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Pinning Down Worry-Free Health Care

Americans May Not Want To Choose Between Wider Coverage And Lower Costs

In several recent columns, I reviewed aspects of public opinion that may pose a challenge to health care reform, including arguments about higher taxes, the role of government and general fears of a worsening status quo.

In short, surveys have identified much about health care reform that makes Americans anxious. Yet, according to the new USA Today/Gallup poll released last week, a majority of Americans (56 percent) continues to favor "Congress passing a major health care reform bill this year," while 33 percent are opposed.


Why? And what exactly do Americans hope such reform will accomplish?

Back in February, the Kaiser Family Foundation asked a straightforward question of a national sample of adults: "When you hear people talking about health care reform, what does that mean to you, in your own words?"

Most responses sorted into two categories: Forty percent said something about reducing the costs of health care, while almost as many (39 percent) said something about expanding coverage to more people.


In recent months, Kaiser and at least a half-dozen other media pollsters have asked Americans to choose the more important goal: reducing health care costs or expanding health care coverage to those without insurance. However, as Democratic pollster Mark Mellman pointed out in The Hill last week, the answers they obtained vary widely. For example,

• In June, the CBS News/New York Times poll found far more who said the "more serious problem" is "providing health insurance for Americans who do not have any insurance" (65 percent) rather than "keeping health care costs down for average Americans" (26 percent).

• Yet last week, in the USA Today/Gallup poll, more chose "controlling rising health care costs" (52 percent) as a "more important" goal than "expanding health care coverage to include nearly all Americans" (42 percent).

Mellman offers two explanations for these apparent discrepancies. First, questions that "frame the issue in terms of significance for the country" tend to produce more support for increasing coverage, while those that focus more on personal preferences tend to produce more concerns about cost.


He also wonders if by forcing voters to prioritize these goals we are trying to measure what pollsters call a "non-attitude," an issue that "voters have never considered an issue until we ask." Questions about non-attitudes often produce strange results, since the answers are mostly reactions formed on the spot.

Put another way, how many Americans think reducing cost and expanding coverage are equally important?

Recent survey results show that many Americans do just that. For example, last week's USA Today/Gallup poll asked respondents to rate a series of health reform goals separately (on a scale of "extremely important, very important, somewhat important, or not important"). They found:

• 86 percent rated "being able to get health insurance regardless of your job status or medical situation" as at least very important (including 43 percent who consider it extremely important).

• 83 percent rated "making your health insurance more affordable" as at least very important (including 40 percent who consider it extremely important).

Not surprisingly, the overlap is considerable. According to additional data kindly shared by the Gallup Organization, more than four out of five adults (77 percent) rated both of these goals as at least very important, while 31 percent said both are extremely important.

The February survey conducted by the Kaiser Foundation obtained similar results. According to data they shared, more than two thirds (69 percent) of adults gave a "very important" rating to both "making health care and health insurance more affordable" and "finding a way to provide health insurance coverage to most Americans."

So what should policy makers and proponents of health care reform take from these results? The first and most obvious is the conclusion reached by Clifford Young of Ipsos Public Affairs in his review of the new Ipsos/McClatchy poll results: "It is important that both coverage and cost be addressed by the reform."

Second, although most Americans with health insurance express satisfaction with their coverage, they also worry about increasing costs. The February Kaiser survey found that "half of Americans (53 percent) say that their household has cut back on health care in some way over the past year because of cost concerns." Almost as many (45 percent) said they are "very" worried about paying more for health care or insurance, "the highest proportion measured in Kaiser polls since late 2006."

Finally, these results imply that the most enticing aspect of health care reform exists at the intersection of cost and coverage. True, the February Kaiser survey found relatively less anxiety about "losing your health insurance coverage" -- 34 percent were "very worried," another 20 percent "somewhat worried" -- but Americans also understand that a loss of coverage means a catastrophic increase in personal cost, especially in the event of a major illness.

Slate's Mickey Kaus puts it more simply: The aspect of reform that "most voters might desperately crave" is "not having to worry about where their health insurance will come from anymore."

So (the pollster in me is tempted to ask), would you say they the potential benefit that Kaus describes is mostly about reducing costs, mostly about expanding coverage -- or both?

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