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:
1993 July 2002 October 2007
1. Economy/Jobs 45% 1. Terrorism 37% 1. War/defense 42%
2. Health care 31% 2. Economy/jobs 37% 2. Health care 28%
(excluding Medicare) (excluding Medicare)
3. War/defense 13%
3. Federal deficit 19% 3. Economy/jobs 21%
4. Health care 9%
4. Education 10% (excluding Medicare) 4. Immigration 12%
5. Abortion 9% 5. Education 8% 5(t). Education 6%
6(t). Taxes 7% 5(t). Terrorism 6%
6(t). Programs 5(t). Budget/Govt spending 6%
for the poor 7%

Note: Open-ended, may sum to more than 100% because each respondent was asked to give up to two
different answers.
Harris Interactive polls.
 Americans’ Views of the US Health Care System, 1994-
2006
Percent saying…

1994 2000 2002 2003 2005 2006

State of 17% 12% 11% 14% 18% 22%
Crisis

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

Problems

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

Problems

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

“Don’t know” responses not shown

Gallup Polls, 1994-2006.
 Public Views of the Bush Administration’s
Health Care Policies
Approve of Handling of Health Care

Approve 24%

Disapprove 60%

CBS News poll, February 2007.

 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
 Cost Problems of Families with Someone
Diagnosed with Heart Disease, Cancer and Asthma
% reporting in last year skipped treatment, cut pills or
didn’t fill prescription due to cost

No chronic health 19%

condition

Heart disease 35%

Cancer 43%

Asthma 44%

Source: USA Today/Kaiser Family Foundation/ Harvard School of Public Health Health Care Costs Survey
(conducted April 25 – June 9, 2005)
 Postponed Medical Care, By Insurance Status
Percent who say… Uninsured
Insured

There have been times in past year 38%

when they or a family member
needed medical care and didn’t get it
9%

They or a family member skipped 51%

a medical test, cut pills or didn’t
fill a prescription in the past year
because of the cost 25%

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

50% 50%
47%
42%
38%
28%
19%
11%
6%

Works pretty well/only Some good So much wrong/Needs

minor changes needed things/fundamental to be completely rebuilt
changes needed

1982 1991 2007

Source: Harris Interactive polls, 1982 and 1991, NY Times poll 2007.
Public Support for Federal Government Guaranteeing
Health Insurance for All Its Citizens

Favor 64%

Oppose 27%

Don't know 9%

CBS News/NY Times poll, 2007.

 Public Support for Truman Health Plan

(1949) Support Social Security covering MD and hospital bills

68%

(1949) Oppose Truman Health Plan

38%

(1950) Oppose Truman Health Plan

61%

Health Affairs (March/April 2001)

 Public Support For the Clinton Health Plan
% approving
71%

59%

43%

April September April

1993 1993 1994
US News and World Report poll, 1993.
USA Today/CNN polls, 1993, 1994.
 Insured Americans’ Satisfaction with Their
Own Health Care
% satisfied
Health plan performance
(A or B rating)1 72%

Quality of health care

received2 88%

Ability to get most

sophisticated treatment2 81%

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

Put off Treatment for Serious Illness Last Year

Uninsured 38%
Insured 12%

Dissatisfied with quality of care received

Uninsured 33%
Insured 11%

Dissatisfied with ability to get latest treatments

Uninsured 41%
Insured 15%

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

 Public Worries about the Future

Worried you’ll have to pay more for your health

care or insurance1

65%

Think there will be rationing2

64%

Sources:1 Kaiser Family Foundation/Harvard School of Public Health poll (2007); 2 Washington Post/ABC News poll
(October 2003).
 Public Support for Federal Government
Guaranteeing Health Insurance
for All Its Citizens

Favor if it means paying higher taxes1

64%

Favor if substantial tax increase required2

35%

Sources:1 CBS News/NY Times (2007); 2 Harris Interactive poll (2000), involves slightly different question wording.
 Who Should Be in Charge of
the Health Insurance System

For profit
22%
companies

Government 31%

Non-profits 26%

Not sure 21%

Harris Interactive poll, 2003

How negative arguments affect support for proposals to
cover the uninsured (1)
Expanding existing state programs
What if you heard that expanding 82%
these programs would require
55%
raising taxes to pay for the cost?

Employer mandate
What if you heard that it would be 76%
so expensive that employers would 35%
be forced to lay off workers?

Tax credits and deductions

for the uninsured 70%
What if you heard that the amount 36%
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)

Legally requiring all residents

to have health insurance 56%

What if you heard that even with

the government’s help, people 22%
won’t be able to afford insurance
and the law will cause financial
hardship?

Single payer government plan 50%

What if you heard that you would
have to wait longer for some 30%
hospital and specialty care?

Initially favors Favors after challenge

Note: Responses of Massachusetts adults

Source: Harvard School of Public Health/BCBS Foundation/Cogent Research poll (2003).
 Public Preference:
Current System or Universal Coverage?
100%
90%
80%
70%
60% 56%

50%
40%
40% 33%
28%
30%
20%
10%
0%
Current system Universal Universal Universal
coverage coverage, with coverage, with
waiting lists for limited choice of
non-emergency doctors
treatment
ABC News/Kaiser Family Foundation/USA Today Poll, 2006.
 Americans’ Views About National Spending on
Health Care
% saying

Government Nation as a whole

100%
90%
80% 71%
70%
57%
60%
50%
40%
30% 26%
20% 11% 11% 9%
10%
0%
Too much About right Too little
Pew Research Center Health Care poll, March 2006.
 Public Views on Spending for Health Care by
Average Americans
% saying

100%
90%
80%
70% 65%
60%
50%
40%
30%
17%
20% 12%
10%
0%
Too much About right Too little

Pew Research Center Health Care poll, March 2006.

 Public’s Perception of Reasonableness of Prices
of Selected Products and Services
% saying unreasonable

Prescription drugs 57%

Hospital charges 54%

Doctors bills 43%

Automobiles 36%

Clothing 16%

Packaged foods 10%

Harris Interactive poll, April 2003.

 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 71%

Number of malpractice lawsuits 58%

Amount of greed and waste that

occurs in the health care system 59%

Use of expensive, high-tech

medical equipment and drugs 46%

Doctors making too much money 31%

People having little incentive to

look for lower cost doctors and 34%
services
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?

Hurt Helped

Uninsured 73%

Poor people 64%

50%
Middle class
0% 20% 40% 60% 80% 100%
Washington Post poll, October, 1993.