Understanding the Public on the Health Care Costs/Uninsured Issue: Implications for the Next Debate Surveys developed in collaboration with the Kaiser.

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 GovernmentHarvard School of Public Health

Most Important Issues for Government to Address

Percent saying issue is one of two most important:

1. War/Defense 52%

2. Economy/Jobs 17%

3. Health care 12% (excluding Medicare)

4(t). Gas & oil prices 11% Energy

4(t). Education 11%

6(t). Terrorism 9%

6(t). Taxes 9%

1993

Note: May sum to more than 100% because each respondent was asked to give up to two different answers.

November 2005

1. Economy/Jobs 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%

Harris Interactive polls, 1993, 2005.

Public Views of the Bush Administration’s Health Care Policies

Handling of Health Care1

1 ABC/Washington Post poll, January 29, 2006. 2 NYT/CBS poll, January 20-25, 2006.

Country’s Health Care System at End of Bush’s Second Term2

60%

37%Approve

Disapprove

9%

40%

50%Will be about same

Will be worse

Will be better

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

19%

47%

28%

6%

50%42%

16%

47%

35%

Works pretty well/onlyminor changes needed

Some goodthings/fundamental

changes needed

So much wrong/Needsto be completely rebuilt

1982 1991 2005

Public Attitudes Toward U.S. Health Care System

Source: Harris Interactive surveys, 1982-2005.

Public Support for Federal Government Guaranteeing Health Insurance for All Its Citizens

Pew Center Poll, July 2005.

6%

30%

64%

Don't know

Oppose

Favor

1%

13%

23%

39%

Quality of care

Senior/Medicareissues

Uninsured/access tocare

Health care costs

Most Important Health Care Issue for Government to Address

% saying issue is one of two most important

Source: Kaiser Family Foundation/Harvard School of Public Health/ICR poll, August 2005.

61%

38%

68%

Public Support for Truman Health Plan

(1950) Oppose Truman Health Plan

Health Affairs (March/April 2001)

(1949) Oppose Truman Health Plan

(1949) Support Social Security covering MD and hospital bills

71%

59%

43%

Public Support For the Clinton Health Plan

% approving

April 1994

September 1993

US News and World Report poll, 1993. USA Today/CNN polls, 1993, 1994.

April 1993

Insured Americans’ Satisfaction with Their Own Health Care

Source: 1Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll (December 2003); 2Washington Post/ABC News poll (October 2003).

81%

88%

72%Health plan

performance (A or B rating)1

Quality of health care received2

Ability to get most sophisticated

treatment2

% satisfied

The Uninsured Vs. Insured in America

15%

41%

11%

33%

12%

38%

Source: Washington Post/ABC News poll (October 2003).

Put off Treatment for Serious Illness Last Year

Dissatisfied with quality of care received

Dissatisfied with ability to get latest treatments

Uninsured

Insured

Uninsured

Insured

Uninsured

Insured

Public Worries about the Future

64%

65%

Worried your health insurance will be too expensive1

Sources:1 Kaiser Family Foundation/Harvard School of Public Health poll (June 2005); 2 Washington Post/ABC News poll (October 2003).

Think there will be rationing2

Public Support for Federal Government Guaranteeing Health Insurance

for All Its Citizens

35%

64%

Favor if it means raising taxes1

Sources:1 Pew Center poll (2005); 2 Harris Interactive poll (2000), involves slightly different question wording.

Favor if substantial tax increase required2

How negative arguments affect support for proposals to cover the uninsured (1)

36%

35%

55%

70%

76%

82%

Expanding existing state programs

Employer mandate

Tax credits and deductions for the uninsured

What if you heard that expanding these programs would require raising taxes to pay for the cost?

What if you heard that it would be so expensive that employers would be forced to lay off workers?

What if you heard that the amount of tax relief would not be enough to cover the cost of a private plan?

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)

30%

22%

50%

56%Legally requiring all residents to have health insurance

Single payer government plan

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?

What if you heard that you would have to wait longer for some hospital and specialty care?

Initially favors Favors after challenge

Source: Harvard School of Public Health/BCBS Foundation/Cogent Research poll (2003).

Note: Responses of Massachusetts adults

33%

62%

38% 35%

Current system Universalcoverage

Universalcoverage, withwaiting lists fornon-emergency

treatment

Universalcoverage, with

limited choice ofdoctors

Public Preference: Current System or Universal

Coverage?

Source: Washington Post/ABC News Poll (October 2003).

Americans’ Views About National Spending on Health

7%14%

77%

0%10%20%30%40%50%60%70%80%90%

100%

Too much About right Too little

General Social Survey (2004)

% saying

Public’s Perception of Reasonableness of Prices of

Selected Products and Services

10%

16%

36%

43%

54%

57%

Packaged foods

Clothing

Automobiles

Doctors bills

Hospital charges

Prescription drugs

Harris Interactive poll, April 2003.

% saying unreasonable

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

Amount of greed and waste that occurs in the health care system

Doctors making too much money

Use of expensive, high-tech medical equipment and drugs

Number of malpractice lawsuits

People having little incentive to look for lower cost doctors and

services

71%

58%

59%

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?

64%

73%

50%

0% 20% 40% 60% 80% 100%

Hurt Helped

Uninsured

Poor people

Middle class

Washington Post poll, October, 1993.