How Do Americans Really Feel About Health Care?

Town hall meetings on the health care overhaul raised questions about why Americans are upset. Andrew Kohut of the Pew Research Center and Drew Altman of the Kaiser Family Foundation found answers when they asked Americans what's important to them in this health care debate.

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LINDA WERTHEIMER, host:

This is TALK OF THE NATION. I'm Linda Wertheimer in Washington. Neal Conan is away this week.

Today, the White House announced that there has been no change in White House policy with respect to a government-run insurance plan to compete with private insurers. That's after a couple of weeks of grass-roots fussing over exactly what form health care overhaul should take.

Town hall meetings gave us all a sense of what some people are thinking, and the shouting, finger-pointing and adversarial arguments reveal a number of misconceptions of what changes might mean for each of us.

The president has been on the road out West, working to make his points more clearly, but perhaps the clearest thing we've learned in the last two weeks is that there seems to be a lot of disagreement out there.

Today we hear from experts who've been taking America's pulse and are ready to tell us what's worrying folks about changing health care. Later in this hour, we'll let his fans have a word with Oscar winner Ben Kingsley. But first, whether you support health care change or oppose it, what is the one issue that could make you change your mind? Our number here in Washington is 800-989-8255. Our email address is talk@npr.org, and you can also join the conversation on our Web site. Go to npr.org, and click on TALK OF THE NATION.

First, we have Andrew Kohut, who is the director of the Pew Research Center for the People and the Press, and he joins us from Studio 3A. Andy, welcome back.

Mr. ANDREW KOHUT (Pew Research Center for the People and the Press): Hi, Linda, glad to be here.

WERTHEIMER: Now, we have mostly talked about politics and political polling and so forth, and you've saved me more than once on - with all of your polling, but what we're wondering about now is the polls that you've been conducting on the issue of health care and the overhaul of health care. What do you think is the thing that worries Americans most about these changes?

Mr. KOHUT: Writ large, the biggest concern is people worry that the government's going to have too much influence on the health care system. Then that plays out in a number of specific concerns, that their choices are going to be limited, that Medicare and Medicaid will be restricted in terms of what kinds of things are going to be covered, and just a general worry, a wariness of changing a system that for most people is okay, certainly okay in terms of quality.

People do have concerns about the costs, but there are - there's a lot of anxiety about health care reform.

WERTHEIMER: Change being something that people thought that they wanted in the election season, but confronting actual change, maybe not so excited.

Mr. KOHUT: Well, you know, people still support the goals of health care. Sixty-one percent, sixty-three percent say we should provide insurance to people who can't afford it, and the government should do that, and we should try to limit the cost of health care. But when they hear about these proposals, the polls have been coming in with pretty much of an even division of opinion, equal numbers of people saying they favor or support what they hear.

We had more opposition, 44 to 38, than favor. CNN had the balance just the other way. You put all those polls together and people are basically divided on what they're hearing about.

Now, the problem here is that people are also telling us this is hard to follow, and the complexity of it, combined with the anxiety and the over-arching concern about government, has created a climate of opinion that is best, I think, characterized as anxious.

WERTHEIMER: Let's ask Drew Altman to join us now. He's the president and chief executive officer of the Henry J. Kaiser Family Foundation, and he is at their studios in their Menlo Park office in California. Drew Altman, welcome to the program.

Mr. DREW ALTMAN (Henry J. Kaiser Family Foundation): Hi, Linda. Hi, Andy, too.

Mr. KOHUT: Hi.

WERTHEIMER: We are interested in how people view health care, and we're interested in what their perceptions are of it. So Drew, you want to weigh in on that?

Mr. ALTMAN: Well, to underscore Andy's last point, you know, we do a monthly tracking poll also, and in our most recent poll we found that a lot of people are hopeful, some people are afraid, and really a lot of people are just plain old confused. So that's really something to emphasize. People are trying to figure this out at this point. I think the town meetings and especially the media coverage of the town meetings has eroded support, and it's made people anxious, and it's made people jittery, but that's also fairly typical in a health reform debate at this stage, if you look back historically at previous debates, and still the majority of people in our monthly tracking poll are for moving ahead.

So this has not completely unraveled support. It's not a rout, and it's certainly not fatal at this point, though it is fluid. Any public opinion is movable, and I think that when the Congress returns, it will get back to the central issues, which really are not these side hot-button issues we've been hearing about this month that activists on the right and the left are very focused on, but they are, instead: Can they agree in the Congress on how to pay for this? Can they forge any kind of bipartisan agreement on the legislation, even if it's cosmetic agreement? And most especially, this is really the big one, because people are out there really trying to answer one question: What does this mean for me and my family, and will I benefit? Can they put together legislation that will meet the expectations of the American people for tangible help with their health care costs? That's really what brought us this whole debate about health reform in the first place.

WERTHEIMER: Andy, who is for health reform, reforming the health care system, and who is not? Can you see in the population, do groups stand out as being people who are for it and people who are not?

Mr. KOHUT: Well, the biggest gap is a partisan one, with Republicans being largely opposed, the Democrats being largely in favor, and the independents breaking either a little bit for or a little bit against, depending upon what poll you look at.

Beyond that, wealthy people are more likely to say they're opposed in our poll, poor people more likely to say they favor. There's a big racial gap. Whites lean against, blacks and other non-whites lean in favor. So it falls along the socioeconomic and demographic lines that you would expect.

The really interesting thing is the age gap. The biggest group of people who are worried, and they're very worried about government involvement, are the 65-and-olders. They are opposed to a system of changing health care that's going to bring in too much government, and of course they operate under Medicare. So it's one of the great ironies.

WERTHEIMER: Which is a government plan.

Mr. KOHUT: Which is a government plan which sailed through in the '60s both in the Congress and in public opinion.

Mr. ALTMAN: Just to emphasize that, I mean, seniors are absolutely a key group, and the first thing to say is, in our polls they're just really trying to figure this out, and they're confused because they see some things to worry about. Medicare payments may be cut, so they worry is this going to hurt the Medicare program, which they really care about.

On the other hand, they hear this famous donut hole in their drug coverage may be filled, and they like that. They really care about that. And also, they hear, well, health reform may help assure that Medicare will be around in the future. It may help with Medicare solvency in the future.

So they're there trying to figure this out. And they're jittery at the moment. They're worried about this. They're seniors, but they are a critical group because they matter politically so much.

WERTHEIMER: We're going to - we're going to check out a caller - Mark, who joins us from New Britain, Connecticut. Mark, could you tell me what you think is the sort of most important thing that we need to think about?

MARK (Caller): Well, for me, the make-or-break issue here is the existence of a public plan. My biggest worry is that without a public plan, this bill is going to end up being another huge giveaway to the corporate interests, the insurance companies, the way the Medicare plan for drug benefits was a bit giveaway to pharma. And frankly, if we don't have a public plan still in the mix, I don't want this to go forward.

WERTHEIMER: So you would actually jump off the boat if a public plan does not exist?

MARK: I would jump off the boat without a public plan. Actually, I would get on the boat, I would seriously consider leaving the country if we fail to do it this time.

WERTHEIMER: Oh my goodness - well - there are - you obviously though are not the only sort of - yours is not the only view, and we have somebody else that we're looking at here who wants zero government involvement. So I'm going to go to, let's see, Jason. I think it's Jason Held(ph) or - no, Jason Redding. I see. Jason in Redding, Pennsylvania.

JASON (Caller): Yes.

WERTHEIMER: So what's your view of what is wrong with what people are talking about with the health care overhaul?

JASON: Yeah, my view is we need to get the government out of it 100 percent. Any time you put the government bureaucracy in, you're doing nothing but create a problem.

There are some things we could pass that, you know, make everybody buy insurance, make it so the insurance companies can't reject anybody, make them to operate to have to take a certain portion of people that can't pay strictly based on income levels. Put it 100 percent in the private sector, and let price controls, let the capitalism do its job. But get the government out of it.

WERTHEIMER: You don't have any feeling that somehow capitalism has failed to do its job so far? Health care costs keep going up.

JASON: Subsidizing, interfering with capitalism, you've got to have capitalism or no capitalism. We don't have true capitalism. We have capitalism. Then we interfere with that, and then we wonder why it doesn't operate properly.

WERTHEIMER: I see. Okay, so is this something that would cause you to be - if there were no public plan, would you say, okay, go with the rest of it, I'm for it?

JASON: Yes, no public plan, we're on the right direction.

WERTHEIMER: Okay.

JASON: (Unintelligible). You can't have perfection, but hey.

(Soundbite of laughter)

WERTHEIMER: Thanks very much, Jason in Redding, Pennsylvania. Okay, what do you guys think here? We've got…

Mr. ALTMAN: This is Drew. Fairly typical of the divide in the reaction that we see, and really what they're trying to do is - in this legislation, it can be viewed as the fine-tuning of a centrist compromise that in truth the left and the right aren't going to be completely thrilled with, and you can see that Democrats and liberals really care about the public plan option and conservatives and Republicans don't like it very much. But let's just for a second very quickly talk about what's in this legislation.

So there are insurance market reforms…

WERTHEIMER: I'm not sure we have enough time for you to talk very quickly about it. Why don't you just talk about what kind of public plan possibilities are being talked about.

Mr. ALTMAN: I want to put it in context, which I can do in two seconds. There are insurance market reforms, the stuff like you can't be turned away if you're sick. There are coverage expansions and subsidies for people who are uninsured or work for small businesses and don't get insurance. There are delivery and payment reforms. The public plan option is the leading example of that. And there's a prevention component.

Those four things, that's what the legislation does. So the public plan option is one element of the legislation. It's not the central element of the legislation that will directly help people with their health care costs, but it's an element some people really care about.

WERTHEIMER: I want to congratulate you on actually taking a very short time to explain what's important and the possibilities for health care overhaul.

We're talking about how the country views this possibility. What one - and we're asking what one issue would change your mind in the debate, whether you support a bill or not. We'll get to more of your calls in a moment. Our number is 800-989-8255, or you can send us an email. The address is talk@npr.org.

(Soundbite of music)

WERTHEIMER: This is TALK OF THE NATION. I'm Linda Wertheimer in Washington, and today we're trying to understand how Americans feel about the health care overhaul. One way to do that is polling numbers, and those do show a clear breakdown by issue and by demographic groups.

Our guests are Andrew Kohut, who is the direct of the Pew Center for the People and the Press. He's been watching the latest polls on health care. Also, Drew Altman, who is president and chief executive officer of the Henry J. Kaiser Family Foundation.

And we have our own little unscientific poll. If you support health care change, or you oppose it, what is the one issue that would make you change your mind? Our number here in Washington, 800-989-8255, and our email address is talk@npr.org.

Okay, let's go back to the questions. Now, of the four factors, the four elements of this plan, Andy Kohut, that Drew just outlined for us - some changes in the behavior of insurance companies, like being unable to, say, drop people for pre-existing conditions…

Mr. KOHUT: Majority support, big majority.

WERTHEIMER: So that is - that's something that - that's good for most people…

Mr. KOHUT: Every poll shows that. Pre-existing conditions, we're going to get rid of that term. Big support there.

WERTHEIMER: And Drew, what was the next one?

Mr. ALTMAN: The - expanding coverage for the uninsured and providing subsidies to give people who can't afford it help paying for their health-insurance premiums.

WERTHEIMER: So is that a good idea in terms of the public?

Mr. KOHUT: People favor that, but when you get to how are we going to pay for this, they reject higher taxes on rich or well-covered health insurance plans. They're even concerned about putting penalties on employers. The only thing that we see in our polls that they favor is taxing very rich people.

(Soundbite of laughter)

Mr. KOHUT: So there's a real - you know, there's a real issue here about how do you achieve that. And while the questions - the general questions in the polls have said higher taxes, when you come to it, higher taxes for me, I'm a little less certain about that.

WERTHEIMER: But the American people, by and large, do take what it seems essentially a compassionate position that there should be insurance. Everybody should be able to get it.

Mr. KOHUT: They do, and when Drew asked a very good question that he's been asking for a long time, you get the real tension in polling, in public opinion - 51 percent say the country will be better off if health insurance reform passes, but only 39 percent say they're pretty sure that they and their family will be better off.

So there's a tension between looking at what's going to be good for other people and what just might happen to me.

WERTHEIMER: I know that exactly the same kind of tension exists, generally speaking, for tax bills. It exists for any kind of big money thing. People somehow feel that it's not going to do them any good, even though this is one of those unusual pieces of legislation that actually does affect everyone in the country.

Mr. KOHUT: It does, but a lot of people, as we said earlier, are concerned about the ways in which it could affect them, and what this amounts - what happens as a consequence, we see people who are opponents of health care reform expressing more intense views, more intense opposition, than people who are supporters of health care reform expressing intense support.

In fact, we have a question which we haven't released, so we're going to break it here. Eighteen percent of the public that we polled last weekend said they would be angry if health care reform passes. Only nine percent, in a separate question, said they would be angry if it fails.

So a lot of what we're seeing playing out in these town hall meetings is how much more energized the ideological opponents of health care reform, and the anxious people, along with the ideologues, are compared to the people who say, yes, this is a good idea, but I have some concerns about it too. And that's a really important element to the politics of this.

WERTHEIMER: We're going to check in with a caller in Vernon, New York, Cynthia, who has some concerns about this health care reform not going far enough. Am I correct? Am I characterizing this the right way, Cynthia?

CYNTHIA (Caller): Hi, Linda, and your guests. Yes, I am 79 years old. I've had Medicare and Social Security and Blue Cross Blue Shield since it began in the '50s or '60s, and yet I'm for a single payer system because I believe that it's a human right and that we have - and that it's doomed because the folks who wanted single payer, they weren't even invited to the table to discuss it. So…

WERTHEIMER: So this debate started in the wrong place, as far as you're concerned. You're being offered the wrong choices.

CYNTHIA: Yeah. The choice isn't even being offered, and so even though I'm - well, I don't like mine anymore now that I found out - and the other thing for the pollsters, they say, oh, the people who've got it, 85 percent like their insurance - well, I'll tell you, I loved mine for all these years because I never got sick.

(Soundbite of laughter)

CYNTHIA: Now that I am sick, I'm finding out, oh, Jesus - I'm sorry, excuse my language - gee - I'm not covered for this amount of days in the nursing home, and I've paid insurance for, you know, 40, 50 years.

WERTHEIMER: Well, Cynthia…

CYNTHIA: Anyway, the other thing is - the last thing is this. There's absolutely no understanding of the term public. Nobody knows what it means. It's not defined, and this they can't possibly do it in one week. It's like trying to teach kids long division before you teach them how to subtract or multiply. It cannot be done in a week, when they go back. It's not well thought out, but every single person needs to be covered, just like they are for fire when the firemen. Those are - and police.

We have agencies for the public good - (unintelligible) libraries. Why can't health care be for the public good instead of being - they just call it socialism, and that's a scare word. I talked long enough.

WERTHEIMER: Thank you very much for calling. Let me just ask these guys here who are talking with us about what they think. This is something that one of our health care correspondents says all the time. She says people love their insurance if they've never used it. Once they have to use it, they don't always love it.

Mr. ALTMAN: This is Drew. It's absolutely correct. There's just a couple of points there. People say they are reasonably happy with their plan, but what they really are upset about, having problems with, worried about, are their health care costs. And they're also worried that they may be dropped, and that is what is driving this debate.

What really happened is health care became an economic issue, a pocketbook issue for people. When people say the economy is my number one issue, their problems paying for health care and health insurance is a dimension of their economic concerns. That's what gave health care political traction again and caused the president and congressional leaders to make it a top priority.

So they may or may not be happy with their health care plan or with their doctors or with their hospitals, and we see that a lot in polling, people who don't like the Congress, but they're happy with their congressman, but they really are struggling with their health care costs.

And also it has long been true - a lot of people, you know, don't go to the doctor or the hospital very often in the course of a year, but people who are having regular experiences with the health care system are living in a different world. And of course if you're sick, then your health care costs are higher, so they're really struggling with their health care bills.

Mr. KOHUT: I can put some numbers…

WERTHEIMER: Andy Kohut?

Mr. KOHUT: …on what Drew was talking about, 34 percent saying, only 34 percent saying paying for the costs of health care - routine health care is a problem for them. When you talk about paying for the cost of health insurance, the percentage goes up to 43 percent. And then when you talk about paying for the cost of a major illness, which most people haven't experienced, the sense is it's a bigger problem, 48 percent. And those who really get there, of course, as the caller expressed, become even more convinced that's a big problem.

WERTHEIMER: So let's take another call here. This is Tom, who is in Leighton, Utah. Tom, what's your feeling about - what's your concern about health care overhaul?

TOM (Caller): My basic concern is cost, and I don't believe they're doing anything to control the cost. It's going to rise in the future. The public plan is interesting, but until we really take a serious look at other countries whose gross national product is a lot less in health care - we're not going to do what they do - you know, you've got to convince me of it first, if it's going to cut costs.

You know, government usually tries to do something, but it seems like they're just always trying to play with the issues, trying to make everybody happy, and you can't do that.

WERTHEIMER: Well, that, of course, is - I mean, you put your finger right on it. That's exactly what does happen, that legislators and various interest groups are trying to kind of negotiate something that will keep everybody reasonably happy.

TOM: Right, and it won't work. They need to go to a public plan, I believe, but I'm not really for it. I'm not too sure if that's going to control costs. That's what everybody's thinking. You're looking at - if you go to a public plan, it's going to be over $1 trillion in 10 years, and that's scary. That's not controlling cost.

WERTHEIMER: Of course, the even scarier number is what we spend now…

(Soundbite of laughter)

WERTHEIMER: …just more than that in a single year. But let's - let me ask the folks who are sitting here in the studio, what they think. Is it really possible to control costs? Is this something that, you know, the - what is driving the health care debate is to try to see that everybody has access, that more people are insured, that insurance delivery works better? Cutting costs, can you do all those things and cut costs?

Mr. ALTMAN: This is true. Let's look at it from two perspectives, first, from our people perspective. The legislation is going to help people a lot with their health care costs, which is what they're more focused on much more than the country's health care costs, the rate of increase and aggregate health care spending; because those insurance market reforms that we talked about, they're going to help sick people or women or older people who pay more than younger people for their health care premiums.

They're going to even out those premiums and help lots of people with their health care costs. And that trillion dollars, where it goes, is directly to people - some 40 million people, it's going to help them with the cost of their health insurance.

WERTHEIMER: But, of course, one of the things that is so difficult about something like this is that you can't really tell how - people can't see how it's going to work until it's starts to work. And nobody really believes it's going to help until - unless it does.

Mr. ALTMAN: And at this point, we've got five bills. And, you know, the media can't really even focus on the question, what is this going to mean for somebody who makes $50,000 a year with a family of four until we get down to one and you can look at the details.

The other perspective is the national perspective. What's it going to do for that cost curve over time? And that's a tougher one to answer. And I think the fair thing to say is that we've been working at this forever, and the legislation will make a start at making some changes in the delivery system and how we pay for care, that it's hoped over time, will begin to - to use the favored term of this debate, that I think confuses average people a lot…

WERTHEIMER: Bend the curve.

Mr. ALTMAN: Bend the cost curve.

(Soundbite of laughter)

WERTHEIMER: Perfect.

Mr. ALTMAN: Because I think average people don't know what the curve is…

WERTHEIMER: Right.

Mr. ALTMAN: …or what bending it means. But whatever it means, the legislation will, you know, make a start at that. And we can't really say, of the many things that will be started, what will pay off or how soon. It's a 10-…

WERTHEIMER: Okay.

Mr. ALTMAN: …or 20-year proposition.

WERTHEIMER: Andy?

Mr. KOHUT: Yeah. And the other thing is, I think, this is right, that we're really not going to know what public reaction's going to be until it actually plays out. I mean, we saw the same thing a few years ago with the prescription drug benefit, where people were quite skeptical about it going in. But after awhile, settled down, and the public is reasonably happy - seniors are reasonably happy with the prescription drug benefit.

WERTHEIMER: So - but, unfortunately for our - for the efforts that people are making now, we can't see into the future in quite that way.

We'll be back in just a moment. But right now, you're listening to the TALK OF THE NATION from NPR News.

Andy Kohut and Drew Altman are here with us in the studio. And we - well, Drew is in his own studio in California, I should say.

And we're going to take another call. This is a call from Steve in Ithaca, New York. And we've been asking people what would make you change your mind about health care? And what would make you change your mind, Steve?

STEVE (Caller): Nothing.

(Soundbite of laughter)

STEVE: I'm libertarian so I believe in self-responsibility. And I think that America needs to work on themselves, not worry about the government worrying about them. Sixty-four percent of the population is overweight, so let's start there.

WERTHEIMER: Well, you know, there is already a fairly large percentage of the population that is getting help from the federal government on health care…

STEVE: SSI.

WERTHEIMER: …possibly including your mother and father.

STEVE: Actually, no.

(Soundbite of laughter)

WERTHEIMER: Medicare?

STEVE: I'm fortunate in that sense. But, yeah, I would rather not even see health care in form of Medicare. I would rather depend on people depending on themselves, smaller reliance of families relying on each other. And I know that that doesn't sound too good when it deals with poor people. But you - we got to step up. And if people rely on things, they'll take handouts so, you know…

WERTHEIMER: Okay.

STEVE: …give 'em an inch, they'll take a mile.

WERTHEIMER: Let's - let me ask the two gentlemen here who are talking to us about what these all means. Andy, do very many people hold that opinion, do you think?

Mr. KOHUT: Well, you know, I think there is a great deal of - I don't think every - there are many people who are strongly anti-government, as was - libertarian, as was just expressed. But a large part of the climate of opinion about health care reform has to do with how people basically feel about government.

I went back and I looked at reactions to Medicare in 1965 which breezed through respect to the public. And that was the time in which 58, 60 percent of public believed that the government usually did the right thing. And that was a view that'd been held for a decade of polling. By the 1970s, we got to a point where only about a third of the public had believed that they could trust the government to do the right thing. And that continues to be the case today.

And so, a lot of the concerns about health care reform today versus health care reform in the 1960s, is being animated by this general distrust of government that's so much a part of the American way of thinking. And it wasn't that way the last time we had major health care reform.

WERTHEIMER: Let me ask the two of you to answer this question, as we're getting pretty much near the end of our conversation. And that is, if the Congress finally agrees on a single piece of legislation, and then the question is down to yes or no on this health care reform bill, without knowing what the details are yet, what do you think?

Drew, what do you think? Do you think the American people will be for health care reform or against health care reform in the final, final choice?

Mr. ALTMAN: I think at the end of the day, this is not going to be about these hot-button side issues that we see in the town meetings or the controversial issues that they're debating on Capitol Hill, but it's going to be about the struggles the average people are having trying to answer the question - is this good for me and my family? Is there anything in the side should be afraid of?

And so when they look at that legislation, when they try and answer that question, if they - if it meets their expectations, they can say, this is going to give me some help with my health care bills…

WERTHEIMER: Okay.

Mr. ALTMAN: …I'm not going to have to worry that my insurance is going to be dropped, then I think, they'll be for the legislation and…

WERTHEIMER: And the…

Mr. ALTMAN: …that's the shoe that's still to drop.

WERTHEIMER: Andy, very quickly?

Mr. KOHUT: I think unbalanced people will accept it with a great deal of anxiety. One of the factors going for it is they have still have confidence in Barack Obama, and that will help get this through the court of public opinion.

WERTHEIMER: Andy Kohut is director at the Pew Research Center for the People & the Press. He was with us on Studio 3A. Drew Altman is president and chief executive officer of the Henry J. Kaiser Family Foundation. He joined us from the studios at their Menlo Park office in California.

Thank you both very much.

It's TALK OF THE NATION from NPR News.

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