE
COMMONWEALTH
FUND
Figure 2. Support for Features of Presidential Candidates’
Health Care Reform Proposals
“To what extent do you favor or oppose the following features
of the presidential candidates’ health care reform proposals?”
Strongly favor
Favor
53
Implement market regulations against risk selection
Mandate health insurance with premium subsidies
for low and moderate income
86
33
39
83
44
Include a public plan option like Medicare in
new group insurance “connector”
45
34
79
Expand Medicaid and SCHIP to include adults
at poverty level or above
46
33
78
Set a minimum floor on insurance company
medical-loss ratios
30
Allow individuals, small businesses, and associations
to buy private insurance across state lines
Administer an individual mandate and income-related
premium assistance through the tax code
Eliminate the employer benefit tax exemption and
replace it with standard income tax deduction or tax
29
32
62
33
62
52
35
17
11
71
39
32
Employer pay-or-play mandate
34
45
THE
COMMONWEALTH
FUND
Source: Commonwealth Fund Health Care Opinion Leaders Survey, January 2008.
Figure 3. Strong Support for Allowing Public Plans
Like Medicare to Compete with Private Insurance
“Do you think health care reform should . . .?
Please select all that apply.”
Percent
100
80
65
61
60
37
40
11
20
0
Allow public
insurance to
compete with
private insurance
Organize and
regulate private
markets with
an insurance
connector
Replace private
markets with
public insurance
Preserve private
insurance markets
with reduced
regulation
THE
COMMONWEALTH
FUND
Source: Commonwealth Fund Health Care Opinion Leaders Survey, January 2008.
Figure 4. Nine of Ten Health Care Opinion Leaders
Support Financing Expanded Health Care with Taxes
“To what extent do you favor or oppose the following
methods of financing expanded health care coverage?”
Increase taxes on tobacco or other products
that are harmful to health
Repeal or expiration of recent tax breaks
for families with incomes above $200K
17
Implement a revenue assessment on insurers
15
Introduce new national sales tax
or value-added tax
Implement a revenue assessment
on hospitals
Favor
41
47
45
Increase in general taxes
Redirect current subsidies for
uncompensated care
Strongly favor
35
7
26
28
66
50
49
41
12
75
30
49
8
88
38
35
THE
COMMONWEALTH
FUND
Source: Commonwealth Fund Health Care Opinion Leaders Survey, January 2008.
Figure 5. Family Affordability Guidelines
“Determining how much families should pay for premiums and out-of-pocket expenses
is a critical part of health reform. What do you think about the amount the
Massachusetts Authority guidelines require families to pay?”
Percent responding “it is about the right amount”
100
80
80
62
60
54
45
40
20
0
Under 150%
of poverty pay
no premiums
150% up to 200%
of poverty pay
no more than
an average of
2.4% of income
in premiums
200% up to 300%
of poverty pay
no more than
an average of
4.5% of income
in premiums
300% up to 500%
of poverty pay
an average of
8% of income
in premiums
THE
COMMONWEALTH
FUND
Source: Commonwealth Fund Health Care Opinion Leaders Survey, January 2008.
Figure 6. More than Two-Thirds of Health Care Opinion Leaders
Think Information Technology Is an Effective Way
to Improve Health Care Quality
“How effective do you think these features of presidential candidates’
health reform proposals would be in improving health care quality?”
Very effective
Support increased and more effective use
of information technology
35
Support increased use of “medical home”
models of care
32
Reward providers who provide
higher-quality care
A “consumer report” of quality of care
by providers
Hold hospitals accountable for ethnic
and racial disparities in care
35
33
25
Uniform quality reporting and transparency
of information on quality of provider
7
32
29
19
70
65
61
36
29
15
Effective
61
44
26
THE
COMMONWEALTH
FUND
Source: Commonwealth Fund Health Care Opinion Leaders Survey, January 2008.
Figure 7. Seven of Ten Health Care Opinion Leaders Think
the Next President Should Pursue Universal Coverage at the
Same Time as Improving Quality, Efficiency, and Cost Control
“Most candidates’ plans also include provisions that would improve
quality, efficiency, and cost control as well as increase coverage.
In your view, which of the following provisions should the next president focus on?”
Address quality, efficiency, and
costs first and then work on
achieving universal coverage
12%
Not sure
3%
Universal coverage
first, and then
address quality,
efficiency, and costs
14%
Universal coverage
at the same time as
policies to improve
quality, efficiency,
and costs
70%
THE
COMMONWEALTH
FUND
Source: Commonwealth Fund Health Care Opinion Leaders Survey, January 2008.
Figure 8. Two-Thirds of Health Care Opinion Leaders
Feel that Tax Incentives Are Not an Effective Approach
to Controlling Health Care Costs
Tax incentives for
individual insurance market
Very
effective
3%
Effective
5%
Somewhat
effective
26%
Mixed private-public
group insurance system
Very
effective
2%
Not sure
3%
Effective
12%
Not sure
4%
Not
effective
41%
Not
effective
64%
Somewhat
effective
41%
THE
COMMONWEALTH
FUND
Source: Commonwealth Fund Health Care Opinion Leaders Survey, January 2008.
Figure 9. Health Care Opinion Leaders Think Allowing Medicare
to Negotiate Drug Prices Is an Effective Way to Reduce the
Growth in Health Care Costs
“How effective do you think each of these features of presidential candidates’
health care reform proposals would be in reducing the growth in health care costs?”
Percent responding “very effective/effective”
Allow Medicare to negotiate prescription drug prices
65
Correct the imbalance between primary and specialty care
65
Support benefit design incentives that encourage use of
preventive services and chronic condition management
62
Establish a public/private institute on
comparative effectiveness and best practices
48
Offer Medicare or other public plan option in a
new group insurance “connector”
46
Legalize the importation of brand-name prescription
drugs from Canada or other countries
30
Encourage greater consumer cost-sharing
30
Reform the malpractice system
30
Allow individuals, small businesses, and associations to
buy private health insurance across state lines
Source: Commonwealth Fund Health Care Opinion Leaders Survey, January 2008.
29
THE
COMMONWEALTH
FUND
Figure 10. Strong Public Support for Shared Financial
Responsibility for Health Care Costs Across Income Levels
“Who do you think should pay for health insurance for all Americans?”
Percent responding “shared by individuals, employers and government”
100
80
66
70
69
71
Less than
$20,000–
$40,000–
$60,000 or
$20,000
$39,999
59,999
more
59
60
40
20
0
Total
Family Income
Source: Analysis of the Commonwealth Fund Biennial Health Insurance Survey (2007).
THE
COMMONWEALTH
FUND
Figure 11. A Majority of Public Favors Individual Mandate
“Would you favor or oppose a plan that requires everyone to have health insurance
with the government paying for insurance for those who can’t afford it?”
Percent
Somewhat favor
Strongly favor
100
80
60
79
68
70
68
24
27
28
30
40
20
40
55
61
31
43
38
Less than
$20,000–
$40,000–
$60,000 or
$20,000
$39,999
59,999
more
30
0
Total
Family Income
Source: Analysis of the Commonwealth Fund Biennial Health Insurance Survey (2007).
THE
COMMONWEALTH
FUND
Figure 12. Strong Public Support for Employer Requirement
to Provide or Help Pay for Coverage Across Income Levels
“Some people believe that employers should either provide health insurance to their employees
or contribute to a fund that would help cover workers without health insurance.
Others say that employers should not have to provide or contribute. Which do you agree with?”
Percent responding “employers should either provide health insurance or contribute to a fund”
100
81
82
85
83
80
Total
Less than
$20,000–
$40,000–
$60,000 or
$20,000
$39,999
59,999
more
80
60
40
20
0
Family Income
Source: Analysis of the Commonwealth Fund Biennial Health Insurance Survey (2007).
THE
COMMONWEALTH
FUND