Program on International Policy

Americans on Health Care Policy

August 30, 2000

2. Expanding Coverage

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.

The current poll presented respondents with pro and con arguments about whether the government should or should not expand health insurance to more uninsured Americans. A strong 68% majority found convincing the argument that the government "has a responsibility to expand health insurance coverage" because some uninsured Americans "may face financial crisis if they or their children become ill." Additionally, 68% also rejected as unconvincing the con argument that "expanding health insurance coverage is another example of the government getting involved in something that is better left to individual initiative." Having heard those two arguments, respondents were then asked whether the government should or should not "expand health insurance coverage to more Americans." An overwhelming 78% said that it should.

Some polls have even found strong majority support for the ideas that the government should guarantee coverage for all Americans. In October 1999 an NBC News/Wall Street Journal poll found that two-thirds (67%) thought "the federal government should guarantee health insurance coverage for every American." Similarly, a July 1998 Time/CNN poll reported 69% in favor of the idea that "government should guarantee health care for all Americans."15 An October 1999 Public Opinion Strategies/Lake Snell Perry survey found that 90% supported (67% strongly) "making sure all families and children have access to affordable health insurance coverage." And support falls only moderately when costs are implied. When the same question was asked of another portion of the sample, with the added phrase, "even if it costs you more," support was still a strong 75% (40% strongly support).16

A solid majority of Americans believes health care is a fundamental right of citizenship – an entitlement – like public education or police and fire protection. In a February 2000 Kaiser/Lehrer NewsHour study, an overwhelming 84% agreed (15% disagreed) with the statement, "Health care should be provided equally to everyone, just as public education is." By contrast, just 13% agreed (86% disagreed) with the opposing statement, "Health care, like owning a home, should be available only to those who can afford it."17

This sentiment has been fairly constant for some time. In September 1993, just as President Clinton was unveiling his health care reform plan, a Los Angeles Times poll asked respondents to choose between two statements. Fifty-nine percent chose the one that said, "health care is a right all Americans are entitled to receive from the government," while only 36% chose "health care is a privilege Americans should have to earn." A similar Los Angeles Times question from February 1990 found almost the same percentage (61%) choosing that "good health care is a right all Americans are entitled to receive from the government," while only 25% chose the alternative, that "good health care is something people ought to pay for themselves. "18 In February 1992, 83% agreed in a Gallup survey that "everyone should be entitled to the same amount and quality of health care, whether or not they can pay for that care" (41% strongly agreed). Only 11% disagreed.19

As the current poll found, the idea that individuals should be responsible for dealing with the problem of the uninsured simply does not resonate with the public. In the October 1999 NBC/Wall Street Journal poll cited above, respondents were asked to say who should have "the most responsibility for helping ensure that Americans receive health insurance coverage." Forty-three percent chose "the federal government," 28% chose "employers and businesses" and just 17% picked "individuals themselves" (9% volunteered "all of them").20 Again, in the current COPA survey, 68% rejected the idea that expanding health insurance was better left to individual initiative.

In addition, a June 1999 Hart and Teeter poll for the Council on Excellence in Government found a majority (58%) wanted the government to play "a major role in the area of expanding health insurance coverage." Another 18% preferred a "medium role," and 20% preferred a "minor role."21

This perception of health care as an entitlement that should be provided by government was echoed in the focus groups conducted by COPA. In Richmond, a woman stated, "I believe that people are entitled to good health care regardless of how poor or how rich you are. I think that it should be equal for everyone." Another participant said, "I would like to see the government play a major role in providing health care to every individual in this country … They provide public education to everybody in this country. In my opinion, it should be something like that, like a right like education" (man, Richmond). A woman in Cleveland remarked:

I think that it should be the priority of every legislator and health care business to develop a way that all Americans have health care. Period. Everybody should have basic health care. We should not fear going to the doctor because it’s going to cost too much money or we might lose our home. I think if we feel pain we should be able to go to the doctor. I really believe that it is America’s responsibility.

Several people also seemed frustrated that health care is still such a problem in America’s prosperous times. As one participant said, "There’s a lot of families out there that can’t even get basic medical care and we’re the greatest country in this world. We have the resources. Every one of our citizens should have access to health care" (woman, Cleveland).

Findings Continued >>

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