Program on International Policy

Americans on Health Care Policy

Executive Summary
August 30, 2000

This study seeks to address the fundamental questions about Americans’ attitudes about the US health care system, the challenges it faces and what the government’s role should be in addressing these issues. To find out how Americans feel about these issues, the Center on Policy Attitudes conducted an in-depth study that included:

    • A comprehensive review of existing polling data from other sources;
    • Focus groups in Richmond, Virginia, and Cleveland, Ohio;
    • A nationwide poll of a random sample of 652 respondents (margin of error +/-4%) conducted June 23 - July 9, 2000 (results were weighted to be demographically representative).

Findings

General Support for Reform

1. The public sees health care as one of the most important issues facing the country. A majority of Americans believes the US health care system needs major or fundamental changes. The two issues Americans most want to see addressed are expanding health insurance coverage to more Americans and reining in health care costs.

Expanding Coverage

2. A strong majority believes the government should actively work to expand health insurance coverage to more Americans. In principle, most Americans seem to believe that health care is a right, like public education, that should be guaranteed by the government.

3. Though a majority believes the government has the responsibility to ensure the outcome of universal health care, the public leans against the idea the government should undertake a large-scale effort requiring significant tax increases. The public also is inclined against the idea of a full-scale, single-payer government health insurance program.

4. To address the health care needs for most of the population, the majority supports requiring employers to provide insurance to their employees. The majority then favors a variety of government programs to cover specific vulnerable populations that may lack coverage, including children, people with low incomes, those who are unemployed and looking for work and those who are approaching the eligibility age for Medicare. There also is strong support for offering financial assistance such as tax breaks to uninsured Americans.

5. In addition to providing basic coverage to specific populations, a strong majority supports providing a wider range of coverage to seniors on Medicare. Strong majorities support helping seniors with the costs of prescription drugs and long-term care.

6. To support expanded government efforts, Americans show a willingness to accept only modest increases in taxes or insurance premiums, but these levels amount to enough to cover the costs of the programs they say they want.

7. Concern for expanding health insurance coverage is derived from altruistic concerns for the general population as well as self-interested concerns about not having health insurance coverage at some point in the future. Most Americans tend to underestimate the level of concern that the general public has for other Americans with regard to health care.

Controlling Costs

8. A strong majority of Americans perceives that health care costs are rising, and this concerns them. In most cases, this concern is not derived from unhappiness with the level of their current health care costs, but uneasiness that at some point in the future they will have trouble meeting rising costs.

9. Despite their concern about costs, Americans show a reluctance to accept limitations on health care. One reason for this resistance is a growing belief that managed care’s recent efforts to control costs have resulted in a lower quality of health care without a significant reduction in costs. The health care industry is perceived as not passing on the profits of existing cost-cutting measures and making inordinate profits while continuing to be relatively inefficient. Thus, confidence in managed care is low. A strong majority favors more government regulation of managed care and a "patients’ bill of rights" to roll back some of the cost-cutting measures of managed care.

10. Another source of resistance to accepting health care limitations is derived from a broader belief, prompted by moral concerns and self-interest, that every person should receive the maximum level of care, irrespective of their ability to pay. Majorities resist most specific options for limiting treatment, though support becomes stronger if the consumer has a direct financial benefit. A strong majority does say that, if the savings were passed on in the form of lower insurance premiums, it would be willing to sign a living will limiting life-extending efforts when death is imminent.

11. In general, a strong majority feels that the government should play a more active role in the effort to control health care costs. A majority favors the government regulating the costs of drugs that are produced under an exclusive patent.


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