2. Key findings are based on recently conducted surveys: 2  Questions from an Election Night Survey A national phone survey of 800 actual voters conducted on November 2nd, 2004, election night. The margin of error on this survey is +3.5%. This survey was conducted by Public Opinion Strategies.  A National Survey of Registered Voters A phone national survey of 1000 registered voters conducted November 4, 6-7, 2004, with a margin of error of +3.1%. This survey was conducted by Public Opinion Strategies in conjunction with Hart Research.

3. Key findings are based on recently conducted surveys: (cont.) 3  An Internet Survey of 500 Physicians An internet survey of 500 physicians conducted November 3-4, 2004. The margin of error on this survey is +4.4%. This survey was conducted by Cooper Research in conjunction with Blue Cross Blue Shield Association. The physicians survey used a fax/internet methodology to recruit and interview the respondents. The sampling frame was a list of over 342,000 practicing U.S. physicians in The Little Blue Book Physician Master File. Two systematic random samples of 10,000 physicians each were drawn from the total file. Only one physician from each office was eligible to participate. Physicians were invited to take part in the survey via broadcast faxes which were sent out on two successive waves on November 3rd and 4th. The invitation asked the physician to participate in a major non-partisan survey on critical election issues related to health care. Each physician was given the survey URL as well as and a unique login code to access the site. If a physician encountered problems in either accessing or completing the survey he/she could receive assistance via a toll free help line. Hourly reports of completed interviews by years in practice, geography, and medical specialty were monitored to ensure the interviews were well balanced. Responses were cut off when 501 interviews were completed.

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5. 5 Health care concerns ranked third behind Iraq and the economy in what issues were important to voters when deciding how to vote for President.

6. 6 Kerry Advantage Bush Advantage Presidential Ballot By Respondent’s Top TWO Most Important Vote Issues 11% HOMELAND SECURITY (BUSH 82% - KERRY 18%) 14% MORAL VALUES (BUSH 75% - KERRY 24%) 13% WAR ON TERROR (BUSH 72% - KERRY 27%) 31% IRAQ (BUSH 38% - KERRY 61%) 23% ECONOMY (BUSH 35% - KERRY 63%) 15% HEALTH CARE (BUSH 21% - KERRY 78%) 64% 51% 45% 23% 28% 57%

7. 77 Voters were asked, based upon what they heard during the presidential campaign, whether they thought President Bush and Senator Kerry each had a plan to “make health coverage more affordable.” Among those voters who recalled either candidate having a health care plan, we asked voters to describe what they remember and whether this plan made them more or less likely to vote for that candidate.

8. 8 Just over one third (35%) of voters said they thought President Bush had a plan “to make health coverage more affordable” during the campaign. What voters recall most about President Bush’s plan was his proposal to make health care more affordable and more accessible for everyone, especially seniors. In addition, voters were aware of his stand against frivolous lawsuits and his support for decreasing government control and emphasizing health care delivered by the private sector. Some respondents also mention Bush’s support for health savings accounts and the preservation of Social Security. And did George W. Bush’s affordable health coverage plan or proposal make you more likely to vote for him, less likely to vote for him or did it not really make a difference in your vote? Recall of President Bush’s health care plan. Asked of those who recalled President Bush having a health care plan

9. 9 Almost half of the electorate (47%) said they thought Senator Kerry had a plan “to make health coverage more affordable.” What voters recall about Senator Kerry’s plan was his proposal to make health care more affordable and available to seniors and the poor in particular, by getting rid of tax breaks for the upper income bracket. Voters also cite his idea to offer the health care coverage congressional members have to every American. Some respondents also mention his proposal for increasing government control and creating a “national health care” plan. And did John Kerry’s affordable health coverage plan or proposal make you more likely to vote for him, less likely to vote for him or did it not really make a difference in your vote? Asked of those who recalled Senator Kerry having a health care plan Recall of Senator Kerry’s health care plan.

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11. 11 When voters are asked to select their two most important domestic issue priorities, they select “the economy and jobs” and “health care and prescription drug prices.”

12. 12 Almost two thirds of those with private health insurance say their out-of-pocket costs have gone up over the past year.

13. 13 Given the concern about cost, we asked voters to rate on a scale of one to five, with five being the most important, multiple factors to learn more about what they believe contributes to rising healthcare costs. The findings highlight the focus on prescription drug costs, the cost of hospital care, and medical malpractice costs. “Profits in the health care industry” scores in the middle rank of the other factors tested.

14. 14 FACTOR CONTRIBUTING TO RISING HEALTH CARE COSTS % '5' The cost of prescription drugs60% The cost of hospital care51% Medical malpractice insurance and lawsuits48% Waste, fraud and abuse in healthcare44% Profits in the healthcare industry40% The cost of medical technology such as CT scans and MRI’s 39% The poor health habits of Americans38% The aging population36% Federal and state laws imposing new regulations on health care providers 29% The increased use of health care services22% Top factors voters believe contribute to rising healthcare costs.

15. 15 Looking forward to the next Congress, we asked people to rate on a scale of one to five, with five being the most important, how important it was to them that Congress make progress on this issue over the next two years. Interestingly, there is not one key health care issue that voters feel is most important for Congress, but rather a variety of issues that require attention.

16. 16 TOP TIER ISSUES CONGRESS SHOULD MAKE PROGRESS ON IN NEXT TWO YEARS % '5' Assuring every American has access to health care coverage 68% Making sure people have access to affordable prescription drugs 67% Slowing down the steep rise in health care costs 63% Reducing the costly fraud and abuse in the health care system. 56% Working with those people whose incomes are too low to afford their own health care coverage but still make too much to be eligible for government health programs, to make sure they get the health insurance coverage they need. 52% Providing new tax credits to small businesses that can NOT afford health insurance so they can pay for health care coverage for their employees 51% Making sure the millions of adults and children eligible for government health programs get enrolled in these programs to get the health care coverage they need. 50% Issues Congress should make progress in the next two years.

17. 17 MIDDLE AND BOTTOM TIER ISSUES CONGRESS SHOULD MAKE PROGRESS ON IN NEXT TWO YEARS % '5' Providing new tax credits so people who can NOT afford health insurance would be able to buy it. 49% Making sure seniors have more choices of different private health care plans to receive their Medicare benefits. 46% Reforming the medical malpractice liability system 45% Getting Americans to adopt healthier lifestyles by, for example, increasing the number of people regularly exercising or losing weight 40% Expanding programs to educate those Americans who do not have health care coverage but are making fifty thousand dollars a year or more about the importance of health care coverage and the financial risks and pitfalls of going without it. 22%

18. 18 Looking across partisan lines, there is some agreement on the top five issues that are most important for Congress to address – specifically “slowing down the steep rise in health care costs” and “making sure people have access to affordable prescription drugs.”

19. 19 ISSUES CONGRESS SHOULD MAKE PROGRESS ON IN NEXT TWO YEARS (%5) Republicans (41%)Independents (18%)Democrats (39%) Slow steep rise in health care costs 59% Every American access to health care coverage 71% Every American access to health care coverage 83% Reform med mal liability system 57% Access to affordable Rx drugs 70% Access to affordable Rx drugs 76% Access to affordable Rx drugs 56% Slow steep rise in health care costs 65% Slow steep rise in health care costs 66% Reduce fraud & abuse in the health care system 55% Reduce fraud & abuse in the health care system 55% Coverage for incomes too low to afford, but to high to be eligible gov’t programs 63% Tax credits to small business 53% Coverage for incomes too low to afford, but to high to be eligible gov’t programs 52% Those eligible for gov’t programs get enrolled 62% However, it is clear that Republicans are more focused on the medical malpractice issue while Democrats feel more attention should be given to government programs.

20. 20 We tested ten different programs that we told participants could be sponsored by health insurance companies and asked people how important a priority each should be. The findings broadly mirror the results of the other portions of the study.

21. 21 TOP TIER HEALTH CARE PROGRAMS TOTAL ABSOLUTE/ HIGH PRIORITY Work with doctors to get consumers the most effective drugs at reasonable prices. 78% Work with law enforcement to cut down on the waste, fraud, and abuse in the health care system by focusing on medical providers who submit false claims, pad the bills, or provide less care for the money billed. 65% Work with a team of health care professionals to help people better manage chronic conditions such as diabetes, asthma, or heart problems. 63% Partner with doctors and hospitals to develop new approaches to improve the quality of care. 62% The clear message across multiple questions and multiple scales is a concern about the need to deal with the cost of prescription drugs.

22. 22 MID TIER HEALTH CARE PROGRAMS TOTAL ABSOLUTE/ HIGH PRIORITY Provide consumers with information about medical conditions and treatment options to enable them to make informed decisions for themselves and their families. 58% Provide doctors with information from their extensive claims database to improve the quality of medical care by identifying the most effective treatments 58% Emphasize preventive medicine, which would include reminding patients to schedule regular physicals, well-baby visits, mammograms, or cancer screenings. This would also include 24-hour a day, seven days a week nurse advisory line for patients to call and ask questions 54% Work together to develop a system allowing the electronic exchange of clinical and administrative information between doctors, hospitals, insurers, patients and the government to help minimize expensive paperwork. 51% Provide public education campaigns to promote healthier lifestyles, such as encouraging greater physical activity, even as little as half an hour each day of walking, fighting obesity, and stopping smoking. 48% Develop new health insurance products to help consumers better manage their own health care costs. 45%

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24. 24 FACTOR CONTRIBUTING TO RISING HEALTH CARE COSTS (% ‘5”) DoctorsVoters Medical malpractice insurance and lawsuits71%48% The aging population42%36% The cost of prescription drugs42%60% The poor health habits of Americans37%38% Federal and state laws imposing new regulations on health care providers 35%29% The cost of hospital care32%51% The cost of medical technology such as CT scans and MRI’s 27%39% The increased use of health care services26%22% Profits in the healthcare industry24%40% Waste, fraud and abuse in healthcare19%44% There’s one overall finding that dominates the response from the physicians surveyed: Fix the medical malpractice liability system.

25. 25 ISSUES CONGRESS SHOULD MAKE PROGRESS ON IN NEXT TWO YEARS (% ‘5’) DoctorsVoters Reforming the medical malpractice liability system 80%45% Assuring every American has access to health care coverage 43%68% Getting Americans to adopt healthier lifestyles by, for example, increasing the number of people regularly exercising or losing weight 43%40% Making sure people have access to affordable prescription drugs 40%67% Providing new tax credits to small businesses that can NOT afford health insurance so they can pay for health care coverage for their employees 39%51% Working with those people whose incomes are too low to afford their own health care coverage but still make too much to be eligible for government health programs, to make sure they get the health insurance coverage they need 32%52% Providing new tax credits so people who can NOT afford health insurance would be able to buy it. 30%49% Slowing down the steep rise in health care costs 30%63% Making sure the millions of adults and children eligible for government health programs get enrolled in these programs to get the health care coverage they need 27%50% Reducing the costly fraud and abuse in the health care system 24%56% Expanding programs to educate those Americans who do not have health care coverage but are making fifty thousand dollars a year or more about the importance of health care coverage and the financial risks and pitfalls of going without it. 20%22% Making sure seniors have more choices of different private health care plans to receive their Medicare benefits 16%46% There’s one overall finding that dominates the response from the physicians surveyed: Fix the medical malpractice liability system.

26. When asked at the end of the internet study, “to tell us what you think are the one or two most important things that could be done to reduce the rising cost of healthcare,” there are three broad physician messages; however, by a ratio of approximately three-to-one physicians cite the medical malpractice issue:  Limit frivolous lawsuits and support legal reform. Physicians believe that by limiting lawsuits and putting a cap on the amount of money awarded to injured patients, the cost of healthcare will significantly decrease.  Preventive medicine and patient responsibility in health care was another top mention. Physicians say individuals need to take better care of themselves and become more educated about health issues in general.  A national/universal health care plan would lower costs and increase quality and coverage.

27. “Reform of liability insurance to minimize defensive medical practice. fair reimbursements to physicians. limit percentage of settlement that lawyers can reap from suits. physicians improve policing themselves. avoid punitive response to reporting of medical errors in health care system. this would allow for better identification of problem areas and targeted improvement.” YEARS PRACTICE:10- 14 SPECIALITY:OB/GYN “Make people responsible for their health--if overweight, they must demonstrate some weight loss; if smoker, they must stop. perhaps the cost of their copay would go up if they don't try to improve their health? Make a connection between the care received and the cost of that care. Too many people insist on MRI when they don't require one.” YEARS PRACTICE:10-14 SPECIALITY: Rheumatology “Reduce malpractice costs which include extra tests and care performed to protect care providers reduce cost of medicine and medical products including product liability costs.” YEARS PRACTICE:10-14 SPECIALITY: Anesthesiology “Universal healthcare or insurance rates based on patient's healthy or unhealthy lifestyles.” YEARS PRACTICE:10-14 SPECIALITY: Family/General Practice

28. 28 TOP TIER HEALTH CARE PROGRAMS Doctors TOTAL ABSOLUTE/ HIGH PRIORITY Voters TOTAL ABSOLUTE/ HIGH PRIORITY Emphasize preventive medicine, which would include reminding patients to schedule regular physicals, well-baby visits, mammograms, or cancer screenings… 65% Work with doctors to get consumers the most effective drugs at reasonable prices. 78% Provide public education campaigns to promote healthier lifestyles, such as encouraging greater physical activity, even as little as half an hour each day of walking, fighting obesity, and stopping smoking. 64% Work with law enforcement to cut down on the waste, fraud, and abuse in the health care system by focusing on medical providers who submit false claims, pad the bills, or provide less care for the money billed. 65% Work with doctors to get consumers the most effective drugs at reasonable prices. 59% Work with a team of health care professionals to help people better manage chronic conditions such as diabetes, asthma, or heart problems. 63% Develop new health insurance products to help consumers better manage their own health care costs. 59% Partner with doctors and hospitals to develop new approaches to improve the quality of care. 62% When presented with the same list of ten items health insurers could sponsor, physicians’ priorities for health insurers differ from the public as physicians put the highest emphasis on preventive care and working to have people adopt a healthier lifestyle.

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