Survey: 42% of Texans support single payer

Health care survey yields surprises for the medical community

By Jenny Deam
The Houston Chronicle, April 27, 2015

Not only do the vast majority of Texans think having insurance is important for them and their families, seven in 10 also want health coverage for everyone else.

And they are willing to dig into their pockets to pay for it.

The results of a first-of-its-kind survey measuring attitudes of state residents on health care and insurance coverage elicited surprise and some dismay among the scores of medical professionals gathered Monday at the start of a conference in downtown Houston.

Earlier this year the Texas Medical Center commissioned Nielsen to poll 1,000 Texans over 18 on a variety of topics surrounding the shifting landscape of health care, including how important insurance was to them, whether everyone should have insurance, who should pay for it and what role patients and doctors have in decision making.

Half of those surveyed said having health insurance for themselves and their family was "absolutely essential," and another 33 percent said it was "very important." Only 5 percent said coverage was not important at all. 

In addition, 70 percent said they thought it important that the nation have universal health care coverage, with 36 percent calling it "extremely important." Thirteen percent said coverage for all was "not important at all."

But the answer to who should pay for coverage seemed to take the doctors and health care executives in the audience by surprise.

Before Dr. Arthur "Tim" Garson Jr., director of the Health Policy Institute for the Texas Medical Center, presented the finding, he asked the audience to guess the result. Many signaled they assumed people wanted insurance to come from employers or the marketplace.

But in fact, the survey showed that 42 percent of Texans favored a tax-supported single-payer plan, something akin to Medicare for everyone. Twenty-seven percent of those polled thought it should come from employer plans and 12 percent answered it should come from the marketplace.

Still, residents did not expect the government to foot the whole bill, the survey showed. Eighty-one percent, including those who earn the least amount of money, were willing to pay at least something out of pocket to guarantee universal coverage.

That lowest-income group, making less than $25,000 per year, said they would pay an average of $47 a month for universal coverage.

"I think that's a lot," said Garson, adding that he found it significant that those whose budgets are stretched thinnest were still willing to pay to guarantee coverage for others.

Also stumping the audience was a question about whether patients want everything medically possible done for them at the end of their lives. Nearly two in three survey respondents answered yes, much to the surprise of the gathered medical professionals, who assumed otherwise.

The survey also found a majority of Texans think foods that lead to obesity should be more expensive. Fifty-two percent said they would support a "fat tax." They also said people with poor health habits should have to pay more for health insurance.

And, despite the crush of medical information now available to online, doctors remain the top source of information across all age groups, including young adults, the survey found.

The health professionals seemed most concerned by the response that not one person of the 1,000 polled thought quality of care was the most important thing about having health insurance. Instead, coverage came first, followed by a tie between access and cost.

"We are totally missing the boat," lamented Dr. Paul Klotman, CEO and president of Baylor College of Medicine, during a panel discussion after the results were announced.

He said the profession needs to do a better job of not only informing the public what good quality health care is, but also guaranteeing it across facilities.

The second annual Medical World Americas convention runs through Wednesday at the George R. Brown Convention Center in Houston. Last year's convention attracted more than 2,000 medical professionals from 33 countries.

Texas Medical Center-Nielsen Survey Reveals Texan's Attitudes Towards Healthcare

HOUSTON, April 28, 2015 /PRNewswire/ -- The Texas Medical Center (TMC) released findings from a healthcare survey of Texans called "TMC 2015 Texas Consumer Health Report: A Texas Medical Center-Nielsen Poll", a survey funded by TMC and initiated by the Health Policy Institute. Dr. Tim Garson, Director of the Texas Medical Center Health Policy Institute, revealed the survey results during his keynote address at the Medical World Americas conference in Houston. 

"As healthcare becomes more consumer-directed, providers are working to better understand what the public wants. We want to know what consumers think about their health insurance, both personally and for the country, and how they want their healthcare delivered," said Dr. Tim Garson. "Of course this is fascinating data for Texas. However, Houston is the fourth largest city in the country and has a diverse population, therefore the findings are likely applicable far beyond the state." 

The statewide survey involved 1,000 respondents, ages 18 and older, to assess their attitudes and behaviors towards health insurance. The Nielsen survey was conducted online through Harris Poll between January 27 and March 3, 2015 and data was weighted by sex, race, ethnicity, income and education.  

"The Texas Medical Center is comprised of 56 member institutions, many of which serve patients. As the world's largest medical center, it is imperative that TMC provides this type of information to our members so we, as a whole, continue to be the leader in world-renowned patient care, research and education," said Dr. Robert Robbins, President & CEO, Texas Medical Center.

Key survey findings include:

How important is having health insurance to you and your family?
Respondents value having health insurance. 83% say having health insurance is absolutely essential or very important.

What is most important: having health insurance, the total cost of health care I have to pay, ability to see a physician or nurse when needed, or quality of health care received? 
Just having healthcare trumps cost and quality. 46% feel having health insurance is most important; 27% say the total cost of healthcare is most important; 27% feel the ability to see a physician or nurse when needed is important; quality of healthcare received is dead last in importance with 0%.

In order for you/your family to have health insurance, what would you be willing to give up? (e.g. eating fast food, cable TV, cell phone…)
Respondents will give up some "extras" for insurance. But, most would rather hold on to internet and cell phones. Insured respondents appear more likely to keep their coverage, while uninsured are less likely to sacrifice.  

How important is it to you that all US citizens have health insurance? 
Respondents value universal health insurance. 55% of respondents say it is very or extremely important to all US citizens to have health insurance. Only 13% say it is not at all important.

How much would you be willing to pay, per month, if it meant that all US citizens would have health insurance? 
Respondents will pay to guarantee coverage for all. More lower-income respondents are willing to pay, but they can afford significantly less, versus respondents with the highest income. 

Which one of the following most closely describes how you believe health insurance should be provided: through one's employer (shared costs), an employee receives money from employer to buy plan on open marketplace, citizens who pay taxes get health insurance (like Medicare or Medicaid), other or not sure? 
Some support for single payer concept in Texas. 42% think citizens who pay taxes should get insurance (i.e., single payer), 27% defer to employers (either insurance or a defined contribution), 12% believe the employee should receive money from their employer to buy a plan on the marketplace.

Which of the following is most important to you when choosing a primary care physician? Reading ratings on the internet/online, recommendation from another doctor, recommendation from family/friends, low cost, other, not sure. 
Word of mouth is key for choosing physicians. 31% say they would choose a physician by asking a friend/family member. 18% would choose from ratings on the internet. 16% would choose based on a recommendation from another doctor.

There are many ways you can get information about your current health. Indicated how important each of the following is as a source of information: doctor or online/internet.
Doctors are the top health information source.  Respondents defer to doctors for information; even in the internet age, only one in four say internet sources are absolutely essential/very important.

Choose: A. I want my physician to make my medical decisions with minimal involvement from me; B. I want to make my own medical decisions with minimal involvement of my physician; C. Not sure.  
43% want to make their own medical decisions with minimal physician involvement; 40% want their physician to make medical decisions with minimal involvement from me; 17% are unsure.  Males are more likely to defer to a physician, while females want to make their own decisions with minimal physician involvement.   

Agree or disagree: for myself or a relative, I would want everything possible done at the end of life, to prolong life. 
63% agree; 37% disagree. 2 in 3 want everything done at the end of life. 

Agree or disagree: People with poor health habits (e.g. smoking, lack of exercise) should have to pay more for health insurance.
59% agree that people with poor health habits should have to pay more for health insurance.  41% disagree. 

Agree or disagree: Foods that lead to obesity (e.g. sugary drinks) should be more expensive.
52% agree that foods that lead to obesity should be more expensive. 48% disagree. Nearly 3 in 4 young adults (18-34) support a "fat tax". 

About the TMC Health Policy Institute
The TMC Health Policy Institute was established to inform, define and lead health policy, ultimately developing the most effective solutions to improve the health of diverse populations around the globe. Utilizing expertise across the Texas Medical Center's member institutions, the TMC Health Policy Institute addresses fundamental health policy issues important to Houston, the state and the nation including public health advocacy, health care delivery models, health care funding, patient quality outcomes, patient safety and health ethics.

About Texas Medical Center
The largest medical complex in the world, the Texas Medical Center is internationally recognized and home to many of the nation's best hospitals, physicians, educational institutions, researchers, and the largest concentration of life-sciences experts. For the first time in its history, the Texas Medical Center has aligned the multi-institutional expertise to formulate five institutions dedicated to: Health Policy, Clinical Trials, Regenerative Medicine, Genomics and Innovation. Together, these institutions will advance the Texas Medical Center as the global leader in human health and life sciences. The Innovation Institute accelerator program, TMCx, launched in March 2015 and the Health Policy Institute executive team and advisory committee first convened in January 2015.