The Public and the Health Care Costs/Uninsured Issue (Robert J. Blendon, D.Sc.)

8/7/2019 The Public and the Health Care Costs/Uninsured Issue (Robert J. Blendon, D.Sc.)

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Understanding the Public on theHealth Care Costs/Uninsured Issue:

Implications for Journalists

in the Next Debate

Robert J. Blendon, Sc.D.

Harvard School of Public HealthKennedy 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%


3. Federal deficit 19%

4. Education 10%

5. Abortion 9%

6(t). Taxes 7%

6(t). Programs

for the poor 7%

H arris Interactive polls.

1. Terrorism 37%

2. Economy/jobs 37%

3. War/defense 13%

4. Health care 9%


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, 1994-2006.³Don¶t know´ responses not shown

Percent saying«



Public Views of the Bush Administration¶s

Health Care Policies

Approve of H andling of H ealth 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 fromstatus 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: US A Today/Kaiser Family Foundation/ H arvard School of Public H ealth H ealth Care Costs Survey (conducted April 25 ± June 9, 2005)

Asthma



25%

9%

51%

38%

Unin ur d

In ur d

Po tpon d M dical Car , By In uranc Statu

Th y or a family m mb r kipp d

a m dical t t, cut pill or didn¶t

fill a pr cription in th pa t y ar

b cau of th co t

P rc nt who ay«

Source: US A Today/Kaiser Family Foundation/ H arvard School of Public H ealth H ealth Care Costs Survey

(conducted April 25 ± June 9, 2005)

Th r hav b n tim in pa t y ar

wh n th y or a family m mb r

n d d m dical car and didn¶t g t it



19%

47%

28%

6%

50%

42%

11%

50%

38%

orks pre y ell onlyinor changes needed

So e goodhings unda en al

changes needed

So uch rong eedso be co ple ely rebuil

1982 1991 2007

Public Attitudes Toward

U.S. Health Care System

Source: H arris 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

a or



61%

38%

68%

Public Support for Truman Health Plan

(1950) Oppose TrumanHealth Plan

H ealthAffairs (March/ April 2001)

(1949) Oppose TrumanHealth Plan

(1949) Support Social Security covering MD and hospital bills



71

59

43

Public Support For the Clinton Health Plan

% approving

April

1994

September

1993US News and World Report poll, 1993.US A Today/CNN polls, 1993, 1994.

April

1993



Insured Americans¶ Satisfaction with Their

Own Health Care

Source: 1H arvard School of Public H ealth/Robert Wood Johnson Foundation/ICR poll (December 2003); 2 WashingtonPost/ ABC News poll (October 2003).

Health plan

performance (A or B

rating)1

Quality of health

care received2

Ability to get mostsophisticated 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:1Kaiser Family Foundation/ H arvard School of Public H ealth 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 H arris Interactive poll (2000), involves slightly different question wording.

Favor if substantial tax increase required2



Who Should Be in Charge of

the Health Insurance System

ot sure

on- rofits

Go ernment

or rofit

com anies

H arris 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:H arvard School of Public H ealth/BCBS Foundation/Cogent Research poll (2003).



How negative arguments affect support for proposals to

cover the uninsured (2)

30

22

0

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 financialhardship?

What if you heard that you would

have to wait longer for some

hospital and specialty care?

Initially favors Favors after challenge

Source:H arvard School of Public H ealth/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 Universal

coverage

Universal

coverage, with

waiting lists for

non-emergency

treatment

Universal

coverage, with

limited choice of

doctors

Public Preference:

Current System or Universal Coverage?

ABC News/Kaiser Family Foundation/US A 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%

0%90%

100%

Too much About right Too little

Government Nation as a whole

Pew Research Center H ealth Care poll, March 2006.

% saying



Public Views on Spending for Health Care by

Average Americans

4

oo much About right oo little

Pew Research Center H ealth Care poll, March 2006.

% saying



Public¶s Perception of Reasonableness of

Prices of Selected Products and Services

10%

16%

36%

43%

54%

57%

Packa ed foods

Clot in

utomobiles

Doctors bills

Hospital c ar es

Prescription dru s

H arris Interactive poll, April 2003.

% saying unreasonable



Perceived Reasons For Rising Health Care Costs

Percent who say each is a ³very 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%

5 %

59%

46%

31%

34%

Source: US A Today/Kaiser Family Foundation/ H arvard School of Public H ealth H ealth 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-classtaxpayer?

� 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

Uninsur ed

Poor people

Middle class

Washington Post poll, October, 1993.

Documents

The Public and the Health Care Costs/Uninsured Issue (Robert J. Blendon, D.Sc.)