Public opinion on health care reform in the United States

Public opinion on health care reform in the United States is mixed. Many Americans express a desire for health care reform because they see health care as too expensive and because they perceive that insurance companies avoid meeting health costs through coverage exclusions, caps, and co-pays. Americans also express concern that the system as a whole does not cover everyone, and some support malpractice reform and Medicare payment reform. Some polls show majority support for the creation of a government-run insurance plan to compete with private insurers, known as a public option, or a single-payer health care system. Many Democrats in Congress support setting up a single payer health care system (see United States National Health Care Act).

General

A 2001 article in Health Affairs reported on fifty years of surveys finding "much dissatisfaction with the health care system and with private health insurance and managed care companies, and...general support of a national health plan. However, most Americans remain satisfied with their current medical arrangements, do not trust the federal government to do what is right, and do not favor a single-payer type of national health plan." A 2005 article in Health Affairs stated that "for many years, public opinion surveys have found that 65–86 percent of U.S. respondents support a government guarantee of health care for everyone who needs it."

According to journalist Jonathan Alter, most Americans do not consider healthcare is a 'right' in the sense that all people have an inalienable right to care. Self-described liberals tend to see healthcare as such a right, based on a community-centered ethical view of the issue. Self-described conservatives tend to disagree, based on an individual-centered ethical view of the issue.

In an article published in the May/June 2008 issue of Health Affairs, pollsters William McInturff and Lori Weigel concluded that the current health care debate is very similar to that of the early 1990s, when the 1993 Clinton health care plan was under consideration. Similarities noted by the authors include a strong desire for change, a weakening economy, and an increased willingness to accept a larger governmental role in health care. New factors include high military spending and a higher burden placed on businesses by health care costs. However, the authors argue that many of the barriers to reform that existed in the early 1990s are still in play, including a strong resistance to government as the sole provider of care ("'I like national health insurance,' patiently explained one focus-group respondent. 'I just don’t want the government to run it.'"). The authors conclude that incremental change appears more likely than wholesale restructuring of the system.

Polling Results

Poll results pre-2008

According to a Washington Post-ABC News poll in October 2003, 62% of respondents preferred "a universal health insurance program, in which everybody is covered under a program like Medicare that's run by the government and financed by taxpayers," compared to 32% who preferred the current system, in which most people get their health insurance from employers. Of the 62% of people who support universal heath care, 56% would still support a universal health insurance program even if it limited their own choice of doctors, and 63% would still support it even if it meant there were waiting lists for some non-emergency treatments.

According to a New York Times/CBS News poll in February 2007, 54% of respondents said that "fundamental changes are needed" in the health care system, and 36% said that "Our health care system has so much wrong with it that we need to completely rebuild it." 57% were dissatisfied with the quality of health care in this country, although 77% were satisfied with the health care they themselves received. 81% were dissatisfied with the cost of health care, and 52% were dissatisfied with the costs of their own health care. 65% said that providing for the uninsured was more important than keeping costs down. 95% said that it is a serious problem that many Americans do not have health insurance. 64% said that the federal government should guarantee health insurance for all Americans, and 60% would pay higher taxes to do so. But only 43% said that it would be fair for the government in Washington to require all Americans to participate in a national health care plan funded by taxpayers, compared to 48% who said it would be unfair.

2008 poll results

A poll published in early 2008 found Republicans are significantly less likely to give the current system poor reviews, are more likely to report satisfaction with their own care, and less likely to express concern about losing coverage. Differing levels of satisfaction with the current system result in differences in the preferred policy solutions of Democrats and Republicans. Democrats are more likely to believe that the primary responsibility for ensuring access to health care should fall on government, while Republicans are more likely to see health care as an individual responsibility, and are more likely to believe that private industry is more effective in providing coverage and controlling cost than government. Democrats are more likely to support higher taxes to expand coverage, and more likely to require everyone to purchase coverage.

A poll released in March 2008 by the Harvard School of Public Health and Harris Interactive found that Americans are divided in their views of the US health system, and that there are significant differences by political affiliation. When asked whether the US has the best health care system or if other countries have better systems, 45% said that the US system was best and 39% said that other countries' systems are better. Belief that the US system is best was highest among Republicans (68%), lower among independents (40%), and lowest among Democrats (32%). Over half of Democrats (56%) said they would be more likely to support a presidential candidate who advocates making the US system more like those of other countries; 37% of independents and 19% of Republicans said they would be more likely to support such a candidate. 45% of Republicans said that they would be less likely to support such a candidate, compared to 17% of independents and 7% of Democrats.

Another poll released in February 2008, conducted by the Harvard School of Public Health and Harris Interactive, indicated that Americans are also divided in their opinions of "socialized medicine," and this split too correlates strongly with their political party affiliation. Two-thirds of those polled said they understood the term "socialized medicine" very well or somewhat well. When offered descriptions of what such a system could mean, strong majorities believed that it means "the government makes sure everyone has health insurance" (79%) and "the government pays most of the cost of health care" (73%). One-third (32%) felt that socialized medicine is a system where "the government tells doctors what to do". The poll showed "striking differences" by party affiliation. Among Republicans polled, 70% said that socialized medicine would be worse than the current system. The same percentage of Democrats (70%) said that a socialized medical system would be better than the current system. Independents were more evenly split, with 43% saying socialized medicine would be better and 38% worse.

A 2008 survey of over two thousand doctors published in Annals of Internal Medicine, shows that physicians support universal health care and national health insurance by almost 2 to 1.

Polling data from June 2008 show that Americans who are currently covered at work are hesitant about moving away from the employment-based system. Majorities say that it would make it harder to find a plan that meets their needs, make it harder to keep up with administration issues, harder to find and keep coverage, and harder to get health insurance at a good price.

In August 2008, the Chicago Tribune reported that health care was falling behind in the polls as an issue in the presidential election, having been superseded by the economy, the Iraq War and the price of gasoline. A September 2008 poll of registered voters by the Kaiser Family Foundation somewhat disputes this conclusion, ranking health care as the third most important issue, superseded only by the economy and only slightly by the Iraq War.

2009 poll results

An April 2009 protester in New York City advocating for a single-payer health care system.

A Pew Research Center poll issued in June 2009 found that "most Americans believe that the nation’s health care system is in need of substantial changes." However, the survey found that, compared to the early 1990s when the Clinton Health Reform plan was being considered, fewer Americans believed the country was spending too much on health care, fewer believed that the health care system was in crisis, and fewer supported a complete restructuring of the system. Most supported extending coverage to the uninsured and slowing the increase in health care costs, but neither issue found the same level of support as they did in 1993.

A Time Magazine poll in late July found 80% of Americans support guaranteed issue, i.e. requiring insurance companies "to offer coverage to anyone who applies, even if they have a pre-existing health condition."

An August NBC News/Wall Street Journal poll asked Americans on what they felt was "likely to happen" as a result of health care reform: "Health care to illegal immigrants – 55%", "Pay for abortions – 50%", "Government takeover – 54%", and "Government decides on health care for the elderly – 45%".

Gallup polls in August and September 2009 found 44% of men opposed the bills vs. 33% in favor, while 40% of women supported the bills vs. 33% against; young adults and blacks were generally more likely to favor the bills than oppose them, whereas older people, whites, and mixed race persons were more inclined to be against. Gallup noted "a distinct shift against reform among those with four-year college degrees but no postgraduate education; this group opposes a new law by an even larger 17-point margin," while postgraduates (a group that includes doctors who would profit from the bills) supported the bills by a 9-point margin.

In November, 81% said they were satisfied with the health care they receive, and only around 69% said they were satisfied with their coverage.

55–57% of Americans by December opposed to the current Congressional bills based on what they had read about them; however, when asked generically whether Congress should vote for or against "a healthcare bill" (rather than the specific bills passed in each chamber), Gallup poll results show opinion evenly divided, fluctuating mostly within the margin of error since September 2009.

By December, more Americans favored the current system than the proposed overhaul, but the public option retains public support, with marginally more (45%) respondents calling the removal of the public option from the Senate bill "not acceptable" than "acceptable" (42%).

The last national polling data from 2009 (December 11–14) came from NBC News and the Wall Street Journal, which reported "Support for Health Overhaul Wanes;" the poll found 44% of respondents opposed passing the President's plan vs. 41% in favor, compared to 45% favor vs. 39% opposed in September. A December 12 Fox News multi-issue poll found President Obama's approval had "regained some ground" while Congressional healthcare proposals lost ground: 57% opposed the proposals, while 34% support; 41% percent wanted Congress to pass major health care reform legislation in 2009, but 54% would rather Congress "do nothing on health care for now." A CNN poll taken December 2–3 found 53% supported a public option, but 61% opposed the Senate bill (which at that time included a public option). (On December 17, a NBC/WSJ poll reported only 45% of respondents called removing the public option from the Senate bill "not acceptable.") These numbers show greater opposition in December than found in November Gallup poll data, when 49% opposed passing a bill in 2009 compared to 44% in favor.

2010 poll results

In January, CBS reported only 36% of Americans approved of the President's handling of healthcare, while 54% of Americans disapproved, and around 60% disapprove of the two major parties' handling of the issue in Congress. Other news sources reported 55–57% of Americans oppose the current Congressional bills. According to Rasmussen Reports in January 2010, 10% of the American public have withdrawn their support from leading Congressional proposals since June 2009, with a majority opposing them since November 2009. In June 2009, 50% were in favor vs. 45% opposed, but in January 2010, support had dropped to 40% and opposition had increased to 55%. Around 80% say they are satisfied with the health care they receive, and around 70% say they are satisfied with their coverage.

In February 2010, Gallup found a new low of 36% approval for President Obama's handling of healthcare., and Rasmussen Reports found Americans opposing the Congressional bills by a 15-point margin, 56% vs. 41%. The Kaiser Family Foundation found most Americans expressed "disappointment, frustration and a fair bit of cynicism" with the gridlock over health care reform and that most people, including most Republicans, feel that the delays have more to do with playing politics than doing what is right for the country. Overall Kaiser said respondents were evenly divided about the bills before congress, though only 38% of Americans said they would be happy or relieved if there was no reform legislation passed in 2010 compared to 58% saying they would disappointed or angry.

On March 22, 2010, one day after the health reform bill was passed by the US House, a Gallup/USA Today poll found that 49% of Americans thought the bill was a “good thing,” 40% said it was a “bad thing” and 11% had no opinion. Reacting to the passed bill, 15% of Americans said they were “enthusiastic” about it, 35% were “pleased,” 23% “disappointed,” 19% “angry," and 8% had no opinion. A combined 50% had favorable views, versus 42% had unfavorable views. The poll had a +/- 4 percent margin of error.

Public option

Main article: Public health insurance option

A CNN report has labeled a proposed plan as a 'lightning rod' for social debate on health care reform.

Popular opinion

Statistician Nate Silver of FiveThirtyEight reviewed various measures of public support for a government-run insurance plan to compete with private insurers, the "public option", in June 2009. The sampled poll results varied between 40% to 83% in support of a government-provided insurance option, with most of the sampled polls showing between 65% and 76% support., A New York Times/CBS News poll in June 2009 found that Americans overwhelmingly support substantial changes to the health care system and are strongly behind a government-run insurance plan. It stated that people think the government could do a better job of holding down health-care costs than the private sector. The poll found that 72% in support of a plan while 20% said they were opposed. Nearly 60% of respondents said that they would be willing to pay higher taxes so everyone could have health insurance, and 40% were willing to pay as much as $500 more per year. 56% supported single payer, believing "the federal government should guarantee health insurance for all Americans". However, the poll also found "considerable unease about the impact of heightened government involvement, on both the economy and the quality of the respondents’ own medical care." While 85% supported fundamental restructuring of the health care system, 77% reported that they were very or somewhat satisfied with their own care.

A Washington Post/ABC News poll also released in June found that "[a] majority of Americans see government action as critical to controlling runaway health-care costs, but there is broad public anxiety about the potential impact of reform legislation and conflicting views about the types of fixes being proposed on Capitol Hill." Respondents were asked if they were concerned that "health-care reform would lead to higher costs, lower quality, fewer choices, a bigger deficit, diminished insurance coverage and more government bureaucracy." In each case, most respondents answered that they were "very concerned." "About six in 10" said that they were at least somewhat concerned about all six potential issues. Over 80% reported that they were satisfied with their own quality of care "and relatively content with their own current expenses." Questions that equated a public plan option with the popular Medicare program or "emphasized the prospect of more choices" received broad support (62%). But questions "framed with an explicit counterargument" received "a more tepid response." Support dropped to 37% when "respondents were told that [a public option] meant some insurers would go out of business." Most (58%) saw "government reform as necessary to stall skyrocketing costs and expand coverage for the uninsured," but 39% were concerned that it "would do more harm than good." When asked how reform would affect their own care, half said they thought it would stay about the same, while 31% expected it to become worse.

Consistent with the June 2009 New York Times/CBS News poll, in a June 2009 NBC News/Wall Street Journal survey, 76% said it was either "extremely" or "quite" important to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance". As well, 55% specifically supported Obama's plan when read a brief synopsis, which was the 32nd question asked. An August 2009 NBC News/Wall Street Journal poll, however, found that 47% of Americans opposed the idea of a public option and 43% expressed support. A July survey by Rasmussen Reports found 50% of Americans opposed and 35% expressed support.

In an August 2009 poll, Survey USA found that the majority of Americans (77%) feel that it is either "Quite Important" or "Extremely Important" to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance." When asked to choose between three statements about a "public health plan administered by the federal government", a 46% plurality chose "... patients might not always have access to their choice of doctors and the government would lower costs by limiting medical treatment options and decisions that should be made instead by patients and doctors."

A Pew Research Center report published on October 8 stated that 55% of Americans favor a government health insurance plan to compete with private plans. The results were very similar to their polling from July, which found 52% support. A USA Today/Gallup survey described by a USA Today article on October 27 found that 50% of Americans supported a government plan proposal and 46% do not.

Between October 28 and November 13, 2009, Democratic Senator Dick Durbin's campaign organization polled Americans to rank their support for various forms of the "public option" currently under consideration by Congress for inclusion in the final health care reform bill. The 83,954 respondents assigned rankings of 0 to 10. A full national option had the most support, with a 8.56 average, while no public option was least favored, with a 1.10 average.

On October 27, journalist Ray Suarez of PBS stated that "Public opinion researchers say the tide has been shifting over the last several weeks, and now is not spectacularly, but solidly in favor of a public option."

Physicans

A survey designed and conducted by Drs. Salomeh Keyhani and Alex Federman of Mount Sinai School of Medicine done over the summer of 2009, surveying a random sample of more than 2,000 physicians, found that most medical physicians, at 73%, support a public option. An IBD/TIPP poll of 1,376 physicians showed that 45% of Doctors "would Consider leaving or taking early retirement" if Congress passes the health care plan wanted by the White House and Democrats. This poll also found that 65% of physicians oppose the White House and Democratic version of health reform. Statistician and polling expert Nate Silver has heavily criticized that IBD/TIPP poll on multiple grounds. Its unusual methodology, the bias in its earlier questioning, the company's poor track record with previous polling in finding a properly random panel, the fact the results were published before the sample could be fully reported, and the fact the full methodology was not published.

A survey reported by the New England Journal of Medicine in September, based on a random sample of 6,000 physicians from the American Medical Association, stated that "...it seems clear that the majority of U.S. physicians support using both public and private insurance options to expand coverage."

Purchasing mandates

Main article: Health insurance mandate

Public opinion polls from 2009 through 2011 continue to find that most Americans reject penalizing people for not buying health insurance. In 2010, voters in at least three states enacted ballot measures to block the federal mandate that is scheduled to take effect in 2014, "laying the foundation for future legal challenges... Oklahoma approved an opt-out ballot initiative by a 2-to-1 margin. Proposition 106 in Arizona gained 55 percent of the vote while Colorado's Amendment 63 was trailing early Wednesday morning. Missouri voters approved a similar measure, Proposition C, with 71 percent support on a primary ballot in August." In November 2011, the issue appeared on the ballot in Ohio, where a Quinnipiac University Polling Institute of registered voters found that "when asked if they agree with a mandate that they obtain coverage or face fines, opposition jumped to 67 percent, with just 29 percent backing the mandate;" subsequent reports showed 66% of voters rejected the mandate.

Single-payer healthcare

Between 2003 and 2009, 17 opinion polls showed a majority of the public supports various levels of government involvement in health care in the United States. Many polls, such as ones administered through CNN, AP-Yahoo, New York Times/CBS News Poll, and Washington Post/ABC News Poll, Kaiser Family Foundation showed a majority in favor of a form of national health insurance, often compared to Medicare. The Civil Society Institute and Physicians for a National Health Program have both found majorities in favor of the government offering guaranteed insurance, and a Quinnipiac poll in three states in 2008 found majority support for the government ensuring "that everyone in the United States has adequate health-care" among likely Democratic primary voters.

In contrast, a October 2011 Rasmussen Reports poll of American adults showed only 35% of respondents in favor of single-payer health care, with a plurality (49%) opposed. Politifact rated a statement by Michael Moore "false" when he stated that "[t]he majority actually want single-payer health care." Responses on these polls largely depend on the wording. For example, people respond more favorably when they are asked if they want a system "like Medicare," less favorably when stated as "socialized."

Paul Ryan Plan

Main article: Path to Prosperity

Another major proposal has been the Path to Prosperity plan created by Wisconsin congressman Paul Ryan. It seeks to reform Medicare and lower its costs by converting it into a voucher system.

According to Politico, most polls are unfavorable towards the plan. According to Washington Post columnist Ezra Klein when CBO estimates of benefit cuts are factored in, 80 percent or more of Americans oppose the plan.

In June 2011, a CNN/ORC poll found that 58 percent of Americans opposed the idea while 35 supported. Among seniors, 74 percent opposed the plan. In the same month a Pew Research poll surveyed support for changing Medicare and found that 41 percent of Americans opposed it while 36 percent supported it. The Pew poll found that the more Democrats and Independents were made aware of the plan were more likely to oppose it; Republicans were more supportive the more they heard about it. An NBC/Wall Street Journal poll found that 31 percent of Americans thought it was a bad idea while 22 percent thought it was a good idea.

In April 2011, a New York Times/CBS poll found that 61 percent of Americans thought Medicare was "worth the cost" making it politically risky to implement the plan. The poll also found that 47 percent approved of turning Medicare into a private insurance program while 41 percent disapproved. A Gallup poll in the same month found an even split for deficit reduction plans with 44 percent of Americans supporting the Democratic plan while 43 supported the Ryan plan, although the same poll found that senior citizens preferred the Ryan plan over the Obama plan. As well, in a Washington Post/ABC poll found that 65 percent of Americans opposed the plan while 34 percent supported it.

In April 2011, A Kaiser Family Foundation poll found that 50 percent of Americans wanted to keep Medicare the way it is while 46 percent favored turning it into a voucher system per the Ryan plan. Among seniors, 62 percent wanted to maintain Medicare while 30 percent favored turning it into a voucher program.

State proposals

A November 2008 ballot initiative in 10 legislative districts of Massachusetts resulted in 73% of voters saying yes to the question: "Should the representative from this district be instructed to support legislation creating a cost-effective single payer health insurance system that is available to all residents, and oppose laws penalizing those who fail to obtain health insurance?" A poll in January 2010 produced mixed results and seems to confirm that the wording of questions seems to affect the outcome. When asked "Generally speaking, do you oppose or favour the healthcare reform plan proposed by President Obama and the Congressional Democrats?" 47% favored or somwehat favoured the plans and 48% opposed or somewhat opposed them. However, when asked the question "Do you support the proposed national near universal healthcare law?." 51% of Massachusetts voters answered no to and 36% responded yes.

The California legislature has twice, in 2006 and 2008 passed a single payer health care bill SB 840. Both times, Governor Arnold Schwarzenegger vetoed the bill.

See also

• Health care in the United States
• Health care reform debate in the United States
• Health care reform in the United States
• Health policy analysis
• Health care politics
• Health insurance cooperative