Bethesda, MD -- Americans say that high costs and the lack of insurance and access to care are the most pressing health care problems for government to address, Robert Blendon and coauthors report in an article published today as a Health Affairs Web Exclusive. Writing a month before the 2006 congressional election, the researchers also say that health care overall is a “second-tier issue” for the American public, ranking behind Iraq, the economy, and gasoline prices as a priority for government action.
“When it comes to health care, the press has been writing mostly about the Medicare prescription drug benefit, and many researchers have been focusing on quality-of-care issues,” said Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. But in an April 2006 survey sponsored by Harvard and the Robert Wood Johnson Foundation, 43 percent of Americans surveyed named high costs as one of the two most important health care issues for government to address, while 34 percent flagged the lack of insurance and access. Issues related to Medicare and the drug benefit finished a distant third, named by only 15 percent as one of the two most important health care issues, while low-quality care was even further behind at 11 percent.
“Americans want their government to do something about health care costs and the problem of the uninsured,” Blendon said. “And when Americans talk about health care costs, they’re talking about the hit on the family budget, not about a percentage of the gross domestic product.” In 2006, for example, two-thirds of respondents opined that the average American spends too much on health care. By contrast, and contrary to the opinion of many experts, majorities of Americans consistently say that both overall U.S. health care spending and government health care spending are too low.
Government Action On Health Care Is Not Among Americans’ Top Priorities
In recent surveys, the public has consistently ranked the overall issue of health care as the fourth priority for government action. In an August 2006 Harris Interactive survey, for example, 42 percent ranked the war and national defense among the two most important issues facing the United States. The economy and jobs was second, but far behind at 18 percent, while 16 percent named gas and oil prices as one of the two most crucial areas for government to address. Only 13 percent of respondents said that health care (excluding Medicare) was one of the two most important issues facing the country.
Health care is thus far less prominent an issue for the public than it was in 1993, when it was the subject of major national debate and named by 31 percent of Americans as one of the country’s two most pressing issues, behind only 45 percent for the economy and jobs. However, even having lost its place at the top of the public’s priority list, health care “ranks higher today than many other national problems often identified as being very important,” Blendon and coauthors point out. Specifically, health care still outranks education, the environment (including global warming), Social Security, poverty, and crime.
“Health care might not be as conspicuous an issue as it was in 1993, but the public is still dissatisfied with the health care system,” Blendon said. “Health care has consistently ranked in the top few issues for government to address, and politicians ignore it at their peril.”
Other notable findings reported by Blendon’s team include the following:
-- While Americans express dissatisfaction with the nation’s health care system, they rate their own medical care much more favorably. Of the three-fourths of Americans who have received medical care in the past year, more than four out of five rated the services and physician care they received as excellent or good. Blendon and coauthors posit that this divergence could stem from the fact that “general health system questions tend to measure broader public concerns about the insecurity of health insurance coverage, high prices, bureaucracy, waste, and disparities in access to care . . . . Measures of personal experiences are narrower and reflect individuals mostly positive recent experiences with care received from doctors and nurses.”
--When Americans were asked to identify the two most important diseases or conditions for government to address, cancer (51 percent) and HIV/AIDS (41 percent) topped the list. Avian flu (21 percent), heart disease (16 percent), and diabetes (11 percent) followed. When respondents were asked to name the health conditions that posed the greatest threat to the American public, the results were “essentially identical,” except that obesity tied with diabetes for fifth place. “This suggests that a share of the public sees obesity as a serious national health concern but not as a current top priority for government action,” Blendon and coauthors say, something that could change over time “as obesity receives more attention from the media and health professionals.”
The article can be read at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.25.w508