Americans on Health Care Policy
of Personal Concern
One of the reasons that Americans have a desire to expand health insurance coverage is that many are afraid that they may someday be without health insurance. In the current survey, respondents were asked to say on a scale of 0 to 10 "how concerned you are about the possibility that at some point you will not be able to afford health insurance," with 0 being not at all concerned and 10 being extremely concerned. The mean response was 8.05, indicating a very high degree of concern. Over four in five (82%) gave a response of 6 or higher, and a majority (51%) gave a response of 10, by far the most common rating.
In the focus groups, a number of participants gave voice to this concern. Although almost everyone in the groups had their own health insurance, their confidence that they would continue to have coverage was particularly fragile. They were concerned about the possibility they may not have insurance in the future due to unforeseen circumstances such as a job loss. As a woman in Cleveland said, "I would hate to think that if I was going to change my job, what I would do with a 30-day waiting period, because you never know whatís going to happen in that time frame." Another woman put it more bluntly, "If I lose my job, then there goes the health insurance. Itís definitely a concern."
Others gave poignant testimony about how easily they found themselves facing terrible health coverage problems because of the lack of guaranteed insurance in the US system of health care.
My husband and I are in somewhat of a unique situation. He was terminated from his employment in November and then was diagnosed with cancer in January. So, we have gone from very healthy to catastrophic kind of health concerns. Thank goodness for COBRA, we were covered for 18 months. One of our concerns is he has not been able to look for work in this time period because of the seriousness of his illness, and the COBRA coverage is for 18 months. So thatís a concern. What would happen if his situation is such that he is not able to go to work? (Woman, Cleveland)
I had an incident myself where I was in the hospital Ö I stayed there for three days. I got a $10,000 bill for this and the other. Thank God they took me, because Iím in transition and I donít have health coverage. So I had to pay for everything. I looked at the bill and said, "Maybe I should have took [sic] my chances." Thatís your life youíre talking about. (Man, Cleveland)
Likewise, according to a February 2000 Kaiser/NewsHour poll, three out of four (75%) are "concerned" that the "amount [they] pay for [their] health care services or health insurance will increase." Only 24% were not concerned about this. In previous Kaiser/Harvard surveys, which used the same item wording but a different response set, a majority has said they were even "worried" about cost increases. For example, a December 1999 poll found that 52% were "very" or "somewhat" worried, while 42% were "not too worried" or "not at all worried."64 Finally, a Kaiser/Harvard survey taken in September 1999 found that a majority (51%) believed that, for people like them, "being able to afford the cost of health insurance and necessary medical care" was a "major problem." Another 28% thought that was a "minor problem," while just 20% felt it was "not a problem."65
But at the same time there are strong indications that concern about health insurance coverage is driven by altruistic concerns for others. The current COPA poll asked how much it concerned respondents that "many Americans do not have health insurance." Replying on a scale of 0 to 10, with 0 being not at all concerned and 10 being extremely concerned, the mean response was 8.28 Ė higher than for the respondents themselves.
This concern for others also shows up in the way people respond to questions about the quality of their health care. Despite the high priority they place on the issue of improving health care, most Americans express a high level of satisfaction with the care they receive personally. A June 1998 NBC News/Wall Street Journal poll of national adults found that 79% were very (44%) or somewhat (35%) satisfied with the "quality of the health care [they and their] family receive." Just 18% reported being dissatisfied. The same poll found a majority of respondents (56%) also were satisfied with the "cost of the health care coverage" they receive (41% were not satisfied).66
However, Americansí assessment of the health care system of the nation is much less sanguine. In a July 2000 Washington Post/Kaiser/Harvard poll, asked to rate their "satisfaction with the state of the nation" in different areas, only 46% were satisfied with "the availability and affordability of health care." Fifty-three percent were not satisfied.67 In addition, an October 1999 NBC News/Wall Street Journal survey reported that a very strong majority of 77% believed "the fact that many Americans lack health insurance coverage" is a "very serious problem."68 Thus, it appears certain that a strong sense of national altruism also drives support for reform.
This altruistic concern was very evident in the focus groups, even though most participants were satisfied with their own coverage. When talking about problems with the US health system, they were expressing concern for the possible plight of others a majority of the time.
Presently I am very happy with the quality of the health care. My husband works full time and we have great insurance. I do have two small children and I worry for their benefit what will be available in the future. (Woman, Cleveland)
It seems to me that a lot of the blue-collar segment, the guys building the bridges, houses, buildings, those are the Ė lot of the people who work for private contractors, they do not have health care and itís a huge [part of the] equation. (Man, Richmond)
Well, my health care, I feel that who I go through is very good, [but] I see independent employers, people that have their own business, they donít have good health coverage. (Woman, Richmond)
Iím pretty happy currently with my own situation. However, I know not everyone is as fortunate as I am. A lot of people donít have any insurance at all and Ö Even if you do have insurance, youíre getting prescriptions that cost $250 out of your pocket anyway Ö Iím pretty concerned about it for the future. (Man, Cleveland)
Ö Not so much for myself as for those that are uninsured and those that really need it. I think the government must allocate the necessary money to cover the uninsured Ö I think thatís what government is there for, is to help those that need the help. (Woman, Cleveland)
I donít have a problem with the HMO that I belong to [but] my biggest concern is the people that are out there, especially young people, trying to start in a business or something like that and they havenít got health coverage, just hoping that they donít get sick. (Man, Richmond)
I have coverage through my husband Ö and Iím happy with it. But my concern was for the older people Ö (Woman, Richmond)
Interestingly, Americans tend to underestimate how much other Americans are concerned about the state of health care in the nation. Again, on a scale of 0 to 10, COPA asked, "How much do you think the average American is concerned that many Americans do not have health insurance?" In this case, the mean response was only 6.24, more than 2 points lower than the mean respondentsí concern for others.
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