Program on International Policy

Americans on Health Care Policy

August 30, 2000

On the subject of health care, there are areas in which there seems to be a public consensus with implications for policy. In other areas no such consensus exists.

Most broadly, a clear majority feels the government should be taking a more active role in addressing the problems of health care. Only a small minority thinks this is not an appropriate role for the government. However, this consensus does not necessarily spell out just what the government should do.

At a more specific level, there is consensus on the question of expanding health care coverage. Clearly, a strong majority believes that the government should take a more active role and that the government has a responsibility to pursue the goal of health care coverage for all citizens. However, there is not a clear majority calling for the government to provide health care services directly or to provide universal health insurance. American public skepticism about government programs is still high.

Putting the different pieces together, though, it does appear that there is a coherent consensus about what the government should do. First, the backbone of health care coverage would be a government requirement that all employers provide health insurance to their employees. Beyond that, majorities seem ready to have the government directly provide insurance to limited and specific vulnerable populations, including the unemployed, children, those approaching retirement age and those with low incomes.

The majority is also ready to support expanding the range of coverage for seniors by providing coverage for prescription drugs and for long-term care.

Besides health care coverage, the other big concern for Americans is the question of health care costs. In this case, however, there is not a clear consensus about what should be done. The consensus in the early to mid-1990s in favor of managed care as a way to control costs has broken down. Clearly, many Americans feel that through managed care the health care industry has diminished the quality of care and imposed limits on Americans’ access. It is difficult for Americans to accept any such limits: on questions of health care Americans are prone to think that everyone should have access to the maximum level of treatment irrespective of their ability to pay.

But most important, Americans do not perceive that the limits they have accepted as part of the movement to managed care have significantly controlled the costs of health care. Apparently Americans believe that the health care industry has simply pocketed the gains from the limits that Americans have already accepted, and thus the health care industry is making unfair profits.

In this context of declining confidence in the health care industry it is difficult to get Americans to consider options for limiting access. If anything, Americans seem to be prone to try to regain some of the ground they feel they have given up in the movement to managed care. Thus there is strong support for a ‘patients’ bill of rights.’

Many Americans do understand that there are other factors contributing to the growth of health care costs apart from the self-interested actions of the health care industry. But they are in a wary mood. The only cost-cutting proposal that gets strong majority support is for individuals to receive lower insurance rates in exchange for accepting in advance limits on the use of extreme measures in the terminal stages of a disease.

The problem of costs will become a greater issue in the future as costly new technologies and treatments become available. To move beyond the impasse, it will be necessary for the health care industry to take steps to regain the confidence of the American public.

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