Surveys developed in collaboration with the Kaiser Family Foundation

1. Understanding the Public on the Health Care Costs/Uninsured Issue:Implications for the Next Debate Surveys developed in collaboration with the Kaiser Family Foundation Robert J. Blendon, Sc.D.Kennedy School of Government Harvard School of Public Health

2. Most Important Issues for Government to Address Percent saying issue is one of two most important: 1993 November 2005 1. Economy/Jobs 45% 2. Health care 31% (excluding Medicare) 3. Federal deficit 19% 4. Education 10% 5. Abortion 9% 6(t). Taxes 7% 6(t). Programs for the poor 7% 1. War/Defense 52% 2. Economy/Jobs 17% 3. Health care 12% (excluding Medicare) 4(t). Gas & oil prices 11% Energy 4(t). Education 11% 6(t). Terrorism 9% 6(t). Taxes 9% Note: May sum to more than 100% because each respondent was asked to give up to two different answers. Harris Interactive polls, 1993, 2005.

3. Public Views of the Bush Administration’s Health Care Policies Handling of Health Care1 Country’s Health Care System at End of Bush’s Second Term2 1 ABC/Washington Post poll, January 29, 2006. 2 NYT/CBS poll, January 20-25, 2006.

4. Key Points • A principle – policy gap exists in health care • Public concerned about health care problems and supports the principles that: • There needs to be fundamental change from status quo in health system • Government should guarantee health insurance for all • Government should address costs/uninsured problems

5. Key Points • But, public will oppose policies reflecting principles if the trade-offs include: • A major negative change in their care arrangements or premiums • A substantial tax increase • Substantially hurting the economy • Media/expert role is critical here • Public does not understand the magnitude of tradeoffs • Public differs with many researchers over causes of high costs and is confused by their proposals • Trusted independent sources of information can be important to outcome of debate

6. Public Attitudes Toward U.S. Health Care System Source: Harris Interactive surveys, 1982-2005.

7. Public Support for Federal Government Guaranteeing Health Insurance for All Its Citizens Pew Center Poll, July 2005.

8. Most Important Health Care Issue for Government to Address % saying issue is one of two most important Source: Kaiser Family Foundation/Harvard School of Public Health/ICR poll, August 2005.

9. Public Support for Truman Health Plan (1949) Support Social Security covering MD and hospital bills (1949) Oppose Truman Health Plan (1950) Oppose Truman Health Plan Health Affairs (March/April 2001)

10. Public Support For the Clinton Health Plan % approving April 1993 September 1993 April 1994 US News and World Report poll, 1993. USA Today/CNN polls, 1993, 1994.

11. Insured Americans’ Satisfaction with Their Own Health Care % satisfied Health plan performance (A or B rating)1 Quality of health care received2 Ability to get most sophisticated treatment2 Source: 1Harvard School of Public Health/Robert Wood Johnson Foundation/ICR poll (December 2003); 2Washington Post/ABC News poll (October 2003).

12. The Uninsured Vs. Insured in America Put off Treatment for Serious Illness Last Year Uninsured Insured Dissatisfied with quality of care received Uninsured Insured Dissatisfied with ability to get latest treatments Uninsured Insured Source: Washington Post/ABC News poll (October 2003).

13. Public Worries about the Future Worried your health insurance will be too expensive1 Think there will be rationing2 Sources:1 Kaiser Family Foundation/Harvard School of Public Health poll (June 2005); 2 Washington Post/ABC News poll (October 2003).

14. Public Support for Federal Government Guaranteeing Health Insurance for All Its Citizens Favor if it means raising taxes1 Favor if substantial tax increase required2 Sources:1 Pew Center poll (2005); 2 Harris Interactive poll (2000), involves slightly different question wording.

15. How negative arguments affect support for proposals to cover the uninsured (1) Expanding existing state programs What if you heard that expanding these programs would require raising taxes to pay for the cost? Employer mandate What if you heard that it would be so expensive that employers would be forced to lay off workers? Tax credits and deductions for the uninsured What if you heard that the amount of tax relief would not be enough to cover the cost of a private plan? Favors after challenge Initially favors Note: Responses of Massachusetts adults Source: Harvard School of Public Health/BCBS Foundation/Cogent Research poll (2003).

16. How negative arguments affect support for proposals to cover the uninsured (2) Legally requiring all residents to have health insurance What if you heard that even with the government’s help, people won’t be able to afford insurance and the law will cause financial hardship? Single payer government plan What if you heard that you would have to wait longer for some hospital and specialty care? Favors after challenge Initially favors Note: Responses of Massachusetts adults Source: Harvard School of Public Health/BCBS Foundation/Cogent Research poll (2003).

17. Public Preference: Current System or Universal Coverage? Source: Washington Post/ABC News Poll (October 2003).

18. Americans’ Views About National Spending on Health % saying General Social Survey (2004)

19. Public’s Perception of Reasonableness of Prices of Selected Products and Services % saying unreasonable Harris Interactive poll, April 2003.

20. Perceived Reasons For Rising Health Care Costs Percent who say each is a “very important” factor in causing higher health care costs… High profits made by drug and insurance companies Number of malpractice lawsuits Amount of greed and waste that occurs in the health care system Use of expensive, high-tech medical equipment and drugs Doctors making too much money People having little incentive to look for lower cost doctors and services Source: USA Today/Kaiser Family Foundation/ Harvard School of Public Health Health Care Costs Survey (conducted April 25 – June 9, 2005)

21. What Do Researchers and the Press Need to Tell the Public About the Trade-Offs in the Next Health Care Debate? • What happens to people with the problems? • What happens to the insured middle-class taxpayer? • What happens to others? • Business, insurers • MDs, hospitals, Rx companies

22. How Does the Public Learn the Health Policy Answers from the Media? • Presentation of objective facts and descriptions • Portrayal of views of leading partisan (political) figures • Portrayal of views of trusted independent figures • Reports of interest group advertising

23. Who Will be Helped or Hurt by the Clinton Health Plan? Uninsured Poor people Middle class Washington Post poll, October, 1993.