Public Opinion About Health Care - Most Americans Believe That Access To Health Care Is A Right, Many Americans Are Concerned About Their Ability To Pay For Health Care
system reform dissatisfaction media
As with many other social issues, public opinion about health care systems, providers, plans, coverage, and benefits varies in response to a variety of personal, political, and economic forces. Personal experience, and the experience of friends, family, and community opinion leaders—trusted sources of information such as members of the clergy, prominent physicians, and local business and civic leaders—exert powerful influences on public opinion. Health care marketing executives have known for years that the most potent advertising any hospital, medical group, or managed care plan can have is not a full-page newspaper advertisement or primetime television ad campaign. It is positive word-of-mouth publicity.
Political events and election campaigns can focus public attention on a particular health care concern, supplant one health-related issue with another, or eclipse health care from public view altogether. Health care reform and a strong push for national health insurance were hallmarks of former U.S. President Bill Clinton's campaigns in the 1990s but by 2000 were all but forgotten in favor of debates about Medicare reform, prescription drug benefits, and passage of a patients' bill of rights. The events of September 11, 2001, also realigned health concerns as much as they affected other national priorities. In the final months of 2001, several public opinion surveys reported preventing bioterrorism as Americans' numberone health concern. During September 2002 the media were focused on U.S. preparations to take military action in Iraq. As a result, there were far fewer news stories about the upcoming open-enrollment period (when employees can switch health plans) than usual.
By 2004, economists, political observers, and pollsters opined that after concern about the U.S. economy and Iraq, health care costs would be a prominent issue in the election year. A record 9.5% increase in health care spending in 2002—the largest annual increase in more than a decade, followed by a 7.4% increase in 2003—coupled with consumer and media attention to issues such as prescription drug costs combined to intensify Americans' concerns about their ability to afford health care services.
The national economy and the rate of increase of health care costs, especially out-of-pocket expenses, play important roles in shaping public opinion. When unemployment rates are high, the proportion of persons without insurance increases, workers fear losing their jobs and their health care coverage, and dissatisfaction with the present health care system grows. Multiple surveys have shown a direct relationship between rising out-of-pocket expenses and dissatisfaction with the health care system. The recent spike in health care costs coupled with survey findings that employers intend to pass off some of the increasing costs to their employees will likely inspire renewed interest in health care reform.
There also is evidence that Americans do not anticipate that reform will substantially improve health care access, availability, or quality in the foreseeable future. A 2004 Gallup Poll revealed that Americans anticipate that health care will continue to be a problem twenty-five years from now (Raksha Arora, "Future Imperfect: Americans Predict Woes of 2029," The Gallup Poll Tuesday Briefing, February 2004). Survey respondents named healthcare as likely to be the fifth most pressing problem, and concern about Social Security and Medicare was considered the second most pressing problem, following concern about the economy in general. (See Figure 9.1.)
Demographic changes, particularly the aging of the "baby boomer" generation (people born between 1943 and 1960) into Medicare eligibility, may also fuel dissatisfaction with the health care system. If the health care futurists who have projected glaring deficiencies in the current system's capacity to meet the needs of the aging population are correct, this generation may become the largest and most vocal advocates for health care reform.
Finally, the influence of the news media, advertising, and other attempts to sway health care consumers' attitudes and purchasing behaviors cannot be overlooked. A single story about a miraculous medical breakthrough or lifesaving procedure can reflect favorably on an entire hospital or health care delivery system. Similarly, a lone mistake or misstep by a single health care practitioner can impugn a hospital or managed care plan for months or even years, prompting intense media scrutiny of every action taken by the facility or organization.
Some industry observers believe that health care providers, policymakers, biomedical technology and research firms, and academic medical centers have fanned the flames of consumer dissatisfaction with the health care system by "overselling" the promise and the progress of modern medicine and the U.S. health care system. They fear that overzealous promotion of every scientific discovery with a potential clinical application has created unrealistic expectations of modern medicine. Health care consumers who believe there should be "one pill for every ill" or feel that all technology should be made widely available even before its efficacy has been demonstrated are more likely to be dissatisfied with the present health care system.