As Health Care Costs Take a Toll, Some Changes Win Broad Backing

Oct. 16, 2006 — -- Costs in the nation's health care system are ensnaring millions more Americans: One in four report problems paying their medical bills, and nearly three in 10 -- rising to nearly half of women with children -- have put off treatment because of the cost, often despite a serious illness or condition. Both are new highs in polls dating back a decade or more.

Such problems contribute to substantial public disapproval of the country's health care system overall, in terms of its cost, the level of uninsured Americans, and to a lesser extent, the quality of care. Yet most people remain satisfied with their own personal costs, coverage and care --experience that makes the risk of change less attractive.

Still, support for change does exist. Most Americans, 56 percent, favor shifting from the current health system to a taxpayer-financed universal health insurance program. But there are provisos: Support has slipped a bit from its 2003 level, as Republicans have moved farther away from the idea. And support for universal coverage drops sharply if it means higher costs, waiting lists for some care or less choice of doctors or treatments.

Support goes much higher for other, somewhat less fundamental, changes. Large majorities favor employer mandates, expanded government health insurance programs and special aid to provide low-income Americans with health coverage. Many of these are not only supported by much of the public, but "strongly" so.

This extensive survey on public attitudes on health care was conducted by ABC News; the Henry J. Kaiser Family Foundation, an independent non-profit research organization that specializes in health care issues; and USA Today. The poll supports a weeklong series, "Prescription for Change: Fixing American Health Care," Oct. 15-20 on ABC.

The poll finds that one reason for discontent with the current system is apprehension about the future. A minority of Americans, 40 percent, are dissatisfied with their own current health care costs. But, given rising rates, six in 10 insured people are worried about being able to afford their premiums over the next few years. And nearly as many worry they could lose their insurance because of the loss of a job. (Many fewer, though, are very worried.)

Cost and insecurity aren't the only concerns: Despite generally positive personal experiences, more than half, 54 percent, are dissatisfied with the quality of health care generally in the country. And 89 percent call the number of uninsured Americans a serious problem or worse, including 52 percent who call it "critical."

Proposals -- Given concerns about losing insurance through the loss of a job, an employer mandate is among the most popular possible changes to the current system. Nearly eight in 10 favor a federal requirement that all employers offer insurance to their full-time workers; 69 percent "strongly" support it.

Nearly two-thirds favor such a requirement for part-time employees as well. And to help pay for it, a vast 86 percent favor tax breaks or other incentives to businesses that do offer health insurance to their workers. Six in 10 strongly back that idea.

Such a mandate would have an impact: In this survey, nine percent of Americans who hold full-time jobs report that they currently have no health insurance, and it's 14 percent among those who are employed part-time. (Note, estimates of the uninsured population vary somewhat in different surveys. One factor is the time period specified --e.g., uninsured currently vs. ever uninsured in the last year.)

Given the current, employer-based system, lack of insurance soars among unemployed Americans (excluding retirees). And there the public favors changes as well. Eighty-two percent support expanding state-run health programs for low-income people, such as Medicaid and the Children's Health Insurance Program. Alternatively, about as many support tax credits or other aid to help the poor buy private health insurance.

In another approach, three-quarters like the idea of expanding Medicare, the government program that covers retirees, to cover people as young as age 55 who lack other health insurance; 55 percent strongly back this proposal. (Support is lower among seniors, who may fear that expanding the popular program could endanger it.)

Another notion -- requiring all Americans to obtain health insurance, with tax credits to help the poor pay for it -- gets two-thirds support. But strong support for this, the most sweeping of these proposals, is lowest -- just 35 percent. Again it seems the most-preferred approaches are not the most systemic ones.

This poll measures baseline support for all these measures; each would likely be heavily debated, and various lines of criticism (for example, negative assessments of their impact on jobs or taxes) could potentially impact their popularity.

In one example of movable attitudes, while 65 percent in general favor requiring all Americans to have health insurance, there's less support specifically for a mandatory plan like the one in Massachusetts, which carries penalties for being uninsured. That plan gets 52 percent support; the drop occurs overwhelmingly among conservatives, possibly given Massachusetts' reputation as a liberal state.

Consumer-Directed Plans -- In another direction, nearly eight in 10 Americans think that allowing people to shop around for their own medical care would be an effective way to control costs. But the idea of consumer-driven care looks less popular if it's accompanied by the risk of higher out-of-pocket expenses.

Making consumers more aware of the cost of care is a motivating force behind proposals such as "health savings accounts." In these people would be insured only for major medical needs; for routine care they'd have an annual pool of money to spend as they chose, but once depleted, further routine care would come from their own pocket. This poll finds that two-thirds oppose the idea, including as many conservatives as liberals, and six in 10 Republicans along with 73 percent of Democrats.

Such proposals are complex; other aspects could enhance their appeal in some groups, such as tax breaks on contributions made by employers and individuals; lower premiums; and the accumulation of unspent health care funds in the accounts, which can be rolled over from year to year and job to job. Still, the risk associated with these arrangements appears to be a significant hurdle for consumer-driven health plans to overcome.