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

About three in 10 also cite administrative costs, unnecessary treatments, unhealthy lifestyles and expensive new drugs and technology. Last on the list is the notion that more people are getting better care than ever: Just 12 percent see this as a top factor in rising health care costs.

Pressure on costs looks unlikely to drop, given the interest in high-end treatments and technology. Forty-seven percent of Americans think expensive new drugs, treatments and technology produce better results than older, less expensive alternatives. (There's less support for the idea that high-end doctors make much difference: Just 21 percent think more expensive doctors provide better medical care.)

While there's plenty of interest in medical products and procedures, there's still hope for cost control: Most people want these to be proven before insurance covers them. Seventy-two percent say insurance should cover expensive new drugs or treatments only if they've been shown to be more effective than other, less expensive options. Sixty-two percent feel that way even if a doctor recommends the higher-end alternative.

End of Life and Higher Risk -- Even though the aging population is not seen as a leading factor in rising costs, the high cost of end-of-life care does come in for scrutiny. Forty percent of Americans say a terminally ill person should be kept alive as long as possible, regardless of the cost. Forty-eight percent, instead, say it's better to make a judgment as to whether it's worth the expense to keep that person alive.

Interestingly, senior citizens are more likely than others to say it's better to make a cost/benefit judgment. Sixty percent say so, compared with 47 percent of adults 18-64.

In another area, there's broad support for charging higher health insurance premiums for people who smoke cigarettes – 63 percent favor the idea. But far fewer (30 percent) favor higher premiums for people who're overweight. Self-interest may be at play -- about a quarter of Americans smoke, while two-thirds are overweight.

Quality --As noted, very sizable majorities of Americans rate the quality of their current care positively, and these ratings too are essentially unchanged since 2003. Nonetheless they're far from perfect: While most are satisfied with their own care, coverage and even cost, far fewer are "very" satisfied.

For instance, while 88 percent say their coverage overall is excellent or good, that includes just 33 percent who call it "excellent." While 57 percent are satisfied with their own costs, just 23 percent are very satisfied. And even on overall quality of care, while 89 percent are satisfied, fewer are very satisfied, 52 percent.

While these are little changed from 2003, several have been much better. Most notably, in 1995 and 1997 polls about three-quarters were satisfied with their health care costs, compared with today's 57 percent. And the number who are "very satisfied" with their ability to get the latest treatments, see top specialists and get a doctor's appointment, are, respectively, 17, 15 and 11 points lower now than in 1995.

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