The Public’s Health Care Agenda for the New President and Congress

Kaiser Family Foundation
January 15, 2009

The public ranks action on health care highly as part of efforts to stem the impact of the economic recession and also views reforming health care as one of the top priorities for President-elect Obama and Congress, according to a new national survey conducted by researchers from the Kaiser Family Foundation and the Harvard School of Public Health.

One of the key questions of health care reform is how to pay for it. The survey suggests that, as has long been the case, the public is split down the middle in its willingness to sacrifice financially in order to cover more individuals: roughly half (49%) say they are not willing to pay higher insurance premiums or taxes, while a similar percentage (47%) say they are. There are big partisan differences here, with most Democrats (59%) saying they are willing to pay, most Republicans unwilling to pay (67%), and independents divided (49% willing, 47% unwilling).

Any debate over health reform options will also involve negotiating the very different views of rank and file Democrats and Republicans. Democrats are significantly more likely to place a priority on action on health care, which ranks second on their priority agenda (61% say it is a top priority), compared to Republicans, who rank it eighth (23%). More than three-quarters (77%) of Democrats think health reform “is more important than ever” due to the economy, while six in ten (62%) Republicans believe the nation “cannot afford to take on health reform now.” Democrats are more likely to favor a big push on coverage, and as noted above, more willing to pay for it.

The survey also suggests that as in the past early support for a number of reform proposals could fade in the face of arguments that opponents might raise in a public debate. For example, seven in ten Americans (71%) say they favor the idea of employer mandates. But when given the argument often made by critics that this may cause some employers to lay off some workers support falls dramatically, to just under three in ten (29%). The same pattern holds on the topic of individual mandates. Roughly two in three (67%) favor requiring all Americans to have health insurance with help for those who could not afford it. When given the criticism that some people may be required to buy health insurance they find too expensive or do not want, support falls to two in ten (19%).

Toplines (24 pages):

There are no real surprises in this new poll on the public’s attitude toward health care reform. Most do believe that we are in a window of opportunity for reform based on the fact that the public ranks health care reform as one of the top priorities for President-elect Obama and Congress. But the feasibility of comprehensive reform comes into question when noting that 62 percent of Republicans believe that the nation cannot afford to take on health reform now, and only 23 percent of them believe that reform is even a priority.

As with all polls, there are concerns in this one as well.

Questions 10, 11 and 12 initially demonstrate public support for both an employer mandate and an individual mandate. But then asking about one trade-off for each (employers laying off workers, or individuals finding insurance to be too expensive) results in a dramatic decline in support for either option. Two lessons here: 1) support for the leading options is very fragile and can easily lead to failure in our efforts to achieve reform, and 2) since support plummets with only a single additional bit of information, it is quite clear that the public is very poorly informed on the fundamental policy issues of reform.

Question 13: “Would you be willing to pay more — either in higher health insurance premiums or higher taxes — in order to increase the number of Americans who have health insurance, or not?” The public is split, 47 percent saying they would, and 49 percent saying they would not. The problem with this question is that it presumes that covering more individuals will cost more money. That is true of the leading proposals under serious consideration, but it is not true of the single payer model.

They need to ask, “Would you support a government-administered insurance program that covered everyone and was financed through the tax system if that meant that most Americans would pay somewhat less than they are now paying for health care and only the wealthy would pay more?” Until now, polls asking only about government and taxes in health reform usually have provided about a 60 percent positive response.

Because this more complete question has not been asked, we can only speculate what the response would be, but the question does need to be asked. We should find out whether working Americans are willing to continue to beat up on themselves in order to provide the rich with financial protection that they don’t even need.