More on "Satisfaction" with Health Coverage

06/25/2009 03:28 pm ET | Updated May 25, 2011

I want to follow-up on yesterday's post about satisfaction with health care coverage and cost, by making an admittedly wonky methodological point that yields a lesson about what makes Americans both eager for health care reform and nervous about it.

Before I started blogging I had the good fortune to conduct a long-running customer satisfaction survey program for a major American corporation. The heart of the survey was a battery of questions that asked customers to rate their satisfaction with various aspects of the company's service. Satisfaction questions of this sort have long been a staple of market research, so I never had any hesitation about asking them, but over the course of that survey are grew more and more, well, unsatisfied with questions that ask about "satisfaction," per se.

The biggest problem is that satisfaction is an attitude based on a comparison between expectations and experience. You might express satisfaction, for example, with a less than optimal experience if you start out with low expectation for that service. I wonder if something like that may be happening with satisfaction questions pertaining to the cost and quality of health care coverage.   

Consider the results obtained in surveys conducted by Democracy Corps, the polling project run by Democratic pollster Stan Greenberg and Democratic consultant James Carville. On a survey they conducted earlier this week, 71% of voters say they are satisfied with their "own health insurance coverage" (44% are very satisfied), while 25% are dissatisfied (and note, they asked this question of voters with and without health insurance). But in their analysis, Democracy Corps reports:

Conservatives and some in the media think these voters are not serious about change, but that misreads them, as we realize from our focus groups last week. They are "satisfied" with their choice of doctors, that their employer is picking up most of the cost and that they may have better insurance than others. But, they are not happy about having traded off wages or gotten locked into a job because of health care or about the fate of a child with a chronic ailment who may not be able to get insurance in the future. So, they are nervous about change, but they want it.

Greenberg and his colleagues argue that the sense of "satisfaction" with current coverage may hide negative experiences that make Americans uncomfortable with the status quo. And some findings from other surveys bear them out. In addition to the Kaiser Family Foundation results I cited yesterday, consider this example from the June survey by the Pew Research Center. They found nearly half of adults (48%) saying that "paying for the cost of a major illness" is a "major problem for you and your family" (50% say it is "not a problem"). Almost as many (43%) say that "paying for the cost of health insurance" is a major problem (61% say it is not).

And even though Americans are satisfied with their current coverage, they also express great anxiety about the future. The CBS/New York Times survey, for example, found 49% of Americans saying they are very concerned, and 37% somewhat concerned "about the health care costs you and your family might face in the coming years" (only 13% were not at all concerned). The ABC/ Washington Post survey obtained a similar result: "A whopping 85 percent are concerned about their future costs, with 59 percent 'very' concerned."

Of course, that same ABC/Post surveys shows that the anxiety cuts both ways: "About eight in 10 [adults]," the ABC analysis tells us, "are concerned that reform may reduce their quality, coverage and choice of care, and increase their costs, government bureaucracy and the federal deficit, with anywhere from 51 to 62 percent 'very' worried about each of these."

Yes, in this climate, as KFF's Mollyann Brody told me, "it is really easy to scare people into thinking that reform will make their own situations worse off." But at the same time, people are also very anxious about their costs and future coverage under the status quo. It is that latter anxiety -- much less than any altruistic desire to help out Americans without health care coverage -- that drives the huge general desire for change and reform.