Program on International Policy

Americans on Health Care Policy

August 30, 2000

1. General Support for Reform

The public sees health care as one of the most important issues facing the country. A majority of Americans believes the U.S. 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.

Since the early 1990s, health care has been one of the public’s perennial policy concerns, and it seems health care is in the top tier of voting issues in this election year. The current Center on Policy Attitudes (COPA) survey found that health care is one of the issues the public most wants to hear about when candidates articulate their positions. COPA asked, "In the context of making a decision to vote for one candidate or another, please tell me how important it is to you to know each of the following things ... on a scale from 0 to 10." Education, with a mean score of 8.52, is seen as the most important issue for the upcoming election. But very close behind was health care, with a score of 8.35. Health care was considered as somewhat more important than Social Security (8.12) and a substantially higher priority than foreign policy and defense (7.27).

A review of several other national polls from July 2000 reveals that health care ranks invariably in the top three most important national concerns. A Washington Post/Kaiser Family Foundation/Harvard School of Public Affairs poll found that health care, when combined with Medicare, was the most important issue for "deciding [their] vote for president." Forty-four percent of all registered voters gave this as one of their top two responses – ranking it higher than the economy, crime, jobs, the budget and even education."1 A similar Fox News survey in ten key states asked respondents which issue "will be most important to you personally as you make up your mind who you will support for president." Forty percent chose health care, compared to 27% for education and 26% for Social Security. 2 A Bloomberg News/Princeton Survey Research Associates poll, which allowed only one choice, found health care – at 17% – to be the second most important issue for deciding which presidential candidate to support, right behind the economy (21%) and just ahead of education (14%).3 Polls by other organizations, including Harris Interactive, The Los Angeles Times and Gallup also found health care to be in the top three most important national issues to be addressed.4 In an October 1999 Pew Research Center poll, 90% of respondents said that it was important (69% very important) for them to "personally hear what positions presidential candidates take on … how to provide health insurance to children and adults who can’t afford it."5

In a number of poll questions in recent years, a modest to strong majority of respondents has said it believes the US health care system needs major or fundamental changes. About one in four believe the system needs radical change, while only a small percentage thinks no change is necessary. The latest such question, asked by CBS News in July 1999, offered three alternatives. Sixty-one percent agreed with the statement, "There are some good things in our health care system, but fundamental changes are needed." Another 25% went even further, choosing the option, "Our health care system has so much wrong with it that we need to completely rebuild it." Only 12% were satisfied with the current system, picking the statement, "On the whole, the health care system works pretty well and only minor changes are necessary to make it work better." A Matthew Greenwald & Associates poll from March 1999 found nearly identical results: 28% wanted the system to be "completely redone," 67% thought "some things need to be changed," and just 3% believed the "system does not need to be changed at all."6

Other recent polls also reveal significant dissatisfaction with the current system and a desire for meaningful change. Another Greenwald & Associates poll (June 1999) found that 53% believed the "health care system in America today … needs major change." Forty-two percent favored "minor changes," and again, only 3% thought "the system does not need to be changed at all."7 Likewise, in a July 1998 Time/CNN survey, 52% thought that "the country’s health care system needs a great deal of reform," while 40% wanted "only some reform," and just 4% preferred "no reform at all." Responses to this question have remained very constant since September 1994, after falling from a high of 63% favoring a great deal of reform in April 1993. The 1998 survey also found that 40% considered the US health care system to be in "crisis," and 50% believed it to be a "problem, but not a crisis." Just 8% said there was "no health problem."8

Despite significant changes in the American health care system over the past few years (e.g., the dramatic increase in managed care and the slowing of cost increases), there are no signs that the majority feels that health care is improving. In February 1999, an Associated Press survey revealed that only about one in four (24%) felt "the health care system in this country is … better today than it was " in 1994. Slightly more than a third (36%) found it to be "about the same" and another third (34%) thought it was "worse today than it was."9 A Harris poll question, which has been asked five times since 1996, presents a more mixed picture. The question asserted that the "health care system in this country has been undergoing major changes over the past several years" and asks whether the system is getting better or worse. The latest result, from July 2000, found that 50% believed that the health care system is getting worse, but 43% thought it is getting better. However, intensity of opinion is revealing: while a mere 5% said the system is getting "much better," 25% felt it is getting "much worse."10

When the public thinks about priorities for health care and health care reform, its chief concerns are extending coverage to the uninsured and containing costs. A June 1999 Greenwald & Associates poll offered five options and asked respondents to choose which is the "most important goal" when reforming the nation’s health care system. "Providing health insurance coverage to all Americans" and "making health care more affordable" both garnered 37%, combining for nearly 75% of all responses. Ensuring doctor choice, providing high quality care, and fostering the development of new technologies were far down the list.11 In the same poll, 89% said making health care more affordable "should be a major goal" of reform, and 79% said the same of providing insurance coverage to all Americans.12

These priorities also are the most important for the 20% who said that health care (other than Medicare) was the most important issue "that might be discussed in next year’s presidential campaign" in a December 1999 poll conducted by the Kaiser Family Foundation and the Harvard School of Public Health. The 20% who chose health care were then asked this open-ended question: "What health care issue or concern – other than Medicare – do you think will be most important in deciding your vote [in the 2000 election]?" The top two responses were the cost of health care (23%) and dealing with the uninsured (21%). The next most common response was dealing with managed care and HMOs, at only 11%.13

Public attitudes on health reform priorities have remained fairly stable throughout the past decade. Data from surveys taken during the Clinton reform effort and earlier in the 1990s also reveal a similar focus on cost and coverage.14

Findings Continued >>

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