PRINCETON, NJ -- Since earlier this decade, Americans have grown more receptive to the idea of replacing the current healthcare system based on private health insurance with a new government-run system. However, on balance, Americans still favor maintaining the current system, 49% to 41%.
Gallup's annual healthcare trends, updated each November since 2001, show that public concern about U.S. healthcare centers on access and costs, not the quality of medical care. In fact, nearly 6 in 10 Americans (57%) interviewed Nov. 11-13, 2008, describe the quality of healthcare in the country as excellent or good. Attitudes on this have been stable in recent years.
Americans' perceptions are much more negative when it comes to healthcare coverage. Only about one in four Americans currently believe healthcare coverage in the country is excellent or good.
Also, the overwhelming majority of Americans -- 79% -- say they are dissatisfied with the total cost of healthcare in this country, a figure up slightly from the 71% found in 2001.
Perceptions That the System Is Broken
The net result of these observations about the way U.S. healthcare works is that Americans generally believe the system is highly troubled: 14% say it is "in a state of crisis" and 59% think it has "major problems." Only 26% believe it has minor problems and a slight 1% say it does not have any problems.
Also, in line with Barack Obama's campaign promise to fill in the gaps in health insurance coverage for Americans, more than half of Americans believe it is the federal government's responsibility to make sure all Americans have access to healthcare coverage. The 54% currently saying this is the lowest recorded this decade, but still the dominant public view.
Personal Coverage Tells a Different Story
While these indicators seem to provide a solid public endorsement of major healthcare reform, another set of indicators suggests that the current system is actually working quite well.
Most Americans -- 89% of adults aged 18 and older surveyed by Gallup in November -- report that they are currently covered by private health insurance, or a federal program such as Medicare or Medicaid. Only 11% say they have no health insurance.
And among all Americans, 83% say the quality of healthcare they receive is either "excellent" or "good." Only 16% say it's either "only fair" or "poor."
Americans are only a bit less positive about their own healthcare coverage, with 67% describing the coverage they now have as excellent or good.
Despite the persistent inflation in healthcare costs, 58% of Americans are satisfied with the total cost they pay for their healthcare, a percentage that has been consistent in recent years. This could be, in part, because four in five Americans with private health insurance say their employer either shares or pays all of the costs of their premiums.
As the incoming Obama administration considers how to tackle the nation's healthcare woes without producing the backlash that the Clinton administration faced in 1993-1994, it will be important for it to understand the sharp distinction between how Americans perceive national healthcare conditions and how the system is serving Americans' own personal healthcare needs.
Americans believe the system needs reform, particularly when it comes to healthcare coverage and costs. At the same time, they are pleased with the quality of medical treatment in the country, and are mostly satisfied with their own healthcare quality, coverage, and costs.
In short, the public seems to be calling for surgery on the current system -- essentially to expand coverage to those who need it and to rein in costs -- rather than an entire transplant operation.
Results are based on telephone interviews with 1,009 national adults, aged 18 and older, conducted Nov. 13-16, 2008. For results based on the total sample of national adults, one can say with 95% confidence that the maximum margin of sampling error is ±3 percentage points.
Interviews are conducted with respondents on land-line telephones (for respondents with a land-line telephone) and cellular phones (for respondents who are cell-phone only).
In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.