Understanding the Public on the Health Care Costs/Uninsured Issue: Implications for Journalists in the Next Debate

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Understanding the Public on the Health Care
Costs/Uninsured IssueImplications for
Journalists in the Next Debate

• Robert J. Blendon, Sc.D. Harvard School of
  Public Health Kennedy School of Government

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Most Important Issues for Government to Address
Percent saying issue is one of two most important
1993 July 2002 October
2007
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
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
1. Terrorism 37 2.
Economy/jobs 37 3. War/defense
13 4. Health care 9
(excluding Medicare) 5. Education 8
Note Open-ended, may sum to more than 100
because each respondent was asked to give up to
two different answers.
Harris Interactive polls.
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Americans Views of the US Health Care System,
1994-2006
Percent saying
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
Dont know responses not shown
Gallup Polls, 1994-2006.
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Public Views of the Bush Administrations Health
Care Policies
Approve of Handling of Health Care
CBS News poll, February 2007.
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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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Cost Problems of Families with Someone Diagnosed
with Heart Disease, Cancer and Asthma
reporting in last year skipped treatment, cut
pills or didnt fill prescription due to cost
No chronic health condition
Heart disease
Cancer
Asthma
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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Postponed Medical Care, By Insurance Status
Percent who say
There have been times in past year when they or a
family member needed medical care and didnt get
it
They or a family member skipped a medical test,
cut pills or didnt fill a prescription in the
past year because of the cost
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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Public Attitudes Toward U.S. Health Care System
Source Harris Interactive polls, 1982 and 1991,
NY Times poll 2007.
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Public Support for Federal Government
Guaranteeing Health Insurance for All Its Citizens
CBS News/NY Times poll, 2007.
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Public Support for Truman Health Plan
(1949) Support Social Security covering MD and
hospital bills
(1949) Oppose Truman Health Plan
(1950) Oppose Truman Health Plan
Health Affairs (March/April 2001)
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Public Support For the Clinton Health Plan
approving
April 1994
September 1993
April 1993
US News and World Report poll, 1993. USA
Today/CNN polls, 1993, 1994.
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Insured Americans Satisfaction with Their Own
Health Care
satisfied
Health plan performance (A or B rating)1
Quality of health care received2
Ability to get most sophisticated treatment2
Source 1Harvard School of Public Health/Robert
Wood Johnson Foundation/ICR poll (December 2003)
2Washington Post/ABC News poll (October 2003).
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The Uninsured Vs. Insured in America
Put off Treatment for Serious Illness Last Year
Uninsured
Insured
Dissatisfied with quality of care received
Uninsured
Insured
Dissatisfied with ability to get latest treatments
Uninsured
Insured
Source Washington Post/ABC News poll (October
2003).
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Public Worries about the Future
Worried youll have to pay more for your health
care or insurance1
Think there will be rationing2
Sources1 Kaiser Family Foundation/Harvard School
of Public Health poll (2007) 2 Washington
Post/ABC News poll (October 2003).
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Public Support for Federal Government
Guaranteeing Health Insurance for All Its
Citizens
Favor if it means paying higher taxes1
Favor if substantial tax increase required2
Sources1 CBS News/NY Times (2007) 2 Harris
Interactive poll (2000), involves slightly
different question wording.
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Who Should Be in Charge of the Health Insurance
System
Harris Interactive poll, 2003
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How negative arguments affect support for
proposals to cover the uninsured (1)
Expanding existing state programs
What if you heard that expanding these programs
would require raising taxes to pay for the cost?
Employer mandate
What if you heard that it would be so expensive
that employers would be forced to lay off workers?
Tax credits and deductions for the uninsured
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)
Legally requiring all residents to have health
insurance
What if you heard that even with the governments
help, people wont be able to afford insurance
and the law will cause financial hardship?
Single payer government plan
What if you heard that you would have to wait
longer for some 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).
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Public Preference Current System or Universal
Coverage?
ABC News/Kaiser Family Foundation/USA Today Poll,
2006.
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Americans Views About National Spending on
Health Care
saying
Pew Research Center Health Care poll, March 2006.
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Public Views on Spending for Health Care by
Average Americans
saying
Pew Research Center Health Care poll, March 2006.
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Publics Perception of Reasonableness of Prices
of Selected Products and Services
saying unreasonable
Harris Interactive poll, April 2003.
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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
Number of malpractice lawsuits
Amount of greed and waste that occurs in the
health care system
Use of expensive, high-tech medical equipment and
drugs
Doctors making too much money
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)
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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?
Uninsured Poor people Middle class
Washington Post poll, October, 1993.