understanding the public on the health care costs/uninsured issue: implications for journalists in...
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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
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