Americans’ Views on Health Care Policy

Robert J. Blendon, Sc.D.

Professor of Health Policy and Political Analysis

Harvard School of Public HealthKennedy School of Government

States Ideology and Health Policy

Most Conservative Most Liberal

(1) Mississippi (1) Vermont

(2) North Dakota (2) Massachusetts

(3) Oklahoma (3) Rhode Island

(4) Utah (4) New York

(5) South Carolina (5) New Jersey

J. McIver, R. Erikson, and G Wright, “Public Opinion and Public Policy in Temporal Perspective: A View from the States.” Presented at State Politics and Policy Conference, College Station, TX (March 2001).

Public Views on Health Care Policy

• Priorities

• Values

• Changing the health system

• Spending

• Costs

• Taxes

• Uninsured

• Regulations

Most Important Issues for Government to Address

Percent saying issue is one of two most important:

1. Economy/Jobs 39%

2. War/Defense 33%

3. Terrorism 13%

4. Health care 11% (excluding Medicare)

5. Education 8%

6. Taxes 7%

December 2001

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

August 2003

1. War/Defense 48%

2. Economy/Jobs 39%

3. Terrorism 31%

4. Education 12%

5. Taxes 6%

6. Health Care 5%

Harris Interactive polls, December 2001, August 2003.

Americans’ Perceptions of the Most Important Issues for the Government to Address

0%

10%

20%

30%

40%

50%

60%

Jan-93

Jul-93

Jan-94

Jul-94

Jan-95

Jul-95

Jan-96

Jul-96

Jan-97

Jul-97

Jan-98

Jul-98

Jan-99

Jul-99

Jan-00

Jul-00

Jan-01

Jul-01

Jan-02

Jul-02

Jan-03

Jul-03

Harris Interactive Polls, 1982-2003.

% naming health care as one of the two most important issues

55%

11%

Aug-03

Most Important Issues in Deciding 2002 Congressional Vote, by Party

(Open-ended question/verbatim responses recorded)

1. Economy/Jobs 26%

2. Education 14%

3. Health care/Medicare 10%

4. Terrorism/War 6%

5. Taxes 4%

Republicans Democrats

1. Economy/Jobs 18%

2. Taxes 16%

3. Education 14%

4. Terrorism/War 9%

5. Health Care/Medicare 8%

Source: NPR/Kaiser Family Foundation/Kennedy School of Government poll, October 2002 (likely voters).

Most Important Health Care Issue

Cost

Uninsured

Quality

Don’t know

44%

38%

16%

2%

Source: Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll, May-June 2003.

Americans’ Views of the Most Important Health Issues for Government to Address, 2003

% saying the issue is one of the two most important health issues for government to address

3%

4%

4%

5%

5%

15%

19%

Smoking

Obesity/beingoverweight

Diabetes

SARS

Heart disease

HIV/AIDS

Cancer

HSPH/RWJF/ICR poll (May/June 2003)

General Policy Values on the Roles of Government

The government should be smaller, with fewer servicesa

The government has gone too far in regulating business and interfering with the free-enterprise systemb

The [federal] government should do everything possible to improve the to improve the standard of living of all Americansa

46%

62%

56%

Source: Washington Post/Kaiser Family Foundation/Harvard University polls: (a) August-September 2002, (b) October 2000 (registered voters).

Health Policy Values

The government should do whatever is necessary to see that everyone gets the medical care they needa

[Federal] government should assume larger role in assuring access to affordable health careb

Making sure that minorities have health care services equal in quality to whites is responsibility of the [federal] governmentc

69%

73%

62%

Source: (a) Harris Interactive poll, February/March 2003; (b) NPR/Kaiser Family Foundation/Kennedy School of Government poll, May-June 2000; (c) Washington Post/Kaiser Family Foundation/Harvard University poll, March-April 2001.

Public Attitudes Towards the Health Care System

Harris Interactive pols, 1982-2003.

% saying so much wrong it needs to be rebuilt

31%32%

29%30%30%

33%

29%28%

25%

21%

19%

24%

42%

35%31%

24%

0%

10%

20%

30%

40%

50%

60%

1982

1983

1984

1987

1988

1990

1991

1993

1994

1996

1998

1999

2000

2001

2002

2003

Americans’ Dissatisfaction with the State of the Nation in Two Areas

34%

28%

32%

12%

Not too satisfied Not at all satisfied

The nation’s system of improving and protecting the public’s health

The availability and affordability of health care

Total

Source: Harvard School of Public Health/Robert Wood Johnson/ICR poll, May-June 2003.

Total 40%

66%Total

45%

22%

32%

0%

20%

40%

60%

80%

100%

1993 2001 2003

Dissatisfaction with the Availability and Affordability of Health Care

Source: Gallup/CNN/USA Today poll (January 1993) Harvard School of Public Health/Robert Wood Johnson Foundation/ICR polls (2001, 2003).

% saying not at all satisfied

Americans’ Views on Spending to Improve and Protect the Nation’s Health

Spending too little

Spending about right amount

Spending too much

Don’t know

74%

21%

2%

1%

Source: General Social Survey, 2002.

Top Priorities for Future Economic Growth

1%

2%

6%

7%

13%

46%

53%

67%

Clothes

Leisure andentertainment

Automobile andtransportation

Food

Housing

Defense

Education

Health care

Harris Interactive polls July 2003.

% saying 1st and 2nd priority

Public’s Perception of Reasonableness of Prices of Selected Products and Services

10%

16%

36%

43%

54%

57%

Package foods

Clothing

Automobiles

Doctors bills

Hospital charges

Prescription drugs

Harris Interactive poll, April 2003.

% saying unreasonable

Public’s Views of Top Reasons for Increased Health Care Spending

8%

12%

18%

20%

23%

24%

28%

37%

Increased use of medical services

New medical technology and newdrugs

Aging of the population

Higher hospital fees

Increased fraud, waste and abuse

Increased profits in health carecompanies

Medical malpractice and insurance

Higher prices of prescription drugs

Harris Interactive polls, April 2003.

% saying two top contributors to increased spending

Public’s Views on Passing Law to Provide Insurance for Most Uninsured Americans

74%

Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll, May-June, 2003.

% saying extremely/very important to pass a law in next year to provide health insurance to most Americans

The Government Should Do Whatever Is Necessary, Whatever It Costs in Taxes, To See

That Everyone Gets the Medical Care They Need

43%

3%

28%

69%

Agree if substantialtax increase

required

Not sure

Disagree

Agree

Harris Interactive (2003).

% saying

Americans’ Views on What Government Should Do About the Uninsured

Make a major effort to provide insurance, may require a tax increase to pay for it

Make limited effort to provide insurance for some of the uninsured, would mean more government spending

Keep things the way they are

Don’t know/Refused

47%

37%

13%

3%

Source: Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll, May-June 2003.

Percent saying the government should...

15%

35%

50%

Public Views on the New Tax Cut

New tax cut was a good thing

New tax cut was a bad thing

Not sure

Source: Harris Interactive poll, June 2003.

Public’s Views on Different Ways to Guarantee Health Insurance for More Americans

46%

73%

77%

80%

Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll, May-June, 2003.

% favoring

Expanding state government programs for low-income people

Requiring businesses to offer private health insurance for employees

Offering uninsured tax deductions, credits, other assistance

National health care plan, financed by taxpayers, insurance from single government plan

Public’s Views of Government Regulation of Various Industries

10%

11%

21%

30%

31%

35%

44%

52%

57%

60%

Supermarkets

Computer software companies

Banks

Telephone companies

Airlines

Hospitals

Tobacco companies

Oil companies

Pharmaceutical and drug companies

Managed care companies such as HMOs

Harris Interactive polls, April 2003.

% saying need more regulation

Public Support for [Federal] Government Price Controls of Various Products and Services

17%

23%

27%

43%

48%

56%

Clothing

Packaged foods

Automobiles

Doctors bills

Hospital charges

Prescription drugs

Harris Interactive polls, April 2003.

% saying favor

Public’s Perception of US Drug Prices vs. Canada and Western Europe

42%

2%

7%

8%

16%

25%

Not sure

Much lower here

Somewhat lowerhere

About the same

Somewhat higherhere

Much higher here

Harris Interactive polls, April 2003.

% saying

41%

Public Views on Malpractice Reform

62%

48%

64%

57%

60%

(a) KFF/HSPH poll, February 2003; (b) Gallup poll, January 2003; (c) Harris Interactive poll, March 2003.

% saying

Very important cause of health costsa

Too many lawsuitsb

Favor limits on non-financial costsb

Favor $250,000 limitsc

Favor expert/medical special courtsc