Beyond Percent Supporting

As part of my effort to blog the current Health Affairs issue, I want to touch on a point Thomas Bodenheimer makes in "The Political Divide in Health Care: A Liberal Perspective". I have a special soft spot for Bodenheimer, mostly because he authored the first substantial text I read on health policy: Understanding Health Policy. It reads like an entertaining text book and it's a great discussion of the structure of the American health system. I definitely recommend it to anyone looking to deepen their understanding.

Soft spot aside, Bodenheimer makes an essential distinction in health care polling:

A 2004 Opinion Research Corporation survey of U.S. adults found 76 percent agreeing that access to health care should be a right. In a 2003 Pew Forum on Religion and Public Life survey, 72 percent of U.S. adults, including 51% of Republicans, agreed that the government should provide universal health care even if it meant repealing most of the Bush tax cuts . . . One caveat concerns the impact of taxes on public opinion. A 1994 survey found that fewer than half of the respondents would pay more taxes to finance universal health insurance. A 1993 survey found that 64 percent were willing to pay more taxes for that purpose. Many respondents balked at paying even the tiny sum of $100 per year. If respondents were told that increased taxes reduced out-of-pocket health care payments, more than half were willing to pay an additional $1,000 a year.

The tax side of health care polling is key here. It's one thing for people to agree that they want universal insurance. It's a whole other side of the beast when you ask how much they would be willing to pay. And herein lies part of would-be reformers' problem.

We rely too heavily on polls examining support for universal insurance. Past efforts suffered severely because, though people want universal insurance in theory, they're unsure how much it means to them once it gets complicated. Is the health care situation different in 2005 than 1992? Absolutely, but one thing doesn't change -- reformers must convince the public that taxes need to be increased if the reform plan calls for it. And polling must be done beforehand to figure out the acceptable trade-offs. In the 1993 survey, most people were willing to put up to $1,000 more a year if it meant lower out-of-pocket payments. These trade-offs are extremely important issues to take into consideration when designing health care reform.

So while I always enjoy polls reflecting the public's enthusiasm for universal insurance, we must take care to extend those polls to their logical end -- how much are they willing to change to get that guarantee?

Comments

[bangvap]

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