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Most Want Health Reform But Fear Its Side Effects

By Ceci Connolly and Jon Cohen
Washington Post Staff Writers
Wednesday, June 24, 2009

A majority of Americans see government action as critical to controlling runaway health-care costs, but there is broad public anxiety about the potential impact of reform legislation and conflicting views about the types of fixes being proposed on Capitol Hill, according to a new Washington Post-ABC News poll.

Most respondents are "very concerned" that health-care reform would lead to higher costs, lower quality, fewer choices, a bigger deficit, diminished insurance coverage and more government bureaucracy. About six in 10 are at least somewhat worried about all of these factors, underscoring the challenges for lawmakers as they attempt to restructure the nation's $2.3 trillion health-care system.

Part of the reason so many are nervous about future changes is a fear they may lose what they currently have. More than eight in 10 said they are satisfied with the quality of care they now receive and relatively content with their own current expenses, and worry about future rising costs cuts across party lines and is amplified in the weak economy.

President Obama, in a news conference yesterday, sought to leverage that apprehension.

"Premiums have been doubling every nine years, going up three times faster than wages," he said. "So the notion that somehow we can just keep on doing what we're doing, and that's okay, that's just not true."

Debra Matherne, a 43-year-old lawyer in Pennsylvania, agreed, saying she is contemplating leaving a job she loves because health insurance premiums for her family have jumped to $2,000 a month.

"That's just a crazy figure," she said.

The midday news conference was part of an orchestrated attempt by the White House to draw public attention to the need for landmark health legislation. Earlier in the day, Health and Human Services Secretary Kathleen Sebelius released a report documenting the growing financial burden that medical bills are placing on families.

On Wednesday, Obama will host a health-care meeting with a bipartisan group of governors and later participate in a televised town hall session dedicated to the issue.

Obama also used yesterday's news conference to rebut criticism of one of the more contentious ideas being considered: creation of a government-sponsored health insurance program that would compete with private firms.

Insurers and many Republicans warn that the "public option" included in bills filed in the House and Senate "would dismantle employer-based coverage, significantly increase costs" and add to the federal deficit.

"If private insurers say that the marketplace provides the best quality health care; if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business?" Obama said. "That's not logical."

After months of cordial relations between the industry and the White House, Obama's comments were the sharpest to date and come at a time when there is widespread debate and confusion over what the public wants. One of the reasons is the complexity of the issue, something not easily captured in a poll question.

Survey questions that equate the public option approach with the popular, patient-friendly Medicare system tend to get high approval, as do ones that emphasize the prospect of more choices. But when framed with an explicit counterargument, the idea receives a more tepid response. In the new Post-ABC poll, 62 percent support the general concept, but when respondents were told that meant some insurers would go out of business, support dropped sharply, to 37 percent.

Support for an "individual mandate," requiring every American to carry health insurance, ranges from 44 percent to 70 percent depending on the specific provisions.

"The president needs to understand that this is about patients and preserving their options," said Sen. Mike Enzi (R-Wyo.), a key player in bipartisan negotiations in the Senate. "Losing their health insurance is not the kind of change Americans were hoping for."

Even as Obama and the insurers ratcheted up the tenor of the discussion, both sides made clear there is still plenty of room for compromise.

"We are still early in this process, so we have not drawn lines in the sand," Obama said.

Karen Ignagni, head of America's Health Insurance Plans, said that she sensed an opening in the president's enthusiasm to create a government-sponsored plan modeled after the private-market plans from which federal workers choose.

In the poll, 58 percent said they see government reform as necessary to stall skyrocketing costs and expand coverage for the uninsured, while 39 percent said they fear any federal action would do more harm than good. The numbers split sharply along partisan and ideological lines: Ninety-two percent of liberal Democrats said they see government intervention as essential, compared with 19 percent of conservative Republicans.

Beyond general backing for governmental action, a few specific provisions under consideration on Capitol Hill receive significant levels of public support, including higher taxes on households with incomes above $250,000, a limit on medical malpractice amounts and, under certain conditions, a law requiring all Americans to carry health insurance. A large majority, 70 percent, opposes a new federal tax on employer-paid health insurance benefits that exceed $17,000 a year.

Majority support for certain new government action, however, does not come with high hopes: Half of all Americans said they think the quality of their health care will stay about the same if the system changes, and 31 percent expect it to deteriorate.

"We're spending a lot and not necessarily getting the bang for our buck," Philip Arms, 58, of Northwest Washington, said in a follow-up interview. Despite his desire for reform, "I'm not necessarily convinced it won't make things worse."

The poll was conducted by telephone June 18 to 21, among a national random sample of 1,001 adults; results have a margin of sampling error of plus or minus three percentage points.

Polling analyst Jennifer Agiesta contributed to this report.

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