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Public Opinion on Health Care Costs

by Ruy Teixeira

To the extent one can rank people’s personal economic worries, rising health care costs are frequently at the top of the list. For example, in a June 2005 Lake Snell Perry Mermin survey, 27 percent picked rising health care costs, 18 percent wages not keeping up with costs, 14 percent a secure retirement, 12 percent higher taxes and 9 percent rising gas prices as their chief economic worry. Just 5 percent picked losing their job.

A somewhat similar pattern can be observed in a June, 2005 Kaiser Family Foundation survey. That poll asked people how worried they were about a wide range of problems. The top worry was “having to pay more for your health care or health insurance” (45 percent said they were very worried), followed by “not being able to pay medical costs when you are elderly” (42 percent) and “your income not keeping up with rising prices” (40 percent). In contrast, only 24 percent were very worried about not being able to pay their rent or mortgage, 19 percent about losing their savings in the stock market and 17 percent about losing their job.

Obviously, rising health care costs is a very important problem indeed in the eyes of the public. Therefore, it would be good to know more about how exactly rising health care costs are affecting Americans’ lives today. In this regard, a just-released Kaiser Family Foundation survey specifically on the issue of health care costs provides much valuable information. Here are some key findings from the survey.

Two-thirds (66%) of insured adults say their health insurance premiums have gone up over the past five years, including 38% who say these premiums have gone up “a lot”. About one-quarter (24%) say premiums have stayed the same, while just 5% say they’ve gone down.

Around half of insured adults say their co-payments for provider visits (52%) and health insurance deductibles (49%) have risen over the past 5 years. About four in ten say co-payments (40%) and deductibles (42%) have stayed the same, and few say these costs have gone down (5% co-payments, 3% deductibles have gone down).

More than a third (35%) of the public says high profits made by drug companies and insurance companies are the MOST important reason behind rising health care costs. The next most commonly cited reasons are the number of malpractice lawsuits (19%) and the amount of greed and waste that occurs in the health care system (14%).

Nearly one-quarter (23%) Americans have had problems paying medical bills in the past year.

More than six in ten (61%) adults who report problems paying medical bills are covered by health insurance). Among adults who had problems paying medical bills –majorities report that the bills were for basic care such as doctor bills (85%), lab fees (62%) and prescription drugs (56%).

More than one in five (21%) Americans currently has an overdue medical bill, and almost two in ten (19%) report experiencing serious financial consequences in the past 5 years due to medical bills.

Almost two in ten (18%) Americans say health care costs are their biggest monthly expense excluding rent or mortgage payments. More than three in ten (32%) name transportation, and nearly one-quarter each say food or clothing (24%) or utilities (23%) are their biggest expense excluding rent or mortgage costs.

Nearly three in ten (28%) adults report a time in the past year when they did not have enough money to pay for medical or health care, and 62% of these adults are insured. This share has been stable since the mid-1980’s, but is considerably higher than in 1976 when 15% said there was a time they didn’t have enough money to pay for care.

Nearly three in ten (29%) adults report that they or someone in their household skipped medical treatment, cut pills, or did not fill a prescription in the past year because of the cost.

One way to control health care costs, of course, is in the context of a system that would provide universal health insurance coverage to Americans. Would Americans support government action to create such a system? They say they would, though there are nuances to that support which suggest mobilizing the public to move in that direction remains tricky.

Start with the basic fact that the public definitely wants the government to play a leading role in providing health care for all. For example, in an October, 2003 WP/ABC poll, by almost a 2-1 margin (62 percent to 33 percent), Americans said they preferred a universal system that would provide coverage to everyone under a government program, as opposed to the current employer-based system. Similarly, in Kaiser polls from 1992 to 2000, a large majority of the public agreed that the federal government should guarantee medical care for people who don’t have health insurance. Finally, in a slightly different question asked more recently by Kaiser in June 2003, more than seven in ten adults (72%) agreed that the government should guarantee health insurance for all citizens, even if it means repealing most of the tax cuts passed under President George W. Bush, while less than one-quarter (24%) disagreed with this statement.

Note, however, that support for universal coverage drops significantly if such a program would mean a limited choice of doctors or longer waits for nonemergency treatment.

Note also that, when asked specifically about responsibility for covering the uninsured, there is not unanimous support for the federal government to lead the way. Four in ten people (43%) think that the federal government should have the most responsibility for providing health insurance coverage to the uninsured, compared with two in ten (20%) who say state governments should be most responsible, and about one in ten (11%) who say employers should be most responsible. Another two in ten (18%) think the responsibility belongs to none of these or to another group. (June, 2003 Kaiser poll)

In a more recent Kaiser poll (June, 2005), when presented with a variety of options for expanding health insurance to cover more Americans, the public did express a high level of support for nearly every option (ranging from 70% to 88%). (The only option that didn’t garner majority support is a national health plan financed by tax payers-that would provide insurance for all Americans (37%)). However, when asked to select the single best option, no one option attracted widespread support.

Finally, the public is also divided over whether the government should make a major or a limited effort to provide health insurance to the uninsured. The last time this question was asked by Kaiser in May, 2003, 42 percent said there should be a major effort, 37 percent a limited effort and 13 percent said things should be kept the way they are.

So, it appears that public is very open to a government-supported system of universal coverage, but not sure about how to get there and what kind of system it really wants. We shall see if the push of rising health care costs starts to focus the public mind more so that it has been so far.