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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
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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.
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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
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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
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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
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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.
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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
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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.
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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
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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
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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
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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
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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
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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
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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).
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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
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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).
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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
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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
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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)
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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
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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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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.