Health Reform Survey Shows Public Ready To Make Tradeoffs

Americans understand there will be trade-offs in the effort to reform health care, but most believe the time has come to move beyond debate and actually engage in change, according to a bipartisan national survey released last week.

Asked to pick from a dozen issues facing the nation — ranging from the war in Iraq to the environment — more than 2,000 voters identified health care as the second most important issue facing the new administration and Congress. Only employment was considered more pressing, according to the survey by the Stanford Center on Longevity.

Almost seven in 10 respondents (68%) said the country’s health care system does not work well for most Americans, but respondents were divided on how best to reform the system.

“We were a little disappointed that the results didn’t point out something that everybody loved, but it just wasn’t there,” said Laura Carstensen, director of the Stanford Center on Longevity. She said the wide range of opinions underscores the importance of getting public input when considering reform.

The study arrives as Congress begins what promises to be a protracted controversial debate about how to fix a system that most now agree is broken.

“As lawmakers are preparing large-scale legislation with the goal of improving health care in our country, it is critical that leaders engage the public in an intelligent discussion about the options for change and what they mean both for individuals and for the system broadly,” said Carstensen.

‘Shedding Light, Not Heat’

The survey is part of the Stanford research center’s “Building Sensible Health Care Solutions” project, which started nearly two years ago and brings together views from politics, academia and the public with the goal of informing policy decisions that impact longevity.

Researchers were careful to balance public input from Democrats, Republicans and Independents. They said they took special pains to craft questions carefully to avoid the appearance of bias.

“This is all about shedding light rather than heat on the issues,” said Geoff Garin, president of Peter Hart Research Associates, a national research firm that helped conduct the survey.

“We’re not selling something, and we’re not trying to kill anything,” Garin said, adding the survey was a bipartisan attempt to help policymakers get a sense of how the public views health reform options.

The respondents accurately reflect the political makeup of the country, researchers said.

“We are a center-right country, with slightly more Democrats than Republicans and this survey reflects that pretty well,” said Vince Breglio, president, of VJ Breglio and Associates, which helped conduct the survey.

Six Options Described to Voters

Working with political experts and health economists, Stanford researchers zeroed in on six broad defined policy proposals designed to improve access and reduce cost of health care. The six options — three that concentrate on improving access to care and three that concentrate on reducing costs — are based on working proposals on their way to Capitol Hill but were not identified by author or party.

Surveyors guided 2,043 voters through a comprehensive examination of the advantages and disadvantages of each. Researchers said voters’ views about each policy were measured not strictly by “pro” or “con” answers but were interpreted in terms of the tradeoffs and compromises entailed in pursuing various reforms.

“And these people were very engaged,” said Breglio. The average time respondents took to complete the survey online was 50 minutes, Breglio said.

Conspicuously absent among the proposals presented was a single-payer plan, an option with notable popular support but not much political traction.

“We considered that possibility early on, but we dropped it because we don’t see it as a politically viable option at this point,” said Carstensen. 

Garin agreed, saying neither the political wonks nor the academics who helped shape the project thought single payer should be included.

“We were driven by the experts and we did not have a huge advocate among them for that as the solution to access,” Garin said.

Some Key Findings

  • Voters’ reactions to health care proposals are predictably tied to political party affiliation. Democrats are generally more willing than Republicans to support proposals designed to expand access to care.
  • When asked if “Expanding coverage for uninsured Americans” was an important consideration, 27% of the Democrats said yes, compared to 9% of the Republicans.
  • When asked if “Keeping the U.S. health care system out of the hands of government” was an important consideration, 26% of the Republican voters said yes, compared to 2% of the Democrats.
  • All voters — Democrats, Republicans and Independents — share strong concerns about health care costs. Fifty-eight percent are not satisfied with cost and affordability of health care.
  • About 50% of all voters are satisfied with the quality of health care in the U.S.
  • Although 62% said they feel the health care system works well for them, 68% believe it does not work well for most Americans.
  • Voters do not consider maintaining individual choice of hospitals, doctors and treatments a top priority. Only 6% said it was one of the three most important aspects of reform.

Survey ‘Well Received’ on Capitol Hill

Before releasing the survey to the public last week, Stanford researchers shared their findings in a series of briefings with Congressional staffers and health officials in the Obama Administration.

The briefings have been well received, especially in terms of the information about what voters see as the tradeoffs involved, according to a survey spokesperson.

“People really deal with this in an adult way,” said Garin. “People realize there are tradeoffs for everything and I hope there will be open and honest discussion of what those tradeoffs are when we talk about expanding access to health care and lowering costs.

“I think Americans are really ready for that,” Garin said.

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