PRINCETON, NJ -- A review of public opinion research on healthcare reform reveals that Americans may have hit the slowdown button. One primary cause for this appears to be public concerns about cost, but there are a number of additional elements involved. The bottom line is a sense that, while Americans apparently favor some type of healthcare reform in the long term, they are in no hurry to see healthcare reform legislation passed in the short-term on a rushed schedule.
Herewith is a summary of 10 key elements of American public opinion on healthcare reform, based on a review of the latest survey research as of the week of July 27-31.
1. Most Americans do not believe that the U.S. healthcare system is in a state of crisis. The economy outweighs healthcare as the most pressing problem facing the country and in Americans' personal lives.
- Although the majority of Americans believe the U.S. healthcare system has major problems, less than 20% perceive that the U.S. healthcare system is in a state of crisis. This has not shifted significantly in 15 years.
- More Americans now mention healthcare as the nation's most important problem than was the case a few months ago. It is unlikely that the quality of healthcare deteriorated in four months, but rather that its salience has increased for the average American with the increased focus on the topic from politicians and the news media. This follows the pattern seen in 1993 and 1994; concern about healthcare shot up as the problem was being addressed in Washington, D.C., but dropped thereafter. The current percentage of Americans naming healthcare as the country's biggest problem is significantly lower than in 1994.
- At this point, almost 7 out of 10 Americans say economic-related issues are the nation's top problem; 16% say healthcare is the top problem.
- One in 10 Americans say healthcare is the most important financial problem facing their family.
2. Americans are not convinced that healthcare reform will benefit them personally. This is, in part, because most Americans are satisfied with their current medical care and access to healthcare. Seniors in particular are not convinced that healthcare reform will benefit them.
- Most Americans do not see a direct personal benefit for themselves if healthcare legislation is passed.
- Eighty-four percent of Americans are insured and most say they are satisfied with their insurance and healthcare.
- Americans are more likely to be convinced that new healthcare legislation will have a negative effect personally rather than a positive one, although a substantial minority falls in the middle, saying it will have no effect on them either way.
- Most Americans rate the quality of healthcare they receive and their healthcare coverage as excellent or good. These views have been stable in recent years.
- While younger adults (those 18 to 49) are as likely to believe reform could help them as say it could hurt them, older Americans, particularly those 65 years and older, are far less likely to perceive that their medical care or access to healthcare would improve under new healthcare legislation.
3. Americans agree that healthcare costs are a major problem for the country. Americans do not, however, believe that healthcare reform would lessen costs -- neither for the system as a whole nor for individuals.
- An overwhelming 79% of Americans say that they are dissatisfied with the total cost of healthcare in this country.
- Forty-five percent say that healthcare costs would increase overall with a new healthcare reform law, compared to 30% who say they would decrease.
- Personally, 34% say their healthcare costs would increase under a new law; 18% say they would be reduced.
4. The push for healthcare reform is occurring in an environment characterized by high levels of concern about fiscal responsibility, government spending, and the growing federal deficit. Americans are being asked to approve major new healthcare expenditures at a time when they are not yet convinced that the last massive outlay of government money -- the stimulus -- has made an impact.
- Americans are worried about their country's budget deficit.
- President Obama gets his lowest marks on handling the federal deficit.
- Those who disapprove of Obama's job performance are most likely to say it is because of the high levels of spending introduced in his administration.
- A Pew Research poll released this week shows that those who are worried about new healthcare legislation are most likely to say it is because it involves too much spending and would increase the deficit.
- Less than a third of Americans perceive that the stimulus plan has made the U.S. economy better, although about half hold out hope that it will eventually.
- Americans, on balance, perceive that the stimulus plan has, thus far, had no effect or made their own financial situation worse (64% and 22%, respectively). Looking ahead, Americans are just as likely to say the stimulus' long-term effect will make their situation worse as make it better.
5. Americans have relatively little confidence in Congress and thus, by inference, little confidence that Congress can effectively and efficiently reform the country's massive healthcare system.
- Two-thirds of Americans say members of Congress do not have a good understanding of the issues involved in healthcare reform.
- Just 17% of Americans have a great deal or quite a lot of confidence in Congress, near the bottom of a list of institutions Gallup measures each year.
6. Americans continue to have more confidence in President Obama on healthcare issues than in either the Democrats or Republicans in Congress. Obama's political capital, however, is waning. This leads to a circularity in which Obama's hard push for healthcare reform may hurt his approval ratings, and his falling approval ratings may hurt his credibility on healthcare reform. One inevitable byproduct of Obama's strong push on reform is the politicalization of healthcare. Most Democrats support it, Republicans oppose it, and independents are in the middle.
- President Obama's job approval rating has fallen from an average of 66% in early May to 56% for the week of July 20-26.
- Given a list of sources for recommendations for healthcare guidance, Americans say they are more confident in Obama than in either Democratic or Republican leaders in Congress -- although doctors, researchers, and hospitals are rated higher than Obama.
- Twenty-two percent of Republicans want a new healthcare law passed this year, compared to 63% of Democrats.
7. Americans have mixed or ambivalent views of the role government should have in healthcare. They favor some government involvement, but not a government-run healthcare system.
- Less than half of Americans favor replacing the current system with a government-run healthcare system.
- Americans responding to questions asked by various polling organizations in recent weeks indicate that they do favor a public option plan (run by the government) that would compete with private plans.
- Americans believe that it is the government's role to help see that all Americans have access to healthcare, although this sentiment was waning as of November 2008.
8. On a case-by-case basis, Americans favor many specific proposals that have been put forth as ways of reforming healthcare.
- Polls from several polling organizations released this week show that Americans favor a public option government plan to compete with employer plans, requiring insurance companies to cover everyone regardless of pre-existing conditions, tax credits to help some people pay for health insurance, and expansion of government plans to cover low-income Americans.
- Americans also appear to agree with a number of different ways of paying for healthcare reform, including taxes on the rich and requiring employers to pay a fee if they don't provide health insurance.
9. Despite positive views of many specific reform proposals, Americans appear ambivalent at this juncture on the overall merits of passing a broad healthcare plan.
- In mid-July a majority of Americans favored passing a major healthcare reform bill (described without reference to who is supporting it).
- By later in July, several organizations' surveys show a plurality of Americans opposed to passage of plans variously labeled as Obama's plan, the plan proposed by President Obama and the Congressional Democrats, healthcare proposals being discussed in Congress, or healthcare reform legislation being considered right now.
- Other recent poll questions, which describe the plan in great detail, continue to show plurality of majority support.
- A plurality, but not a majority, of Americans say that a new healthcare plan would improve the overall level of medical care and improve access to healthcare in the U.S.
10. All in all, while the majority of Americans ultimately favor passage of healthcare reform, many are willing to wait until next year to see it happen.
Bottom Line
Taken together, these findings underscore the conclusion that Americans' views on the push for healthcare reform are in a state of flux, perhaps mirroring the back and forth debate in Congress on this contentious issue. Two keys for the average American appear to be cost and urgency. The data suggest a continuing need to convince Americans of the return on investment of any proposed major investment in healthcare reform. Americans also appear dubious about the benefits of what they perceive to be less-than-fully-informed representatives in Washington rushing into a new healthcare reform law when the need for such legislation is not the highest on the public's agenda.
