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/jobs37% 3. War/defense 13% 4. Health care 9% (excluding Medicare) 5. Education 8%

Americans’ Views of the US Health Care System, State of Crisis 17%12%11%14%18%22% Major Problems 52%58%54% 52% Minor Problems 29%28%32%30%28%19% No Problems1% 2%1% 4% Gallup Polls, “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.

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 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

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

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.

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

Public Support For the Clinton Health Plan % approving April 1994 September 1993 US News and World Report poll, USA Today/CNN polls, 1993, April 1993

Insured Americans’ Satisfaction with Their Own Health Care Source: 1 Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll (December 2003); 2 Washington Post/ABC News poll (October 2003). Health plan performance (A or B rating) 1 Quality of health care received 2 Ability to get most sophisticated treatment 2 % satisfied

The Uninsured Vs. Insured in America 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 Worried you’ll have to pay more for your health care or insurance 1 Sources: 1 Kaiser Family Foundation/Harvard School of Public Health poll (2007); 2 Washington Post/ABC News poll (October 2003). Think there will be rationing 2

Public Support for Federal Government Guaranteeing Health Insurance for All Its Citizens Favor if it means paying higher taxes 1 Sources: 1 CBS News/NY Times (2007); 2 Harris Interactive poll (2000), involves slightly different question wording. Favor if substantial tax increase required 2

Who Should Be in Charge of the Health Insurance System Harris Interactive poll, 2003

How negative arguments affect support for proposals to cover the uninsured (1) 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) 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

Public Preference: Current System or Universal Coverage? ABC News/Kaiser Family Foundation/USA Today Poll, 2006.

Americans’ Views About National Spending on Health Care Pew Research Center Health Care poll, March % saying

Public Views on Spending for Health Care by Average Americans Pew Research Center Health Care poll, March % saying

Public’s Perception of Reasonableness of Prices of Selected Products and Services Harris Interactive poll, April % 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 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? Uninsured Poor people Middle class Washington Post poll, October, 1993.