Although a majority of Americans are dissatisfied with the current health care system, they remain unlikely to accept comprehensive reform legislation, according to a review of numerous public opinion surveys. Middle-income people in particular, while supporting concepts such as universal coverage and Medicare reform, are concerned about the trade-offs that might be required to meet these ambitious goals.
“Some of the changes may have to be more modest at a given time so they are less threatening to people,” said lead author Robert Blendon, ScD, professor of health policy and management at the Harvard School of Public Health, in a press release.
The review was published in The Milbank Quarterly. The authors undertook the review to provide an in-depth look at public opinion regarding health care in advance of the 2008 presidential campaign. The report indicates that public views of health care issues “are more complex and conflicted than often suggested by individual poll results.”
According to the study, health care consistently ranks among the top five pre-election concerns of Americans and most are dissatisfied with the current health care system. Yet people generally do not believe that a completely new approach is needed. In fact, a majority of Americans are relatively satisfied with their own health care. So they feel that “they have something to lose on a day-to-day basis” if the current system changes, Blendon said.
Moreover, when respondents answer relatively simple survey questions, they often do not consider all possible implications of health care changes. Support for reform efforts can then evaporate when people hear about limitations on benefits, increases in premiums or taxes and other necessary trade-offs.
Americans also remain resistant to the idea of more government involvement in health care. In a 2002 Harris Poll asking Americans how much they trusted each of several groups to make the right decisions about their health care, members of Congress ranked last, distrusted by 62% of the public.
“People in politics get in trouble because they just understand the superficial views and not the more in-depth concerns,” Blendon said. “If you want to bring about change, you have to put together proposals that take these concerns into account.”
The review authors give the groundbreaking Massachusetts Universal Health Plan, signed into law in 2006, as an example of a workable compromise. The legislation makes health coverage more affordable by creating a combination of subsidies and penalties, rather than by increasing taxes. For reform-minded policy-makers, Blendon recommends careful tracking of the public’s anxieties and worries.
“Trying to understand at any given time where the acceptable limits are is helpful. This is a field where being current is important,” Blendon said.