What do Americans really care about in their health care coverage?

Americans Don’t Feel the Slowdown in Health Costs

By Drew Altman
The Wall Street Journal, March 31, 2015

National spending on health care and insurance premiums has risen at historically low rates in recent years. But… even when spending and premiums experienced record-low growth in 2013, only 3% of Americans said health costs had been rising slower than usual, and 52% said they had been growing faster than usual. The American people are not out to lunch; their view of the problem of health costs is very different from that of experts.

In more than 20 years of regular polling on health-care issues by the Kaiser Family Foundation, I have found that Americans with coverage care about:

  • Their premium costs, or the share of premiums they pay if they have employer coverage;
  • Their deductibles and other forms of cost sharing, especially when deductibles have been rising steadily;
  • Their drug costs (this is particularly an issue for the chronically ill, who use a lot of drugs);
  • Whether their insurance covers the services they think they will need;
  • Whether they can go to the doctor or hospital they want without having to pay more. People are more willing to accept a lower premium for less choice if they do not have a regular doctor or hospital;
  • The hassle and red tape in health care and health insurance. Increasingly, people care about getting information to be informed about their health and make smarter insurance and health care decisions.

Two other things stand out:

  • Seniors care a lot about Medicare and sometimes vote on the issue.
  • And Americans overall don’t care as much as experts do about improving quality and eliminating unnecessary care. In general, people think that quality is good and they want more care not less.

Drew Altman is president and chief executive officer of the Kaiser Family Foundation.



By Don McCanne, MD

People want health care coverage that works for them, but they are very concerned about their direct costs, including insurance premiums, deductibles and out-of-pocket expenses for their pharmaceuticals. They rightfully complain about these costs, yet how often do you hear them complain about their payroll deductions for Medicare? They want Medicare to be there when they retire.

They also want reasonably comprehensive benefits and they want to be able to select their own health care professionals and hospitals for their care without being financially penalized for doing so.

Yet the Affordable Care Act was designed not to cater as much to patients as it was to take good care of the private insurers. Other systems that spend much less than we do often eliminate deductibles and much of the other cost sharing. Instead of premiums, many systems use equitable taxes to fund the system. And most do not limit choices of physicians and hospitals to those selected by the insurer.

So the Affordable Care Act, along with the innovations of the private insurance industry and modifications that employers are introducing into their plans, brought people exactly what they do not want: higher premium payments, higher deductibles, and more limited choice of physicians. It is true that a minority of our population receives subsidies for premiums and deductibles for insurance obtained through the exchanges though with more limited choice, but for the majority, premiums, deductibles and choice are all worse.

About 60 percent of health care is already paid for through our tax system, and most of those taxes are not transparent. When we pay taxes for other important government functions we do not receive an itemized tax bill breaking out each tax expenditure. The amount over what we are already spending that would be required to fund a comprehensive system for everyone could easily be absorbed into the tax system.

People would be more satisfied if they received the health care that they need when they needed it, and they knew that it was being paid for through a tax system that was fair to everyone. Of course, that is the way a single payer national health program would work. Let's start taking care of the health needs of the people instead of the business needs of the insurers.