What Americans Want for the Future of Health Care
Co-authored by Dr. S. Ward Casscells
Health care has taken center stage in Washington, and a new poll conducted by Zogby International and commissioned by S. Ward Casscells, MD, a public policy expert at The University of Texas Health Science Center at Houston, gives unique insight into how Americans feel about this hot-button issue. This interactive survey of nearly 4,000 adults nationwide is among the largest and most comprehensive polls on health care issues in America to date. Due to the complexities of the issue, Dr. Casscells and I have decided a discussion format would help to further explore some of the survey findings and possible implications. We each have different takes on this incredibly complex issue, but agree that something must happen when it comes to health care in the U.S.
Dr. Casscells: We conducted this poll in the hopes of overcoming the problems we've had with other health care polls -- they're notoriously fickle, personal, complex, wording dependent, and often sponsored by passionate partisans. But they influence Congress and they've been volatile. In the past, such as in1993, support for health care reform waned as deadlines approached. We asked about health care reform again in this latest survey, and we decided to do it by conducting the largest poll done to date. Of 3,862 respondents we found 84% are satisfied with their health care, although 79% believe rising health care costs are hurting businesses. We also found that 53% believe health care to be a human right and 46% support President Obama's belief that you need a public plan to "keep insurance companies honest". We found that 44% believe the government should have an expanded role in health care.
John Zogby: My years of collaboration with the University of Texas Health Science Center goes back to 2003 and we're so glad to be working together on this survey at such a critical time in America. A word about the methodology, this is an online poll -- this is the wave of the future and the future is now. We invited 60,000 people at random from our panel of 500,000 adults nationwide and over the course of five days 3,862 responded, which is a good response rate. We've had 11 years of experience doing these and we've had a very good record polling Americans online.
Dr. Casscells: We also designed this survey to probe the American public on their feelings about how to best promote quality care. We gave respondents quite a few choices, and the top choice was to promote patient incentives for prevention, that is to say wellness programs such as weight control, vaccinations and cancer screenings. Number two was more government investment in basic research and among the other choices we found support for ranking doctors, more government investment in bedside research, and paying physicians for better outcomes, rather than the number of payments they see. The survey findings provided a strong indication that many Americans are willing to modify their unhealthy behaviors for the right incentive. We asked respondents if for $1,000 a year they would stop smoking or not start, lose 10 lbs., exercise 30 minutes three times per week, and get vaccinations and cancer screenings -- around 60% said yes. If they would hold to it, that would reduce health care costs.
John Zogby: These results really don't surprise me. This was an extremely comprehensive survey, there were over 100 questions. But over the years as we've been polling on health care reforms and while there has been a mandate for change -- reaching a crescendo in the 2009 campaign -- there has not been a consensus on the direction that change should take. What this poll reveals is nothing short of the complexity of the details that are involved. What we see is not only no consensus on no solutions but instead what we see when we pose those solutions is that it's virtually split right down the middle. That's the sort of thing we have seen but has never really tilted in one direction or another in terms of how to make this change.
Dr. Casscells: The poll we undertook was a little bit sobering and I feel a little bit like the designated driver at the party, but I think we need to look at the facts squarely -- President Obama's top priority now is insuring everyone and restraining the growth of health care costs. But as the August deadline approaches and legislation begins to specify who will win, who will control, and who will pay more, this survey shows most now oppose the proposed public plan released yesterday by the House of Representatives and oppose the mandates and the taxes and the individual components of the plan and the plan in aggregate. Is the air coming out of the balloon or is it just a case of cold feet before the wedding?
John Zogby: Democrats are from one planet and Republicans are from another planet, not only on health care reform but on a variety of issues. The critical mass is created generally by independents and moderates and in this instance we see a split among moderates and independents that further complicates this matter. Americans do believe in fairness, no doubt about it. They do believe in universal coverage, though they in no way agree on how to achieve it. I think you can say justifiably that five or six months into the Obama administration that perhaps Americans feel a "stimulus overload" -- a stimulus package, a TARP package from the previous administration, a bank bailout, and a new unit of measurement called trillions, instead of the modest billions many of us grew up with. There's a sense that the sacrifices are taking place up front, but that there hasn't been a return yet to justify more sacrifices so Americans, I think, are in a very, very cautious mood. Interestingly, my personal interpretation it that it's wise that this legislation is before Congress -- this is the time to implement health care reform. Some of the specifics here may not be popular, but President Obama is popular. If Americans do want change than something or someone is going to have to tip the scale and Obama is the person to raise the issue and somehow get it done in the first year of his first term.
Dr. Casscells: The survey also sheds light on how divided Americans are when it comes to health care reform proposals. Forty-two percent agree that we should require everyone in this country to have health insurance and offer federal help for those who cannot afford the premium, but slightly more -- 48% -- are opposed. But the big question of course is how to pay for it -- nearly everyone agrees we need to eliminate fraud, and there is strong support for standardize forms, simplify billing and reduce medical. The survey shows people are willing to have high premiums for those who participate in unhealthy behaviors, such as smoking or gaining weight, not exercising or not getting their cancer screenings -- they think that's fair. They don't think it's fair to have higher premiums for preexisting illnesses. Taxing alcohol is not very popular, but is more popular than taxing high income earners or sugary drinks or increasing the Medicare age to 66. Rationing is very unpopular as is decreasing home care.
John Zogby: There are a lot of complexities here, Democrats and Republicans are both positioning themselves on the basis of going back to their base, so I think that for the President and for Democrats, the moment is absolutely right because this will generate enthusiasm among the Democratic base going into 2010. By the same token this issue will be very appealing for Republicans to take to their base as they try to rally support. In terms of the whole populous though, no one was really polling like this in 1933, but as a historian, I can tell you that FDR, while he was pushing the Keynesian New Deal, was also going before the American people saying "my goal is to balance the budget". I think there was a sense by perhaps by the greatest politician of the 20th century that even the New Deal wouldn't have been terribly popular among all segments of the American people, Franklin Roosevelt re-defined presidential leadership. On balance I think it's a plus for Obama and the Democrats to pursue this, the risk is he certainly can't get this done during an election year, it's too hot of a potato, if he doesn't know where his numbers are going to be in 2010 or 2011 for that matter.
Dr. Casscells: Looking back, we were surprised by these findings. There's less support for sweeping health care reform than we had expected so we began to look at the past several months of health care polls and we found that despite the headlines support has been declining for the proposal to tax the "Cadillac" of public health care plans. The same for public options, support seems to be trending down. Support for the public option seems to be drifting down since early June, and we found the same for support for taxing high-income families to support the uninsured. There is strong support for providing insurance for all Americans, none for rationing care or increasing taxes. There is strong support for simplified billing, decreasing fraud, medical errors and unnecessary care, and particularly incentivizing doctors and patients for performance, especially disease prevention and good health outcomes. Overall, Americans are in favor of improving care and generating economic savings by incentivizing best practices. They want the system put on a diet and an exercise regime before resorting to surgery.
John Zogby: I believe health care reform will pass and it will not be sufficiently bipartisan, but there will be a few Republicans jumping in.
Dr. Casscells: It looks like there is some consensus and I think something will pass, but it looks like more of an engine tune-up than an engine overhaul. I think what we're seeing now is akin to wedding bell cold feet that will resolve once something is passed. This will be just another round in this fight. I think we'll have the biggest legislation since 1965, but I don't think it will be as sweeping as the House bill. I think this 42% support will be a little sobering and will embolden the Senate Finance Committee to find a middle ground. As a patient and a doctor I hope so.
John Zogby is President and CEO of Zogby International, and most recently the author of "The Way We'll Be: The Zogby Report on the Transformation of the American Dream (Random House).
S. Ward Casscells, MD is the Tyson Distinguished Professor of Medicine (Cardiology) and Public Health, Vice President for External Affairs and Public Policy at the University of Texas Health Science Center at Houston; Senior Scholar, Texas Heart Institute; and until May 2009 served Presidents Bush and Obama as Assistant Secretary of Defense (Health Affairs).
To view a webcast discussion of the survey results with John Zogby, Dr. Casscells, and leaders of the health care, business, academic, medical and policy community, please visit www.visualwebcaster.com/healthreform
The survey results are available at http://www.zogby.com/news/wf-healthcarereform.pdf and http://www.zogby.com/news/x-healthcarereform.pdf.
Jeremy Rosner: A Pollster's Advice: Don't Trust the Polls on Health Reform's Demise
If polls about policy proposals don't accurately predict legislative outcomes, why do so many people focus on them?
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Dear Mr. Zogby.
I understand importance of surveys.
However, if Americans were right in what they want, http://www
The surveys cannot answer question that are not asked. In the case of health care reform, we have lack of leadership in working on creative ways of resolving this problem. My concept of separating health maintenance plans from the lifelong health risk insurance, as outlined in my open letter to President Obama http://www
Thanks.
Surveying the American population about health care in order to find out how much they might like a public health system is similar to surveying the ubjibwe people of Patagonia on how much use they would make of Lear jets. The entire American population has had the daylights scared out of them every day since 1945 (it's called state terrorism) and the only thing they know for certain is that any time anything changes it's for the worse. Since you have a God, and He is so utterly convinced that America is His country, y'all better get down on your knees and thank Him for Barack Obama, because if he hadn't come along, you were finito, good night nurse.
The US and Canada both spent the same per person on Health Care in 1972. Now the US spends twice what Canada spends.
Why can't we go back to where we were in 1972 with the laws we had on the books then? Why did our costs rise and Canada stay the same.?
There must have been a law in the US passed which required that we pay for all people that can't afford health insurance.
private health insurance premiums have doubled since 2001 and the private health insurance cartel's profits have more than quadrupled since 2001.
Canada has no private health insurance companies--it has a single-payer national health insurance program.
next question?
If thats the case, we should all invest in health insurance companies because they make so much money. Their stock is publicly traded. Will you buy any?
Health care costs have risen. Forget about insurance premiums. I don't have health insurance. Why have costs risen ?
This report is lame, and the questions are the wrong questions. Forget the answers.
If employed Americans had to pay for their insurance wages would have to rise by at least 25%.
In fact wages have been flat for 30 years.
The big companies write off the costs to reduce their bottom lines. In effect, the cost of employee health insurance is actually subsidized by government tax policies.
Small employers (most of America) cannot afford the 16K per year it costs on average to insure their employees (family of 4). That's just the premium costs. So they offer something or nothing, depending on the strength of their business.
The game is run by insurance companies and corporate America, with our government's support.
It is part of the great divide created by capitalism in a democratic land.
The chips fall in favor of the capitalists every time, and we make sure it goes down that way. Why? because we are a nation of rich-seekers - the only thing we seem to agree on, that getting rich is ennobling.
With our economic system in trouble, the hope of a better future challenged on every front, a growing number of Americans are being left behind.
This is a perfect storm that will end this country's greatness if we do not demand that our leaders shift their priorities and secure all of the people's well-being.
Nothing being offered at the moment will change this dire state of affairs, Obama's rhetoric not withstanding.
One other issue is that large corporations who can provide volume accounts for health insurance companies get steep discounts in their premiums for their employees. I wouldn't be surprised if corporations actually make a profit on some of the policies they offer their employees after deducting the payment from their checks. Anyone paying for health policies on their own pays much higher premiums to cover those discounts. America has the most exploitive and expensive health care system in the world. We stand alone among modernized countries with this type of inequitable and exploitive system. It's absurd. The health care reform proposed by our government is a sham. We need to take the insurance companies out of the equation if we really want to reform healh care. Americans need to wake up and understand how big corporations and money are driving all our policy from bank bailouts to health care reform.
If we started calling our plan "Universal Medicare"* (as opposed to SP), it might allow some sane republicans to join us.
* term used by Stan Brock of Remote Area Medical, on Democracy Now this morning.
HR-676 Single-Payer Health Care program is the only sane, rational, and equitable means of providing medical care to all citizens and legal residents. Other nations spend 40% of what we do on health care and have much better outcomes. Foreign businesses spend less than 30% what US-based companies do for employee benefits, making them more profitable and competitive.
Despite the data and evidence showing the benefits of a single-payer health care system, we have congressional representatives in both houses and on both sides of the aisle who personally benefit from donations made by insurers and health care providers, and will pander to their patrons rather than their constituents, districts, states or the needs of this "Country First."
I agree with just about every comment here so far. That's unusual for me to agree with most comments about a HuffPost story. The small number of comments probably help the percentage of comments I agree with, but I think it shows just how most Americans would answer a poll like this Zogby Health Care Reform Poll. And, there seems to be a wide range of individuals commenting - including health care officials, retired people, small business owners, VA hospital users and even someone from the Netherlands.
One theme definitely came through loud and clear - health insurance companies have used and abused the American public for way too long and a change needs to be made now.
I looked at the Fortune 500 top 1,000 health care industry companies in 2007. There are 13 companies in the top 1,000 based on their revenue. Their total revenue in 2007 was $230 billion and their profit was $14 billion.
Here is a link to that report:
http://mon
If, for arguments sake, we say that the administrative costs for these 13 companies is 22% of revenues. That would amount to almost $51 billion a year
Here's how to make your wishes known and for more information on who and how to contact our PUBLIC SERVANTS. This is a link to Health Care Action Center at the barackobam
http://my.
By the way, the Fortune 500 pharmaceutical companies in the top 500 for 2008 include 12 companies. These 12 companies had total revenue in 2008 of $416 billion and total profits of $78 billion.
Here is a link to that report:
http://mon
Add that to the health care industry numbers for a total revenue of $646 billion and a total profit of $92 billion. That's almost 1 1/2 times the yearly revenue of Exxon Mobile at $443 billion and more profit than Exxon Mobile, Wal-mart and Chevron combined at $82.5 billion!
Here is a link to that report:
http://mon
There will be radical change to the health care system in this country, if not now, soon. Not because we want it, or we think it is a good idea, because we have to. We can't keep letting insurance companies and drug companies grow profits exponetialy forever. It is not sustainable. In the past we have been told by the health care industry that HMO's would contain costs, they didn't. We were told co-pays would contain costs, they didn't. At some point we will not be able to afford the private sectors soloutions any more. We already dedicate enough of our GDP to health care to give every person in this country adequate health care. We are just not getting enough for our money. Believe it or not, the free market system has failed us. We need to do what all the other modern countries in the world have done. Single payer universal health care. If you are not happy with that, I'm sure some private insurance company will sell you suplemental health care insurance, if you can afford it.
Health care is about the un-free-est market there is.
Online polling might be the wave of the future, but I have serious questions about this poll's validity. You invite thousands of people -- by phone or email -- to participate in an -- online -- poll. There's a very important demographic here that is COMPLETELY unrepresented: the truly desperate and destitute (as opposed to the "merely" poor), including the homeless. How on God's green Earth is a homeless person supposed to even KNOW (or care) that a health care poll is being conducted? And what are the odds that that homeless person is "satisfied with his health care"?
True. Odds are, people are going to support getting free goodies at their neighbors expense. It's human nature, unfortunately.
I see several flaws in your thinking, BigShot. I took the poll. I have DSL because it is my sanity. However, I am on disability, our healthcare expenses are killing us. I am desperate for public healthcare because my husband's BCBS costs over $1000 per month. There is so much more to the stories than your easy assumptions.
One things for sure- not many uninsured poor people have a computer to be part of Zogby's online herd that he culled the folks that were polled where he found 84% loving their insurance.
Health care as a hidden tax. I gross about $55,000 a year. The health insurance plan that covers my wife and I costs $16,000 a year. That's 22% of my income. For the last 5 years raises have been skimpy as the cost of health care goes up and up. This year no raise at all. Hospitals in my area are closing, my employer pays more for health insurance every year and every year doctors and hospitals are being paid less, and every year the insurance industry comes up with new co-pays. This is not sustainable and we have to come up with a new model. For the life of me I don't understand why we don't try the model that every modern country has in place, universal single payer health care. Take profit out of health care.
No it isn't. You can't stop paying taxes. You can stop paying for health care.
You earn almost $4.600 a month before taxes, Some familys don't even come close to that.
Of the last 12 Presidents 6 months into their Presidency President Obama is 10th. He's even lower than Jimmy Carter a one term President. See the Poll from USA Today:
http://www
Democrats can't keep running on Bush's popularity forever, Its eather put up or.
I keep hearing that even if a Health Care Reform legislation is passed -- that it won't take effect for FOUR years (2013). Why 4 years? So that the health insurance companies can squeeze blood money from America?
Just like the credit card bill that doesn't go in effect until February, the banks are doing everything they can to get their blood money until then.
So why 4 years? Why not 1 year? Or less?
Good question, DuKe. We need drastic reform (not "overhaul") now, as soon as the bill is signed.
The CBO figures are out on the cost so far of the "bail outs" 24 TRILLION. The Government Take Over of Health Care as now proposed would add another 2 Trillion, add to that the fat Pork Laden budget signed by the President and the fact that he refuses to make public the latest budget delaying for 2 months it's unveiling ( till after Health Care is passed) . Tax Payers....
With all due respect to Mr. Zogby, I think the wrong questions are asked of those polled.
Ask people what they want from the health care system and what role insurance should play. Asking people what they think of healthcare reform when all we've heard about the plans has been spun into nonsense. How can people comment on legislation that is pending? The media and the GOP keep "dropping bombs": the same old scare tacts of lack of choice, government run healthcare & s o c i a l i s m!!! They are taking those items still being constructed to beat us over the head into rejecting health care reform.
These same groups & mindset tried to defeat Medicare.. Do you know anyone who would give it up. . Once we get real healthcare reform the vast majority of Americans will wonder what took so long???
A week or so ago there was a very interesting artilce in (I believe) the Financial Times which reported that the citizens are most content when their society mixes capitlaism and socialism. Capitalism for growth and prosperity, socialism to make sure there's a level playing field in healthcare, education, etc.,
People of these nations also have a different mentality concerning their neighbors and fate. All understand that bad things happen to good people all the time and lives and livilhoods shouldn't be a risk because of a fate they had no part in making.
"How can people comment on legislation that is pending?"
exactly so how do you come to the conclusions you do? Leap of faith?
Gotta keep pushing this idea. ---
Health Care Solution..
Provide basic health care for all U.S. citizens..
Health care solutions ----
All citizens should have access to AFFORDABLE, or FREE,
basic medical care in order to reduce the development and
frequency of costly and avoidable problems. ----
Necessary Parts ----
a. Accessible facilities with certified staff. ----
b. No ability to sue. ----
c. No unnecessary tests. ----
Thank you, ----
Robert Evan Howard ----
aclepd.com ----
aclepd.comepd.com
So if you are maimed or left on massive equipment to keep you alive because some doctor messed up and put you in that position due to neglect, under your plan, you have no recourse!! FAIRY TALE
Why?
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