Health Care an Important Issue This Year

GALLUP NEWS SERVICE

The Importance of Health Care to the Public

Key Point: Health care and Medicare are two very important issues to the American public this year. A strong majority of Americans say that health care generally and Medicare more specifically are important issues influencing their vote for president. A majority of Americans also say that the health care system in this country has major problems, despite the fact that most Americans are satisfied with their personal health care situation.

As in previous elections, health care is a top concern to the American public this year as they evaluate the contenders in the presidential election. Thirty-seven percent of Americans say that the candidates' positions on health care will be "extremely important" in influencing their vote for president. Health care ranks among the top issues driving the campaign, behind education and the economy. The candidates' focus on Medicare reform and providing prescription drug benefits to seniors is in line with much of the public's concern. Thirty-four percent of Americans say that the candidates' positions on Medicare alone will be an "extremely important" part of their voting calculus, putting it near the top of the most important issues -- trailing education, the economy, health care, Social Security, and handling the budget surplus.

Now I am going to read a list of some of the issues that will probably be discussed in this year's presidential election campaigns. As I read each one, please tell me how important the candidates' positions on that issue will be in influencing your vote for president -- extremely important, very important, somewhat important, or not important. [RANDOM ORDER]

July 25-26, 2000	Extremely important	Very important	Extremely/Very important
	%	%	%
Education	43	46	89
The economy	35	51	86
Health care	37	47	84
Social Security	37	45	82
Handling the budget surplus	32	47	79
Medicare	34	44	78
Taxes	33	44	77
Creating opportunities for better-paying jobs	28	44	72
The environment	29	42	71
National defense	30	40	70
The gun issue	30	32	62
Foreign affairs	18	40	58
Abortion	25	27	52
Foreign trade	15	36	51

The importance of health care in the election is not surprising, in light of the fact that a majority of Americans (58%) say that the health care system in the U.S. has "major problems" and 12% say that it is "in crisis." When Americans are asked to identify the most important "problem" facing the country, health care ranks fourth, behind lack of ethics, crime, and education, according to a June 22-25, 2000 poll.

Despite the fact that many Americans are concerned about health care at the national level, most are quite satisfied with various aspects of their own health care situation:

"We'd like to know how you feel about different aspects of health care for you and your family. Are you generally satisfied or dissatisfied with…?" [ROTATED]

The quality of health care you receive

 

	Satisfied	Dissatisfied	No opinion
	%	%	%
2000 Sep 11-13	82	16	2
1994 Jan 28-30	80	18	2
1993 May 10-12	81	17	2

Your health insurance coverage

 

	Satisfied	Dissatisfied	No opinion
	%	%	%
2000 Sep 11-13	70	27	3
1994 Jan 28-30	69	27	4
1993 May 10-12	70	25	5

The cost of the health care you and your family receive

 

	Satisfied	Dissatisfied	No opinion
	%	%	%
2000 Sep 11-13	59	39	2

The health insurance plan you and your family have

 

	Satisfied	Dissatisfied	No opinion
	%	%	%
2000 Sep 11-13	69	27	4

This discrepancy between national and local perceptions of issues is not peculiar to health care. Americans generally perceive greater problems of crime and education at the national level as opposed to the local level. Also, people tend to evaluate their own representatives more favorably than Congress as an institution.

What is it about health care nationally that is troubling so many Americans?

The cost of health care and the problem of uninsured people seem to be driving the perception that the country faces a major health care problem. As shown in the above list, thecostof health care receives the lowest levels of satisfaction, compared with other aspects of health care. When Gallup asked Americans to name the "most urgent health problem facing this country at the present time," more people (23%) said issues of cost and insurance than any other problem (September 11-13, 2000). This percentage has risen considerably over the past two years. In February 1999, only 13% of the public named issues of cost and insurance as the most important health problem.

The Public Divided: Groups for Whom Health Care Problems Are Most Important

Key point:While most Americans are concerned about all aspects of health care, women, the elderly, and the poor tend to say they are more concerned about this issue than other groups.

In contrast to the issue of the economy and taxes (evaluated by Gallup earlier this week), the importance of health care as an issue in this election varies by gender, age, income, education and partisan identification. In general, women, older people, poorer people and Democrats tend to be more concerned about health care than others. This is perhaps not surprising since health care and paying for health care are more likely to be concerns for these groups.

Beyond the importance of health care as an issue, other attitudes about health care also vary by social and demographic factors. Women are slightly more likely than are men to be dissatisfied with the "availability and affordability" of health care (70% vs. 64%). Wealthier people are more likely to express satisfaction in this area than are poorer people. Older people are, in general, more dissatisfied than are younger people. Interestingly, those between the ages of 50 and 64 are the most dissatisfied of any other age group (77% say they are either "not too satisfied" or "not at all satisfied"), including those over 65 years old. The concern among this age group probably reflects their greater tendency to have health problems, but not yet be covered by Medicare.

There are also some important differences among subgroups of the population in their overall evaluation of the health care system. Women are more likely than are men to say that the system has major problems or is in a state of crisis (76% vs. 64%). Older people express more concern than do younger people, with 84% of people between ages 50 and 64 saying that the system has major problems or is in crisis. Fifty-seven percent of those between ages 18 and 29 made the same evaluation. However, upon closer examination, the differences among age groups can be accounted for to some extent by the gender gap -- 58% of men between the ages of 18 and 49 said the system had major problems or was in a crisis, compared with 72% of men over the age of 50. About three-fourths of women ofallages, however, said the system had major problems or was in crisis (75% of women between ages 18 and 49; 78% of women between over age 50).

The only aspect of health care where there is not a big age difference is in people's satisfaction with the quality of their health care. A large gender gap remains, with men more likely to be satisfied with the quality of their health care than are women (60% vs. 48%). Socioeconomic status also plays a role. Wealthier and better educated Americans are more likely to be satisfied with the quality of their health care than are those with less money and education -- not surprising because the wealthy can afford more comprehensive health care plans.

What the Public Wants Done About Health Care

Key Point:Most Americans want the federal government to take an active role in reforming the health care system. The public consensus is particularly strong on federal regulation of the cost of health care – three in four Americans say the federal government should do more in this area. On the timely issue of Medicare reform and prescription drug coverage, more than half of Americans say that Medicare should be expanded to include this entitlement.

The available polling data on health care reveal that many Americans think there are major problems with the U.S. health care system, even though most people do not express concern about their own personal situation. It appears that much of this concern is driven by the perception that the cost of health care is too high and many people do not have insurance. What do Americans think ought to be done about these specific health care issues? Gallup asked the public several questions about the appropriate role of the federal government in this area. A majority of Americans say they think it is the responsibility of the federal government to make sure that all Americans have health coverage (64%). A slightly weaker majority (54%) agrees that if the government tries to reform the health care system in this country it would make health care better. Thirty-five percent say that government reform would make health care worse. There is a broader public consensus on federal intervention in thecostof health care. Seventy-six percent of Americans say the federal government should do more to regulate health care costs in this country.

"Do you think it is the responsibility of the federal government to make sure all Americans have health care coverage, or is that not the responsibility of the federal government?"

 

	Yes, gov't responsibility	No, not gov't responsibility	No opinion
	%	%	%
2000 Sep 11-13	64	31	5
2000 Jan 13-16	59	38	3

"If the government tried to reform the health care system in this country, do you think it would make health care in this country better or worse?"

 

	Better	Worse	NO DIFFERENCE (vol.)	No opinion
	%	%	%	%
2000 Sep 11-13	54	35	2	9
2000 Jan 13-16	55	37	1	7

vol. = Volunteered response

"Do you think the federal government should do more to regulate health care costs in this country, or not?"

 

	Yes, should	No, should not	No opinion
	%	%	%
2000 Sep 11-13	76	21	3
2000 Jan 13-16	77	20	3

One of the most visible aspects of health care costs in the news this year has been the high cost of prescription drugs, which currently are not covered by Medicare. Both presidential candidates have spent quite a bit of time campaigning on this issue and, as Gallup Poll data show, Medicare is a very important issue to many voters this election year. Seventy-eight percent of respondents say that each candidate's position on the Medicare issue is either "very important" or "extremely important" in influencing their vote. Gallup asked the public how the federal government should approach the prescription drug problem by asking respondents to choose between expanding Medicare to include prescription drug coverage and providing federal subsidies to private insurance companies to encourage them to cover prescription drugs. Slightly more than half of Americans (57%) say they think Medicare ought to be expanded while 26% prefer federal subsidies of private insurers.

"Here is one question about health care. As you may know, Medicare, the federal health insurance program for senior citizens, does not provide complete coverage for prescription drugs. In order to deal with this do you think the federal government should expand Medicare to include coverage of prescription drugs as an entitlement for senior citizens, or do you think the federal government should provide financial subsidies to encourage private insurance companies to offer seniors prescription drug coverage, but not make this a federal entitlement, or do you think no changes should be made to this coverage at this time?"

 

	%
Expand Medicare coverage	57
Provide federal subsidies to encourage private insurance	26
Make no changes	12
OTHER (vol.)	2
No opinion	3

vol. = Volunteered response