Understanding the Public on the Health Care Costs/Uninsured Issue: Implications for Journalists in the Next Debate Robert J. Blendon, Sc.D. Harvard School.

Understanding the Public on the Health Care Costs/Uninsured Issue:

Implications for Journalists in the Next Debate

Robert J. Blendon, Sc.D. Harvard School of Public Health Kennedy School of Government

Most Important Issues for Government to Address

Percent saying issue is one of two most important:

1. War/defense 42%

2. Health care 28% (excluding Medicare)

3. Economy/jobs 21%

4. Immigration 12%

5(t). Education 6%

5(t). Terrorism 6%

5(t). Budget/Govt spending 6%

1993 July 2002 October 2007

Note: Open-ended, may sum to more than 100% because each respondent was asked to give up to two different answers.

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.

1. Terrorism 37%

2. Economy/jobs 37%

3. War/defense 13%

4. Health care 9% (excluding Medicare)

5. Education 8%

Americans’ Views of the US Health Care System, 1994-2006

1994 2000 2002 2003 2005 2006

State of Crisis

17% 12% 11% 14% 18% 22%

Major Problems

52% 58% 54% 54% 52% 52%

Minor Problems

29% 28% 32% 30% 28% 19%

No Problems 1% 1% 2% 1% 1% 4%

Gallup Polls, 1994-2006.“Don’t know” responses not shown

Percent saying…

Public Views of the Bush Administration’s Health Care Policies

Approve of Handling of Health Care

CBS News poll, February 2007.

60%

24%Approve

Disapprove

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

44%

43%

35%

19%

Cost Problems of Families with Someone Diagnosed with Heart Disease, Cancer and Asthma

No chronic health condition

% reporting in last year skipped treatment, cut pills or didn’t fill prescription due to cost

Heart disease

Cancer

Source: USA Today/Kaiser Family Foundation/ Harvard School of Public Health Health Care Costs Survey (conducted April 25 – June 9, 2005)

Asthma

25%

9%

51%

38%

Uninsured

Insured

Postponed Medical Care, By Insurance Status

They or a family member skipped a medical test, cut pills or didn’t

fill a prescription in the past year because of the cost

Percent who say…

Source: USA Today/Kaiser Family Foundation/ Harvard School of Public Health Health Care Costs Survey (conducted April 25 – June 9, 2005)

There have been times in past year when they or a family member

needed medical care and didn’t get it

19%

47%

28%

6%

50%42%

11%

50%

38%

Works pretty well/onlyminor changes needed

Some goodthings/fundamental

changes needed

So much wrong/Needsto be completely rebuilt

1982 1991 2007

Public Attitudes Toward U.S. Health Care System

Source: Harris Interactive polls, 1982 and 1991, NY Times poll 2007.

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

CBS News/NY Times poll, 2007.

9%

27%

64%

Don't know

Oppose

Favor

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 you’ll have to pay more for your health care or insurance1

Sources:1 Kaiser Family Foundation/Harvard School of Public Health poll (2007); 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 paying higher taxes1

Sources:1 CBS News/NY Times (2007); 2 Harris Interactive poll (2000), involves slightly different question wording.

Favor if substantial tax increase required2

Who Should Be in Charge of the Health Insurance System

21%

26%

31%

22%

Not sure

Non-profits

Government

For profitcompanies

Harris Interactive poll, 2003

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

40%

56%

33%28%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Current system Universalcoverage

Universalcoverage, withwaiting lists fornon-emergency

treatment

Universalcoverage, with

limited choice ofdoctors

Public Preference: Current System or Universal Coverage?

ABC News/Kaiser Family Foundation/USA Today Poll, 2006.

Americans’ Views About National Spending on Health Care

11% 11%

71%

26%

9%

57%

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

100%

Too much About right Too little

Government Nation as a whole

Pew Research Center Health Care poll, March 2006.

% saying

Public Views on Spending for Health Care by Average Americans

65%

12%17%

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

100%

Too much About right Too little

Pew Research Center Health Care poll, March 2006.

% 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.