Program on International Policy

Americans on Health Care Policy

August 30, 2000

8. Controlling Costs: General Attitudes

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 personal existing health care costs, but uneasiness that at some point in the future they will have trouble meeting rising costs.

Americans show substantial concern about health care costs. A Greenwald & Associates poll from June 1999 found 80% of Americans believed that "over the last five years…health care costs in America have gotten worse." Fourteen percent felt they "stayed the same," and a mere 4% thought they have "gotten better."69 Also, in six surveys taken between December 1997 and December 1998, Kaiser/Harvard asked, "What do you think is the most important problem in health or health care for the government to address?" This open-ended query accepted two answers from each respondent and often elicited more than 20 separate responses. Yet, in every instance when the two most important answers were combined, the "cost of health care/affordable coverage" was the most cited response. In December 1998, 16% referred to costs, and 11% referred to the lack of universal insurance coverage. No other item elicited responses in the double digits.70

Interestingly, in the majority of cases, this concern about rising costs is not driven by personal frustration with respondents’ own costs. As mentioned, a June 1998 NBC News/Wall Street Journal poll found that a majority of respondents (56%) were also satisfied with the "cost of the health care coverage" they receive (41% were not satisfied).71

Among insured Americans – about 85% of the population – satisfaction with the cost of health care is even higher. In a July 1999 CBS News poll, nearly two-thirds (65%) of respondents with health insurance said they were "on the whole…satisfied…with the cost of the health care available" to them and their families. Only 35% said they were not satisfied. Similarly, an April 1998 Wirthlin study found that 67% of those with private insurance believed that what they "personally pay" for the coverage they receive is "about right." Only 27% thought what they pay is "too high" ("too low," 1%).72

However, Americans do show substantial anxiety about their ability to pay for health care at some point in the future. A September 1999 ABC News/Money Magazine poll found that 65% agreed with the statement, "I worry that health care costs I may have in the future will not be taken care of." Just 33% disagreed.73 In a February 2000 Kaiser/NewsHour study, 56% were concerned (32% "very concerned"), that "you might not be able to get the health care you think you need because you can’t afford it." Forty-three percent said they were not concerned.74 In a Tarrance Group/Lake, Sosin, Snell, Perry poll taken in February 1998, 52% said they worry "very often" (32%) or "somewhat often" (20%) about "having health care costs which are not covered by insurance." Forty-five percent worried only "from time to time" (16%) or "never" (29%).75 In 1996, an American Viewpoint/Lake Research survey for the Center for Policy Alternatives found 61% were concerned about "having enough money and insurance to pay the cost of a health care emergency." Just 38% were not concerned.76

Some of this worry about high costs came through in the focus groups. As noted above, when people discuss health issues, most people think about the problems faced by the uninsured and about the problems they may face if they lose their coverage in the future. However, there remains strong concern about costs even among those who are insured, both about the costs of insurance and what insurance does not cover.

I think [health care] is one of the decisive problems of today, and it’s going to get a lot worse. Primarily because the health care is so expensive … some of the prescription drugs are so expensive. X-rays, cat scans… (Woman, Cleveland)

It seems that years ago you would get a job in a company and they would pay for your insurance, not totally, but almost completely. Nowadays, it’s almost totally your responsibility. (Man, Cleveland)

If you’re really poor … you can’t afford private coverage. You have to spend all your money on premiums and stuff like that -- and what about nutrition? What about everything else that you need? What about even to just enjoy life? To have even a couple bucks. I think it’s a problem that a country this rich and this powerful can’t come up with a better system than what they have now. (Man, Richmond)

We do unquestionably have the best health care in the world, and of course it comes with a price. I think the thing I worry about most is after I retire and as you age, you need more health care, and who is going to pay for it? (Man, Cleveland)

Findings Continued >>

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