I.CHALLENGES IN THE CURRENT SYSTEM
III.MEDICARE AND SPECIAL SERVICES
IV.HEALTH CARE AND CREDIBILITY
V.HEALTH AND THE ENVIRONMENT
I. CHALLENGES IN THE CURRENT SYSTEM
A. Most Important Health Care Issue
Public opinion on the most important health care issue facing Americans has swayed somewhat over the course of the decade. In the early to mid-1990’s, Americans expressed a great deal of concern over the availability of health care to all Americans, but that concern has been replaced in more recent years by concerns over the cost of health care.
In an early 1994 survey, four out of ten respondents claimed that the most important aspect of health care reform was that we provide health care coverage for everyone. Likewise, in another early 1994 survey, nearly 40% felt that ensuring that all Americans have insurance was the most important consideration in the health care debate.
However, a later 1994 survey showed that given the choice, more Americans (38%) were most concerned with controlling the costs of health care services, followed by providing health care coverage to all Americans (25%). Then in August of 1995, the most commonly cited health care problem was cost (17%), followed by availability of health care (12%).
Interestingly, in the same 1995 survey, 32% responded that there was no health care problem. Similarly, a quarter of respondents to a July 1996 survey cited no health care problem. Of those who did mention a problem facing health care however, the most common was waste, fraud, and abuse in government; which may have been due to the heated political debate over health care reform.
A 1997 poll explains this shift toward increased concern over cost. A vast majority of respondents (73%) said that the cost of health care is a bigger problem for families than it was five years ago. Fewer than a quarter of respondents said cost was less of a problem now. Comparatively, in a 1995 survey, only a quarter of respondents said that they had experienced difficulty in affording the cost of health care, while 76% said they had never experienced such difficulty. By 1996, 57% of respondents were worried about being able to afford health care costs, and 42% were not worried.
While most Americans are not affected by a lack of health care, it is still a problem for more than a third of the nation. In 1995, 64% said that not having enough health care wasn’t a problem for them personally. However, 22% said it was a serious problem and another 13% said it was somewhat of a problem for them personally.
Lastly, Americans also see the cost of health care as one of the most important of all health-related issues facing the nation. In a 1995 poll, the cost of health care was cited as one of the most urgent health issues in the US by 27% of respondents, as was cancer. AIDS was the top issue of concern, cited by 44%.
B. Medical Care Today
There has been a gradual shift in the past few years of the type of health care coverage most Americans use, with an increased participation in managed care plans. According to a number of polls compiled in early 1995, roughly 55% of Americans belonged to a traditional fee-for-service plan, 20% belonged to Health Maintenance Organizations (HMOs), and 20% subscribed to a Preferred Provider Plan (PPO). In 1995, we begin to see a decline in fee-for-service participation, and nearly a 50% increase in HMO membership. By 1996 there has been a significant jump in managed care members, and fee-for-service users are, for the first time, the smallest group.
Fee-for Service HMO/PPO
Pre-1995 55% 20% 20%
1995 43% 29% 26%
1996 30% 33% 34%
Interestingly, the percentage of women who use fee-for-service plans is even smaller. According to a 1996 survey, only 21% of women were members of a fee-for-service plan, while 35% belonged to an HMO, and 18% belonged to a PPO.
Addressing this trend, a 1997 survey asked respondents whether the growth of managed care membership would improve or harm the quality of medical care. Fifty-four percent responded that this would harm the quality of health care, and 33% said that quality would be improved. Only 7% said that quality of care would not be affected. This is reinforced by the results of another 1997 pool in which 39% of respondents cited fee-for-service plans as the type of plan which provides the best medical care. Responses were split one to one between PPO’s and HMO’s.
A 1993 survey suggests that reduced costs may have been the motivation for abandoning fee-for-service plans, in spite of the fact that they are perceived as providing better care. Nearly 75% of respondents said they would not be willing to pay 20% more than they are currently paying for health insurance in order to receive an unlimited choice of doctors and hospitals.
Furthermore, according to another 1993 poll, 56% of respondents said that they would not be willing to pay anything additional for an unlimited choice of doctors. The second largest group of respondents (27%) said they would pay $10 to $20 more per month for this privilege.
This makes sense considering that in 1995, over 70% of the public felt that their current health care coverage provided either an excellent or good amount of choice of doctors.
Public opinion has remained fairly constant with regard to the quality of health care Americans receive. For instance, in a 1993 poll, 89% of Americans felt satisfied with the quality of care they received from their doctors, and in another 1993 poll, 90% of respondents said that they felt satisfied with the care they received. In 1995, 88% said they were satisfied, and in 1996, 91% said they were satisfied. A 1997 poll also reports that 90% of respondents were satisfied with the quality of their health care. Those numbers apparently do not fluctuate depending on the type of medical care one requires; 89% of people who had experienced a serious illness or injury were satisfied with the care they received, according to a 1997 poll.
C. Reducing Waste and Inefficiency
On the whole, many Americans are cynical of doctors and hospitals. In a January 1992 survey, 40% thought the rising costs of health care could be attributed to doctors and hospitals. Similarly, a March 1993 poll showed that one half of Americans blamed doctors and hospitals for the extremely high expense of health care. According to a 1993 survey, nearly 80% of respondents claimed that doctors charged too much for their visits and were responsible for waste and inefficiency in the system. In another 1993 survey, nearly three-quarters of Americans felt that if doctors paid less attention to making a profit, health care expenses would be greatly reduced. And finally, in another 1993 survey, 82% of Americans favored reducing waste and inefficiency through limiting the amount of money doctors could charge for their services.
Over 75% of Americans felt in March 1993 that doctors who ordered unnecessary medical tests were responsible for bureaucratic inefficiency.
If doctors were largely responsible for waste, Americans felt that they could help to solve the problems. According to a March 1993 survey, if they were to launch a nationwide effort to reduce waste and efficiency, over 80% of Americans thought that they would be successful.
To the extent that Americans were skeptical of doctors, they also felt that companies which make prescription drugs were also responsible for waste and inefficiency in the health care system. In fact, nearly 75% of respondents to a March 1993 survey blamed these companies for waste.
Notwithstanding, health insurance companies and hospitals were by far the most responsible for waste and inefficiency in the eyes of most Americans. In January of 1992, 23% held private insurance companies liable for rising costs. Again in 1993, 22% suspected that private insurance companies were contributing to rising costs. In a March 1993 survey, over 80% of respondents agreed that providing health insurance through large groups like HMOs would be an effective way of eliminating waste and inefficiency in the country’s health care system.
Americans were far less cynical towards their employers than they were of their doctors, hospitals and health insurers. Over two-thirds of Americans speculated that employers were not responsible for waste and inefficiency in the health care system.
Similarly, over 60% of respondents from this March 1993 survey thought that patients could not be held responsible for bureaucratic waste.
II. IDEOLOGICAL DEBATE
A. Government’s Role in Health Care Reform
While doctors, hospitals, and insurance companies continue to carry the blame for rising health care costs, the public feels the federal government is somewhat less responsible for high health care costs. In 1992, 30% blamed the federal government for the cost of health care, and in 1993 only 8% of respondents thought the federal government was to blame for rising health care costs.
However, while the public does not necessarily think the government is to blame for health care costs, Americans do see the federal government as the best vehicle to control health care costs. In an 1992 survey, two-thirds felt that the government should take the lead in solving the problems and costs of health care. In a 1993 poll, a plurality (38% of respondents) claimed that the government is in the best position to influence the costs of health care. And in 1995, 81% of respondents agreed that the government should play an active role in improving health care for low income families (as well as housing and education).
By contrast, in 1996, only 53% of Americans said that Congress should do more to limit how much health insurance companies and managed care plans can charge for services, while 43% said that Congress should not get involved and rather let competition in the marketplace solve the problem.
In 1994, Americans favored reform of health care by state governments over the federal government, 41% to 38%. In 1996 however, 63% of respondents said that financing health care should be mainly the responsibility of the federal government, while only 19% said it should be the responsibility of the state government. Only 9% said that it should be the responsibility of individuals, and local governments and private organizations were deemed to be responsible by 5% each.
In another 1996 survey, the public also expressed concern for the next president to address these health care issues. Twenty-seven percent mentioned Medicare, 15% mentioned the cost of health care, and 14% mentioned availability of health care, as issues that would be important in determining which candidate they would vote for.
In the early 1990’s, before the growth of Americans’ concern over health care costs, the public was somewhat split on what the government’s main objective should be in reforming health care. In 1993, a majority of Americans felt that if the federal government were to reform health care, controlling health care costs should be the main focus, while 43% thought guaranteeing coverage for all Americans was the more important focus. Two surveys from early 1994 reflect similar results. In both cases, about 50% thought that the federal government should be responsible for making sure all Americans were covered by a health care plan, while about 45% felt that the federal government should only be responsible for making sure that health care coverage is available to Americans.
In 1992, 45% of respondents said that the US government should provide national health insurance for everyone, 26% said it should provide national health care for those who cannot afford adequate coverage, and 20% said the US should continue to provide Medicaid and Medicare for the poor and elderly, but should not pay for anyone else’s health care. Then in 1996, 64% of respondents said that the federal government should guarantee medical care for all people who don’t have health insurance, while 29% said that this is not the government’s responsibility.
Federal regulation of health care costs has been met with varying degrees of support, depending on the nature of the legislation. For instance, government regulation of prescription drug prices proved to be very popular, 66% of Americans supported that idea in a March 1994 poll.
On the other hand, in a separate survey, Americans were somewhat undecided on government regulation of the costs of health care and drugs. In a February 1994 poll, 60% of Americans approved of such regulations, while only 35% disapproved. Then, in an August 1994 poll, only 49% approved of a plan that would limit the fees that doctors, hospitals and insurance companies could charge for medical care, while 46% disapproved.
Proposed concepts for federal government control of health care costs have involved certain trade-offs, particularly that public funding of care would restrain people’s options of doctors and medical services. A 1993 survey showed that Americans were evenly split on this issue, 48% supported this type of health care reform legislation, while 46% opposed it. Another 1993 poll also illustrates how polarized Americans are when it comes to making this trade-off. Fifty-five percent said that they would oppose legislation that would restrict their health care options, while 35% said they would support the legislation.
In sum, Americans want the government to help control rising costs of health care, but they are not willing to sacrifice availability. Corroborating this point, a November 1994 poll showed only 45% of Americans supported price controls if they would lead to a rationing of health care.
In June 1992, over three-quarters of Americans believed that the government should guarantee medical care to all Americans. Support for guaranteed health care has steadily declined with time, and by February 1995, only 60% supported the measure.
B. Public vs. Private Health Care
While Americans want government to take an active role in reforming health care, over time they have turned away from a strictly government-administered health care system. In 1991, most Americans were supportive of health care plans in which the federal government would cover all uninsured Americans. In fact, 41% favored the single payer plan, while only 31% chose the private insurance plan.
Although government involvement in health care was acceptable to some people during the early stages of the health care debate, it became less appealing as Americans gained more information about government-run health care. For instance, in November 1992, 71% felt that there was not enough government regulation in the health care system. By April 1994, that figure had dropped dramatically to only 41% preferring more government regulation.
In a 1993 survey, Americans overwhelmingly (73%) preferred a health care system which combined government and private insurance companies. Only 21% opposed integrating the public and private sphere in health care. In another 1993 poll, 70% of Americans favored an integrated health care system which combined public and private insurers, while only 23% favored a national health care system that would be administered by the federal government. However, another 1993 survey demonstrated that Americans found some government involvement in health care acceptable. In fact, 71% claimed that it would be acceptable, while only 27% found increased government involvement unacceptable.
If Americans were willing to accept greater government involvement, they were not wholly convinced that an increased government presence would improve the system. For instance, a March 1993 poll showed that nearly three-quarters of Americans thought that the federal government was responsible for waste and inefficiency in the health care system.
In several surveys, a majority of Americans thought that private industry would do a better job managing health care in the US rather than the government. Furthermore, support for private industry health care increased during the 1990’s. For instance, in January 1993, 57% of Americans preferred private industry, while 26% favored government-managed health care. A July 1993 survey also showed that a near majority of Americans had hardly any or no confidence at all in the government’s ability to provide quality health care.
By 1994, 71% of Americans said that they would favor a plan where private insurance companies continue to play a roll, while those who favored public controlled health care comprised only 21%. However, 72% were willing to accept more government involvement in their health care only if they received a system that would provide basic insurance to everyone, according to a separate 1994 poll.
In 1996, 44% of respondents favored a health care reform plan which would guarantee coverage for all Americans with minimal government intervention, while 31% favored a plan which would make private insurance more available and affordable through insurance reforms without any government guarantee. Interestingly, only 2% of respondents said that the government should do nothing. With respect to increased costs, 54% said that the government should protect consumers from not getting the care they need from managed care companies, while 38% said that this additional regulation would be too costly for everyone, according to a 1996 survey.
Meanwhile, there is also a feeling that employer provided plans are not performing as well as they have in the past. In 1995, 38% said that employers in their local area were losing ground in terms of the quality of health care available to their workers. Only 18% said they were making progress.
Americans were clearly still concerned about bureaucratic inefficiency in 1996. Thirty-eight percent of Americans said that reducing waste, fraud, and abuse in government health programs should be one of the most important issues for the next president to address. Another 47% said it should be very important, and still another 14% said it should be somewhat important.
As with other social issues, the public generally has more faith in the Democrats’ ability to deal with the health care issue. In a 1994 survey, a near majority (44%) of respondents said that they would hold the Republicans in Congress responsible if health care failed to be resolved that year.
In 1995, 46% had more confidence in the Democratic Party’s handling of the issue, while only 31% had more confidence in the Republican Party. Then, in 1997, 51% said a Democratic candidate would be more likely to do a better job with the issue of health care, while only 28% of the public thought the Republican candidate would do a better job.
According to surveys conducted in the early 1990’s, the public has equal distrust of both political parties. Little more than half of the public felt that congressional Republicans were not being honest with the public about health care, while 30% believed they were being truthful. Likewise, half of Americans felt that Democrats in Congress were not being honest with the public on health care reform, while 35% trusted that they were being honest.
D. Health Care and Taxes
In surveys taken from mid-1992, when support for health care reform hovered around the 75% mark, approval of a government-funded health care program declined sharply when taxes were mentioned. Only 55% of respondents to a June 1992 survey favored "adopting a national health insurance plan run by the government, financed through new taxes, which would cover all Americans."
Two surveys conducted in 1992 and 1994 revealed that less than a majority (43% and 47%, respectively) were "willing to pay more taxes–up to $1000 per year–if the federal government paid everyone’s health care costs."
A 1993 survey probed various means of collecting taxes to pay for the availability of health care to all Americans. Six out of ten Americans opposed a 3% sales tax on goods and services to help pay the extra costs. Additionally, 58% opposed a gasoline tax of $0.10 per gallon to help pay for health care. Finally, 54% opposed a 2% increase in income tax to help pay for health care.
That same study found that Americans were very supportive (70%) of a tax on tobacco and alcohol products to help pay for health care. Only 29% of respondents opposed this measure.
Interestingly, another 1993 survey found that a plurality (49%) of Americans favored having their taxes cut and paying for health care themselves, rather than having a tax increase and government provided health care (46%).
Similarly, a 1996 poll found that more Americans favored using tax credits as a way of expanding government funded health care to cover children. While 21% of respondents thought this should be accomplished by expanding Medicaid to include children, and 31% favored setting up a new government program specifically for children, 40% preferred the tax credit method to help parents pay for their children’s health care coverage.
III. MEDICARE AND SPECIAL SERVICES
A. Senior Citizens and Health Care
Throughout the 1990’s, Americans have been concerned about the state of Medicare, but have shown consistent support of the program. As a result, although the public strongly wants to see financial stability for Medicare, they have tended to oppose drastic reform of Medicare, and have consistently opposed any cuts or limitations to the program. In many cases, Americans are even willing to pay for additional health care benefits for the elderly. In a 1995 survey, 65% of Americans were convinced that Medicare faced serious problems and required drastic reforming.
In February 1993, nearly three-quarters of Americans opposed raising the Medicare eligibility age from 65 to 67 years old. Another 1993 poll indicated strong support (70%) for a proposal that the federal government provide long-term care assistance for the elderly, even if it meant an increase in income tax. Similarly, in January 1993, six out of ten Americans rejected the proposal to spend less on care for the elderly and more on care for children and pregnant women. Then, in a 1995 survey, eight out of ten Americans opposed cutting government spending on Medicare. Additionally, six out of ten Americans agreed that Medicare was a special program that should not be cut even if it increased the deficit.
Also in 1995, a number of surveys were conducted to measure public opinion of the "health voucher", or "medical savings account" proposals to reform Medicare, where recipients would receive direct payments from the government to be used either to purchase a private plan or to pay their medical bills directly. These surveys indicate that on average about 34% of the public favored these types of plans, while about 53% tended to oppose them. Only 20% of respondents thought this might improve medical care for the elderly, while 32% thought that quality of care would decline.
In 1997, Americans were somewhat less decided on the issue of cutting the cost of health care for the elderly by reducing their choice of doctors, although the majority still opposed these limits. While 40% of respondents favored requiring all Medicare recipients who did not enter into a managed care type of plan to pay higher premiums, 56% opposed the idea.
In 1998, 71% of respondents said that extending Medicare to people aged 55 – 64 should be a top priority use of potential federal budget surpluses. Respondents to another 1998 survey chose Medicare as one of the most important uses for federal budget surplus moneys of from a list of potential uses. The top uses were increased spending on domestic programs (33%) and making Medicare and Social Security financially sound (32%).
Regarding the scope of Medicare usage, in 1995, about one third of Medicare recipients said they also purchased additional health care coverage to cover expenses not covered by Medicare. Interestingly, in a 1997 survey, only 28% expected Medicare to be their major source of health care funding in their retirement. The majority, 30%, said their private insurance plan would be their main source, while 27% said it would be an employer-paid plan.
B. Mental Health Care
Americans showed strong support for government provision of mental health care in earlier years. In 1993, 71% favored using government money to provide mental health care to all Americans, while only 24% opposed. One year later, two separate surveys indicated that support for government funded mental health care had increased: nine out of ten Americans favored it, while less than 10% opposed.
While there has not been more data available regarding government funding of such medical coverage, mental health care is still somewhat of an important issue. In 1996, 49% of respondents agreed that mental health coverage by insurance companies is very important for the next president and congress to address. Another 42% said it was somewhat important.
Also in 1996, about half of the public was aware of receiving information from their insurance provider about mental health benefits which were available to them.
IV. HEALTH CARE AND CREDIBILITY
In the early 1990’s, nearly two-thirds of Americans thought that the health care industry and insurance companies were not being honest with the public about health care reform. Only one-quarter felt that they were being truthful. Meanwhile, 57% of Americans also thought health care ads in general were not completely trustworthy.
Slightly over 50% felt that congressional Republicans were not being honest about health care with the public, while 30% believed that they were being truthful. Likewise, half of Americans claimed that Democrats in Congress were not being honest with the public on health care reform, while 35% of Americans thought they were.
Americans were evenly split on whether President Clinton was being truthful in health care issues. While 45% began to question the President’s integrity, another 45% trusted his ethics.
Americans were similarly split on the credibility of Hillary Clinton. While 46% thought she was being honest with the public on health care reform, 41% suspected that she was being less than candid.
B. The American Medical Association
Americans tend to see the American Medical Association positively. In a September 1993 poll, over 60% claimed that they had a great deal or a fair amount of confidence in the organization’s judgment to recommend the right thing for health care policy.
In 1994, 58% thought the AMA should play a major role in deciding what kinds of changes should be made in the health care system. In another 1994 poll, a majority of Americans responded that the AMA was doing a good or excellent job helping to assure quality medical care to Americans.
There is, however, some skepticism of doctors’ organizations in general. Without any specific reference to the AMA, 44% of Americans found associations which represent doctors to be believable in 1993. On the other hand, a very slim majority (51%) thought they were not believable.
Still, in 1996 more Americans (46%) looked to physicians’ groups such as the AMA as best able to stand up for them on health care issues than any other group, compared to consumer groups (45%), employer groups (40%), hospital groups (37%), and the federal government (31%). Only 10% trusted the state government.
Also in 1996, 54% of Americans said that an AMA endorsement significantly adds to their confidence in a health care drug, treatment, or product. While 32% said it does not impact their confidence level, only 3% said the endorsement detracts from their confidence level.
In another 1996 survey, 53% of respondents said that the AMA is doing a good or excellent job of assuring quality medical care for Americans. Thirty-four percent rated the organization as doing a fair job, and only 8% said the AMA was doing a poor job.
However, despite the general level of confidence the American public has in the AMA, some concerns remain. According to a 1996 poll, while slightly more respondents were satisfied with the job the AMA has done with health care reform than were dissatisfied (47% to 44&, respectively), twice as many respondents were very dissatisfied as were very satisfied.
V. HEALTH AND THE ENVIRONMENT
A. The Effects of the Environment on Health
According to study which measures the most important top-of-mind issues, the environment ranks very low in priority with only 3% of people mentioning it as their number one issue and 3% as their number two issue. Instead, issues such as crime, the economy and social problems, including health care reform, concern people more.
When prompted, however, people are very concerned about the connection between the environment and their health. In a 1992 study, 88% of respondents (51% strongly and 37% moderately) agreed that they are very worried about the state of the environment in the US and what it is doing to their health.
In a separate 1992 survey, a total of 67% believed that environmental problems now affect their health, with 30% believing that the problems affect them a great deal and 37% a fair amount. People perceive environmental health problems to be growing. When asked how much environmental problems affected their health ten years ago, only 14% agreed that it affected them a great deal and 31% a fair amount. Further, 83% of the respondents (54% a great deal and 29% a fair amount) felt that environmental problems will affect the health of their children and grandchildren.
The public strongly feels (82%) that making sure people are not exposed to such environmental concerns as an unsafe water supply, dangerous air pollution, and toxic waste is very important to improving public health, according to a 1996 poll. Another 15% said these things were somewhat important.
However, people feel that personal habits such as smoking, drinking, stress, and the kinds of food people eat (42%) are a more serious health threat in the US than things in the environment such as air and water pollution and chemical waste disposal (31%), according to a study conducted in the early 1990’s.
B. Health and Chemicals
Americans are very concerned with chemicals in the environment, especially ones used in food products such as pesticides. In a national tracking study which took place in 1992 and 1994, 76% and 72% of respondents respectively said they believed that residues such as pesticides and herbicides constitute a serious health hazard while only 2% and 3% respectively felt that such residues are not a hazard at all.
The public is also aware of risk in everyday items. Forty percent of 1995 survey respondents said there is a great deal of health risk in garden chemicals, and 43% said there is some risk associated with those products.
However, Americans do not necessarily believe that all chemicals cause cancer. In two separate national studies, the public was split on whether all man-made chemicals cause cancer if you eat enough of them. In the 1993 study, 49% believed all man-made chemicals had the potential to cause cancer, while 43% disagreed that those chemicals caused cancer. In 1994, 46% believed that all man-made chemicals had the potential to cause cancer, while 45% disagreed that those chemicals caused cancer.
A tracking study conducted in 1993 and 1994 indicates that the public has more fear of pesticides causing cancer than they do of general chemicals. In 1993, 36% felt that all pesticides and chemicals used in food crops cause cancer while 57% said they did not cause cancer. In 1994, 37% thought that they did cause cancer and 56% did not.
C. Health and Pollution
People feel that air pollution is a serious problem with 55% of respondents to a 1993 poll indicating that it is very serious and 35% saying that it is somewhat serious. Only 9% of respondents answered that it was not serious.
While the public is adamant about their intolerance of pollution-related health risks, they are also somewhat realistic about them. For example, 74% of respondents agree that no amount of health risk due to environmental pollution should be tolerated. However, in the same survey, 79% agree that we have to accept the fact that we will always have to live with some level of potential health risk.
By 1995, 83% of respondents felt that there will always be some level of potential health risk when it comes to environmental pollution.
D. Federal Regulation of the Environment for Public Health Safety
People are in favor of protecting public health and safety by protecting the environment. In regard to government regulation, 53% felt that we need more regulation to protect the public from health hazards. In a 1995 study, 61% of respondents opposed less strict health, safety, and environmental regulations, while only 38% favored them.
Americans are only marginally trusting of federal regulation of clean water and clean air standards. In a 1994 study, 47% of respondents agreed that there would be no long-term health risk to them if pollution levels are well below the amount allowed by federal standards. On the other hand, 50% disagreed, indicating that they believe that the standards are not high enough with regards to public health.
In 1995, the public is still split one to one on the issue, 50% agreed while 49% disagreed, however respondents who feel most strongly about their position tend to be those who fear that the federally mandated pollution levels are not high enough to protect public health. Only 18% agreed strongly that when pollution levels are below federally mandated levels there is no long-term health risk while 28% disagreed strongly.
This analysis is based on interview questions from a variety of surveys. Questions in this format are taken out of sequence. Please note, the sequence of questions within a survey instrument can effect responses.
This analysis of Americans’ attitudes towards health care issues in the 1990s has been prepared by Charlton Research Company in January of 1998. The surveys included are taken from various sources such as the Charlton Report on National Issues and the Roper Organization at the University of Connecticut. The scope and breadth of this analysis shall include attitudes on health care issues within 1990’s. These parameters yielded over 600 records (individual questions and aggregate responses), which were edited, summarized and indexed, and analyzed.
These records are the product of surveys from:
Associated Press/ Media General
CBS News/New York Times
Center for Survey Research, Univ. of Va.
Charlton Research Company
Daniel Yankelovich Group
Gordon S. Black Corporation
Hart & Teeter Research Corporation
Institute for Policy Research, Univ. of Cincinnati
Kane, Parsons & Associates
Los Angeles Times
Louis Harris & Associates
National Center for Health Statistics
New York Times
Opinion Research Corporation
Penn, Schoen & Assoc.
Princeton Survey Research Associates
Over 80% of the questions came from surveys of more than 1,200 respondents.
THE CLINTON REFORM
DEBATE IN THE EARLY 1990’S
I. THE CLINTON AND ALTERNATIVE PROPOSALS
A. The Clinton Health Care Plan
Americans had greater faith in the President’s ability to improve health care than in the Republicans. Seven out of ten respondents to a January 1993 questionnaire thought President Clinton could do a better job improving health care, while only 16% thought the Republicans could do a better job. Then, in May of 1994, 36% had more faith in Clinton’s plan, while 30% had greater trust in the US Chamber of Commerce plan.
Three polls conducted in September of 1993 illustrate the public’s confusion and indecision on the issue. In one poll, 25% thought the level of government involvement in the Clinton plan was excessive, 15% thought it did not go far enough, and 60% thought the plan was an equitable compromise. Yet in another poll, 38% of Americans felt the President’s plan had too much government involvement, 37% felt it was the right amount, and only 18% thought there wasn’t enough. Meanwhile, in another poll, 65% of Americans agreed that the Clinton health care proposal would increase government bureaucracy, while only 30% disagreed.
Then, in a November 1993 poll, Americans were more strongly opposed to the Clinton health care proposal. Slightly less than a majority felt the extent to which the President’s plan expanded government involvement was unacceptable. Then in February 1994, nearly two-thirds of Americans were strongly concerned that the Clinton health care plan would create more government bureaucracy. Only 14% claimed that bureaucratic considerations were unimportant to them. And in a March 1994 survey, slightly less than a majority again felt the President’s plan extended government involvement too far.
However, Americans still showed support for certain aspects of the plan. In September 1993, nearly seven out of ten respondents favored a provision of the Clinton plan to create a National Health Board in Washington to monitor and regulate health care benefits and costs. A March 1993 poll showed that over two-thirds supported another element of the Clinton plan – a ‘phase-in’ over several years of government subsidized coverage for uninsured people who are not working. Only 30% opposed this idea.
One component Americans were concerned about was that the Clinton health care plan would limit peoples’ choices of doctors or hospitals. In a March 1994 survey, three-quarters said that they were worried that the Clinton plan would restrict their choices.
B. Alternative Health Care Plans
In September 1992, about two-thirds of Americans preferred reforming the current system of private health insurance to give employers tax incentives to provide health coverage for their employees rather than adopting a public health care system administered by the federal government and funded through new payroll taxes.
When given three alternative plans: employer mandate, single payer or individual mandate; a September 1993 survey showed a plurality of Americans (41%) opting for the employer mandate system. The individual mandate plan was Americans’ second favorite, with 31% supporting. The single payer plan proved to be the least popular, receiving only 23% of the vote. By December 1993, a plurality (43%) of Americans continued to favor a health care system in which employers provided health insurance. Less than three out of ten Americans preferred a single payer plan.
By 1996, 44% of respondents favored a health care reform plan which would guarantee coverage for all Americans with minimal government intervention, while 31% favored a plan which would make private insurance more available and affordable through insurance reforms without any government guarantee.
Americans oppose reform which would curtail treatment options in order to reduce health care costs. In a 1997 survey, 70% said that any treatment that might help a seriously ill or injured person should be provided, even though it may mean increased costs for all people.
C. Effects of Reform
In January 1992, 43% of Americans felt that increased government involvement would make the health care system more fair. Twenty-three percent thought it would be less fair, while 28% thought it would remain the same.
From the same January 1992 survey, Americans were less optimistic about the degree of flexibility they would receive under a government controlled health care system. Only 19% thought flexibility would improve, while 36% thought it would become worse and 37% thought it would stay the same.
Likewise, Americans in January 1992 expected that any increase in government control of health care would bring about an increase in medical delays. Fully 47% were convinced that delays would be on the rise, while only 13% anticipated delays to decrease. Thirty-five percent did not think government involvement would have any effect on the timeliness of medical service.
Americans from the January 1992 survey were also skeptical about the amount of access they would receive. A mere 16% thought access would improve, while 30% were convinced that it would become worse. Half of respondents believed access to health care would not change at all.
Twice as many Americans felt that increased government involvement in health care would result in increased health care costs as did not. In January 1992, half the American public expected costs to increase, while only 25% expected them to decrease.
In terms of overall quality, Americans’ skepticism of health care reform remained fairly consistent. In 1992, 37% thought quality would decline due to government involvement, and by 1993, 40% still agreed.
II. INFORMATION, COMPREHENSION AND PERCEPTION
A. Information on Health Care
In September 1993, three-fourths of Americans reported following news reports on health care either very or fairly closely. Only 16% said they did not following the events very closely, and 10% said they did not follow the story at all.
In 1994, again three quarters of Americans had seen or heard educational messages or advertisements about health care reform. Messages sponsored by the Health Insurance Industry have reached a sizable proportion of the population. In fact, 60% of respondents who have seen or heard something about health care reform have received messages from the Health Insurance Industry. On the other hand, less than a quarter reported having received no information from the Industry.
Even in July 1994, after the health care reform debate had been a prominent issue in the public arena for over two years, Americans’ desire for knowledge about health care reform continued. Seven out of ten Americans conceded that they did not know enough about the proposals to make a choice among the alternatives. In a 1995 survey, 54% of the public said they had seen news coverage on managed care programs and how they work.
B. Comprehension of Reform Plans
Overall, Americans have been uninformed about the various health care reform plans that have been debated in the 1990s. Most Americans have never heard of proposals like the medical savings account, the individual mandate, the single payer plan and the employer mandate. In none of the surveys did those who had heard of such measures constitute a majority of respondents. Since Americans were so naive about the issue, they were receptive to educational campaigns from both proponents and opponents of reform.
Nearly two-thirds of Americans had never heard anything about the ‘individual mandate’ proposal. Close to half of all Americans did not recall having been exposed to any information about the ’employer mandate’ plan, and 55% of Americans had never heard anything about the ‘single payer’ plan.
C. Comprehension of the Plans’ Consequences
Americans were the least familiar with the ‘medical savings account’ plan. In fact, nearly nine out of ten respondents admitted that they would not know how a ‘medical savings account’ would affect them and their families. Similarly, a strong majority of Americans were unaware of the potential consequences of the ‘individual mandate’ plan. Eight out of ten respondents were unaware of how an ‘individual mandate’ would affect them and their families.
Americans were more informed about the ’employer mandate’ plan. Slightly less than 50% of respondents claimed to understand how an ’employer mandate’ would affect them and their families.
Respondents were the most informed about the ‘single payer’ plan, but remained less than experts on the policy. Nearly three out of ten respondents claimed to be uninformed about the ‘single payer’ plan, while the remaining seven were confident that they understood it.
D. Comparisons of Health Care Proposals
Half of the American public felt the current system of health care provided the greatest amount of choice. Less than 20% thought the Clinton plan would afford more freedom. Slightly under 10% expected the most freedom of choice from the Republican plan.
Over one-third of Americans believed that the Clinton plan would result in the least out of pocket expenses when compared to the current system and the Republican proposals. One-quarter thought the current system costs the least out of pocket, while 8% thought the Republican proposals were the most thrifty. A stunning 30% had no opinion on the matter.
In September 1993, nearly two-thirds of Americans believed that the Clinton plan would provide coverage to all Americans. Fifteen months later, the figure had dwindled to slightly more than half believing this claim.
Similarly, in September 1993, 54% thought the Clinton plan would cover workers who lost their jobs. Losing ground, only 44% believed the unemployed would be insured by December 1994.
Becoming increasingly cynical about the benefits the Clinton plan had to offer, in September 1993, 45% of Americans suspected that their freedom to choose a doctor would be restrained. By December 1994, 70% of Americans had the same suspicion.
E. Perceptions of the Clinton Plan
Nearly two-thirds of Americans thought that they would be able to purchase more insurance if they desired under the Clinton plan. Only one out of ten thought that all Americans would receive the same amount of coverage. Slightly less than 30% said they didn’t know.
About eight out of ten Americans were confident that they would continue to visit their regular doctor under the Clinton plan. Only 10% suspected that they would have to switch doctors.
Forty-three percent of Americans feared that the Clinton plan would lead to a rationing of health care; 20% were optimistic that it would not; and 37% had no opinion.
Six out of ten Americans thought that the Clinton plan would result in people enrolling in HMOs; about 30% didn’t know; and only 8% did not think HMOs were part of his proposal.
Eighty percent of Americans were confident that employers would be forced to pay for their employees’ health insurance under the Clinton plan. Only 4% thought employers would not have to contribute, and 17% didn’t know.
Seven out of ten Americans were afraid that the Clinton plan would result in more paperwork for patients to complete. Less than a quarter thought that paperwork would decrease.
Americans’ expectations of who would pick up the bulk of the tab under the Clinton plan were split: 34% thought it would go to workers, 42% thought it would go to employers, and 8% thought the federal government would be stuck with the bill.
Over 60% of Americans expected the Clinton plan to extend health care benefits either for a little while or indefinitely to those who had lost a job. Only 20% anticipated having to find a new job before regaining coverage. Another 20% didn’t know.
Seven out of ten Americans thought that businesses would be required to provide health insurance under the Clinton plan. Thirty percent didn’t know.
F. Perception of Republican Proposals
Six out of ten Americans had no impression as to whether the Republican proposals would extend health care coverage to all Americans. One-quarter did not think all Americans would be covered, while 13% thought they would.
Nearly two-thirds had no idea whether the Republican proposals would cover those who had recently lost their jobs. While 22% thought the Republican plans would not cover those people, 14% thought they would.
Thirty percent of Americans expected the Republican proposals to result in a rationing of health care, while 17% thought that health care would not be rationed. Over half the public did not know.
One-third anticipated that Americans would have to enroll in HMOs under the Republican proposals. About 10% thought HMO enrollment would be unnecessary. Slightly over half were unsure whether the Republican proposals would result in HMO enrollment.
More Americans suspected that their freedom to choose a doctor would be curtailed according to the Republican proposals, by a two to one ratio. Only 7% expected it would improve. Nearly one-third of the population did not know.
Just over 40% thought that the Republican proposals would include employer mandates, while 17% did not. Another 40% were unsure.
ALTERNATIVE HEALTH CARE PLAN DEFINITIONS
A system in which insurance companies would continue to provide health insurance coverage, with some government regulation to keep costs under control, and in which all employers would be required to provide health insurance for their workers.
A system in which the government would provide coverage to all Americans and would collect all insurance premiums and pay all health care costs, without the involvement of employers or insurance companies.
A system in which the government requires all individuals to have health insurance–similar to the requirement for all car owners to have auto insurance–and low income people would receive tax credits to help them pay for their coverage.