The proportion of US citizens who want “radical change” in their healthcare system reached 36% Republican pollster Bill McInturff told a briefing in Washington DC last week. He has tracked the question since 1992 and has seen the response go as low as 22%. “Every time we have gotten into the mid 30s or higher we have had a huge debate about healthcare.”
“Among the people who say they want radical change are small business owners [43%] and people who work at companies of less than 10 employees [48%]. That is important because much of the opposition to reform during the Clinton administration came from small business.”
Mr McInturff told the meeting, which was sponsored by the journal Health Affairs, that there had been an underlying shift in attitude towards the role of government over the past 13 years.
In 1995, almost two thirds of US citizens said they wanted government to do less. But there has been “a gradual shift over the past decade so that a comfortable majority, 55%, say they want government to do more.”
“I believe the extraordinary cost of our involvement in Iraq has led to a public anger over money that is being spent there that could be spent at home.” McInturff said an economic dialogue over Iraq “was not plausible” in 2004 but has become so now.
Senior health policy advisers to the leading presidential candidates seemed to have studied the same polling data. They offered guarded and carefully phrased comments during their presentations to the conference.
“The way we are going to get to affordability and value is by a comprehensive solution,” said Dr David Blumenthal, adviser to Democratic presidential candidate Barack Obama, “One of the encouraging things to me is that both sides of the aisle are taking the political issue seriously, and the value issue seriously.”
“The cost of care itself is the central issue, and the fact that it doesn’t seem to come with commensurate increases in the quality of outcomes,” said Douglas Holtz-Eakin, adviser to the Republican candidate John McCain.
He said the goal was comprehensive reform “that moves us away from fragmented fee for service medicine that is so common in America, that rewards prevention, and has better care of chronic diseases, which are 70% of our healthcare costs.”
The conference heard that, although many factors seemed to be conducive to reforming health care in the abstract, there was still no consensus on what those reforms should be. About eight in 10 US residents said the system works pretty well for them and their families. The forum moderator Susan Dentzer noted, “Everybody’s second best alternative continues to be the status quo.”
But Democratic pollster Celinda Lake told the meeting that Democratic voters were strongly committed to the idea of comprehensive health coverage. All the Democratic presidential candidates came out immediately with plans for comprehensive health care, because for voters, particularly women, such health care was not “just an issue, it is a value. Voters overwhelmingly believe that health care is a right.”
That belief comes laden with other values, chief of which was personal responsibility. Choice was another paramount value, she said, particularly for people who already have health insurance coverage; and those are the people who vote. “One of the strongest predictors of not voting is not having health insurance,” she said.
“Peace of mind and security are a very big deal in this economy.” Because most US citizens get their health insurance coverage through their job, health care and work are inexorably linked. The majority shy away from increased coverage of the uninsured because they believe it will increase their own health costs through increased premiums and taxes.
US residents also believe they have the best health care in the world—they tend to reject facts showing otherwise—the problem is being able to afford to buy into it.
“People have no idea what Canadian style health care is, but they are absolutely positive they don’t want it,” said Ms Lake. Reforms will have to be packaged as a national innovation.
The priorities for voters are getting costs down, choice, and peace of mind—particularly for women, who make 80% of healthcare decisions in the family.
Although there is some belief that greater efficiencies are possible in the delivery of health care, there is also nervousness that it might result in limiting tests, second opinions, and other choices that are highly valued.