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Health Care Goals: Costs, Coverage or Both?

Mark Blumenthal | July 16, 2009

Topics: Health Care Reform , Measurement

In his column in The Hill this week, Democratic pollster Mark Mellman attempts to make sense out of some very divergent obtained by national pollsters recently on the question of whether Americans consider controlling costs or expanding access to coverage the more important goal for health care reform.  The column is worth reading in full, but I want to add one thought:  I'm not a fan of the costs-or-coverage question. Read on for the reason.

Mellman notes that the recent CBS/New York Times poll finds that providing insurance to the uninsured wins as "the more serious problem" by a 39-point margin (65% to 26%), while many other polls, including those conducted by his firm, tend to show the opposite. A result released just this week by USA Today/Gallup, for example, shows American's choosing the goal of "controlling rising health care costs" over "expanding health care coverage" by a ten-point margin (52% to 42%). I tracked down at least some of the questions he referred to in the column and reproduce them in the table below (results via the Polling Report).

Mellman offers two potential explanations for the wide variation in results. One culprit, not surprisingly, is the text of the questions. "Queries that identify cost as the greatest concern," he writes, "tend to focus on the personal, whereas those that put coverage in the lead focus on the national."

Another concerns the possibility that pollsters are measuring a non-attitude:

When polls produce widely divergent results, the culprit is often non-attitudes. Sometimes the issues voters have never considered an issue until we ask. Pollsters push for opinions respondents don't really have and which could therefore be expressed quite differently in different polls. While healthcare costs and coverage are central to voters, they may have never really prioritized them, though it is hard to imagine a 53-point swing based just on non-attitudes.

Let's put that a different way. All of the questions above force respondents to choose between the goals of reducing costs and expanding access to coverage. What if they feel strongly about both goals?

The new USA Today/Gallup results released this week suggest that many Americans do exactly that. Their survey begins with a list of ways health care reform "might affect you personally," and asks respondents to rate the importance of each. They find:

• 86% rate "being able to get health insurance regardless of your job status or medical situation" as at least very important (including 43% who consider it extremely important).

• 83% rate "making your health insurance more affordable" as at least very important (including 40% who consider it extremely important).

Conceptually, both goals involve the issue of costs. Most Americans understand that if they lose their job or attempt to purchase insurance with a pre-existing condition their personal costs will be significantly higher than with ordinary, employer-provided health coverage. So it would not surprise me that many Americans have trouble disentangling the goals of cost and access to coverage.

I will have more to say about this in my column next week, but the notion that Americans worry mostly rising health care costs or mostly about covering everyone can mislead us about what those Americans who want it really want out of health care reform. It's not about cost or access to coverage. It's about both.

By Mark Blumenthal | July 16, 2009 6:11 PM | Permalink | Comments (2) | TrackBacks (0)