NPR
June 5, 2002
“When asked more specifically to name the two most important health care issues for the government to address, access to health care and insurance issues (54 percent) received the most mentions. Large majorities favor a wide variety of options to guarantee health care for more Americans, including expanding state government programs for low-income people (84 percent), expanding neighborhood health clinics (80 percent), requiring businesses to offer insurance to employees (76 percent), and offering tax credits or other financial assistance to help the uninsured purchase insurance on their own (73 percent). The only option asked in this survey that was not favored by a majority is a national, single payer health plan (favored by 40 percent).”
The actual question asked in the survey:
13. I’m going to read you some different ways to guarantee health care for more Americans. As I read each one, please tell me whether you would favor it or oppose it. Do you favor or oppose (INSERT ITEM)?
a. A national health plan, financed by taxpayers, in which all Americans would get their insurance from a single government plan Favor 40 Oppose 55 Not sure 5
b. Requiring businesses to offer private health insurance for their employees Favor 76 Oppose 22 Not sure 2
c. Offering uninsured Americans income tax deductions, tax credits, or other financial assistance to help them purchase private health insurance on their own Favor 73 Oppose 24 Not sure 3
d. Expanding state government programs for low-income people, such as Medicaid and the Children’s Health Insurance Program, to provide coverage for people without health insurance Favor 84 Oppose 15 Not sure 1
e. Expanding neighborhood health clinics Favor 80 Oppose 15 Not sure 5
Comment: Once again, a major national poll has been widely reported as showing that Americans do not favor “a national, single payer health plan.” But, once again, the actual question asked included “taxpayers” and “government plan,” terms which many find difficult to endorse.
And once again, we can only speculate what the response would have been if the question had been, “Would you favor a single national insurance program that provided comprehensive benefits for everyone, with free choice of health care providers, and with administrative efficiencies that would protect us from cost increases?”
However, some important tentative conclusions can be extracted from the responses to this question:
** The respondents do support a variety of measures that would guarantee health care for more Americans.
** The respondents support employer mandates, although no questions were asked about the threat to the fiscal solvency of businesses, particularly small businesses.
** The respondents support tax policy that would assist with the purchase of individual health insurance in the private market. But it is important to note that no questions were asked to ascertain whether they understood that this approach would threaten the employment link to insurance and subject individuals to the higher premiums characteristic of the individual market as compared to group coverage.
** The respondents do support government programs for low-income individuals and neighborhood health clinics. No questions were asked to ascertain whether they perceived this to represent a lower tier of health care.
** The polls following the tragedy of 9/11 indicated that Americans have greater confidence in the government than previously. But the questions were related to providing security against the threat of terrorism. This poll indicates that this confidence in government does not extend to our health care system, except for the uninsured.
The policy issues are quite complex. Even relatively sophisticated individuals do not have the time to investigate the full implications of various health policies. Consequently, it is essential that health policy decisions should NOT be made based on these important polls of uninformed respondents.
Numerous studies have established the credibility of the single payer model. Yet most Americans have no understanding of the policy implications of single payer. To ask Americans if they want to pay taxes to have a government health plan is not asking a question about single payer reform. It is asking a rhetorical question about government interference and taxes. Maybe someday the pollsters will address the issues of equity, efficiency, universality, comprehensiveness, portability and other features of the single payer model. Until they do, we should not use their polls to determine the direction of national health policy.