Posted on March 2, 2007

Public opinion on health care reform


The New York Times/CBS News Poll
Feb. 23-27, 2007

22. Thinking about the country as a whole, are you generally satisfied or dissatisfied with the cost of health care in this country? Would you say you are very (satisfied/dissatisfied) or somewhat (satisfied/dissatisfied)?

3% - Very satisfied
11% - Somewhat satisfied
22% - Somewhat dissatisfied
59% - Very dissatisfied
4% - DK/NA

24. If you had to say, which do you think is a more serious problem right now — keeping health care costs down for average Americans, OR providing health insurance for Americans who do not have any insurance?

31% - Keeping costs down
65% - Providing for uninsured
5% - DK/NA

25. How serious a problem is it for the United States that many Americans do not have health insurance — very serious, somewhat serious, not too serious, or not at all serious?

70% - Very serious
25% - Somewhat serious
3% - Not too serious
1% - Not at all serious
1% - DK/NA

27. Do you think the federal government should guarantee health insurance for all Americans, or isn’t this the responsibility of the federal government?

64% - Guarantee
27% - Not responsibility
9% - DK/NA

30. If you had to choose, which do you think is more important for the country to do right now, maintain the tax cuts enacted in recent years or make sure all Americans have access to health care?

18% - Cutting taxes
76% - Access to health insurance
1% - Neither
2% - Both
4% - DK/NA

31. Would you be willing or not willing to pay higher taxes so that all Americans have health insurance that they can’t lose no matter what?

60% - Willing
34% - Not willing
6% - DK/NA

37. Do you think it would be fair or unfair for the government in Washington to require all Americans to participate in a national health care plan, funded by taxpayers?

43% - Fair
48% - Unfair
9% - DK/NA

38. Which do you think would be better for the country: 1. Having one health insurance program covering all Americans that would be administered by the government and paid for by taxpayers, OR 2. Keeping the current system where many people get their insurance from private employers and some have no insurance.

47% - One program
38% - Current system
4% - Combination (vol.)
2% - Neither (vol.)
8% - DK/NA

39. Some people have suggested requiring all Americans to have health insurance. Under this plan, employers would be required to provide insurance for all their workers or pay into a fund that would be used to buy insurance for people who do not have insurance. Does this sound like a good idea to you, a bad idea or are you unsure?

36% - Good idea
17% - Bad idea
46% - Unsure
2% - DK/NA

49. Do you think the government would do a better or worse job than private insurance companies in providing medical coverage?

30% - Better
44% - Worse
3% - Same (vol.)
22% - DK/NA


By Don McCanne, MD

Polls continue to show that Americans are very concerned about the problem of the uninsured and about our high health care costs. They believe that the government should guarantee insurance for everyone, and a clear majority are even willing to pay more taxes to accomplish that.

Although we have decided that the problems are very serious and that they must be fixed, we remain divided as to the appropriate respective roles of the government and the private insurance plans. Especially noteworthy in this poll is the fact that only 30 percent of Americans believe that the government would do a better job than the private insurance plans in providing medical coverage.

This lack of confidence in the government isn’t strictly due to anti-government ideology. To the contrary, 64 percent believe that the government should be involved in guaranteeing insurance for everyone. It is much more likely that that those who are healthy and insured believe that their private health plans will work for them should major problems arise. Although they are concerned about increases in premiums, cost sharing, and reduction in benefits, they have not really given much thought as to how the government could address those issues more effectively. The fact that 48 percent believe that it would be unfair for the government to require all Americans to participate in a national health care plan does demonstrate that there is still concern about making the government the exclusive provider of health insurance.

Privately insured individuals incorrectly assume that most of their health cost spending is for the premiums they and their employers pay and the out-of-pocket expenses for themselves and their families. What they don’t realize is that two-thirds of health costs are being paid through the tax system, though with little transparency. They believe that the private plans are funding much of our health care when the heavy weight is actually being carried by us as taxpayers.

Just to list a few other issues that most people don’t think of when they express a preference for private health plans: profound administrative waste, cost shifting, fragmentation of risk pools, medical underwriting, insurance rescission, lifetime caps on coverage, restricted choice of physicians and hospitals, cream skimming, lack of impact on infrastructure to reduce waste and improve value, inability to provide adequate financial security at affordable premiums, inequitable regressive financing of health care, necessity to perpetuate demeaning and underfunded welfare programs, inadequacies of mandates to purchase private insurance, tax dollars wasted on private Medicare Advantage plans, and… (this list is endless!).

So the decision has been made that we must reform health care. We still need to agree on whether that should be through a universal program of government insurance or through an expansion of our inequitable, wasteful, fragmented system of a multitude of private plans and public programs. Polls such as this are being used to suggest that solutions perpetuating the role of private insurers have greater political feasibility. Thus most proposals accept the deficiencies of private plans, such as those listed above, as a tradeoff for increasing the probability of enacting some type of reform, no matter how flawed. Rather than crafting reform to fit misperceptions, shouldn’t we be attempting to change perceptions to align them with reality?

The ultimate decision may default to the government solution once the policy community wakes up and reframes the problem from the straw man of affordable insurance premiums to the blatantly obvious problem of affordable health care. The private insurers have no solutions for the latter, except to dump the real costs onto the taxpayers. Since we’re already paying those, why should we continue to pay the private insurers so much to merely stand on the sidelines and watch? They disappear when it’s their time to play.