March 2008
Health-care reform
Sweating the details
When our questions turned to how, exactly, a reformed health system would work, respondents were considerably more divided
than they were about what such a system should achieve.
We asked for their opinions on four approaches to health-care reform, including those proposed by leading presidential candidates.
The most popular proposal drew support from half of the respondents. That was for a mixed public/private system that would require all uninsured Americans to buy health insurance. The cost of the insurance, deductibles, and co-pays would be adjusted based on income, with subsidies for lower-income Americans. Massachusetts is in the midst of implementing that type of system, and versions of it have been proposed by the leading Democratic presidential candidates.
Thirty-six percent of our poll respondents support public insurance, which would move all Americans, including those now covered through private insurance, to a Medicare-like plan funded by federal taxes. That is an approach similar to the Canadian health-care system.
One-third of respondents we surveyed favored a mix of employer-sponsored plans, private health-insurance plans, Medicare, Medicaid, and other public programs, which is the arrangement we have today. (People were allowed to choose more than one reform proposal, so percentages add up to more than 100.)
Only 26 percent supported the idea of giving tax incentives for individuals to purchase insurance and relying on market pressures and competition among insurance companies to hold prices down. Versions of that idea have been proposed by several leading Republican candidates.
Interestingly, even respondents who identified themselves as conservatives picked a mixed public/private system as their top choice, and one-third favored an all-public plan.
Experts on health-care reform who we consulted said they were not surprised by the disconnect our survey found between the system Americans say they want and the road map for getting there.
"Surveys consistently show that Americans want reforms," said Gerard F. Anderson, professor of health policy and management at Johns Hopkins University. "However, they do not want major changes in how they get health care, and they do not want to pay much to reform the health-care system or to expand coverage."
The Achilles' heel of reform is that most Americans do have some source of insurance most of the time, says Jacob S. Hacker, a political science professor at Yale University who has studied health-care reform. "The easiest way to kill reform is to say that this change will destroy what you have and will make you pay more for less," he says. Reformers need to put forth a "clear, simple, and unthreatening vision of reform that meets public concerns head-on."
We asked for their opinions on four approaches to health-care reform, including those proposed by leading presidential candidates.
The most popular proposal drew support from half of the respondents. That was for a mixed public/private system that would require all uninsured Americans to buy health insurance. The cost of the insurance, deductibles, and co-pays would be adjusted based on income, with subsidies for lower-income Americans. Massachusetts is in the midst of implementing that type of system, and versions of it have been proposed by the leading Democratic presidential candidates.
Thirty-six percent of our poll respondents support public insurance, which would move all Americans, including those now covered through private insurance, to a Medicare-like plan funded by federal taxes. That is an approach similar to the Canadian health-care system.
One-third of respondents we surveyed favored a mix of employer-sponsored plans, private health-insurance plans, Medicare, Medicaid, and other public programs, which is the arrangement we have today. (People were allowed to choose more than one reform proposal, so percentages add up to more than 100.)
Only 26 percent supported the idea of giving tax incentives for individuals to purchase insurance and relying on market pressures and competition among insurance companies to hold prices down. Versions of that idea have been proposed by several leading Republican candidates.
Interestingly, even respondents who identified themselves as conservatives picked a mixed public/private system as their top choice, and one-third favored an all-public plan.
Experts on health-care reform who we consulted said they were not surprised by the disconnect our survey found between the system Americans say they want and the road map for getting there.
"Surveys consistently show that Americans want reforms," said Gerard F. Anderson, professor of health policy and management at Johns Hopkins University. "However, they do not want major changes in how they get health care, and they do not want to pay much to reform the health-care system or to expand coverage."
The Achilles' heel of reform is that most Americans do have some source of insurance most of the time, says Jacob S. Hacker, a political science professor at Yale University who has studied health-care reform. "The easiest way to kill reform is to say that this change will destroy what you have and will make you pay more for less," he says. Reformers need to put forth a "clear, simple, and unthreatening vision of reform that meets public concerns head-on."
