Gallup has today released some analysis on public perceptions of health insurers based on polls conducted from 2006-08. The data cuts to the heart of why the the President is having such difficulty in selling plans to reform health insurance: public or private, people like their health insurance. According to Gallup's data, 87% of people with private insurance and 82% of people on Medicare or Medicaid say that the quality of their health care is excellent or good. Similarly, 75% of those with private plans and 74% on government-run plans rate their insurance plan as excellent or good. It's hard to convince people that change is necessary when they are pretty content with how things are, which is part of the reason Obama's job is so hard.
The problem is that the polls like this don't capture the critical reasons why reform is necessary. Firstly and foremost, this poll doesn't represent the voices of millions of uninsured Americans, and extending coverage to those people is one of the primary motivations for reform. But, as pollster Bill McInturff, who along with Peter Hart conducted the most recent NBC/ Wall Street Journal poll, told reporters in a round table discussion last week, most Americans are convinced that covering the uninsured will require some sort of sacrifice on their behalf, and most people simply aren't prepared to give up anything to ensure that everyone has access.
The second pressing reason for health care reform is spiraling costs, a fact upon which insurers, physicians, hospitals and government all agree. It's been well reported that, as a percent of GDP, the U.S. spends significantly more than comparable nations - around 16% to Sweden or Italy's 9%, or France's 11%. But again, most people with insurance, or those on Medicare or Medicaid, don't really worry about costs (unless they get dropped from their plan or denied certain reimbursements). Either the government pays for it, or, for the significant proportion of us, our employers pay nearly all of our premiums, and they do so before tax, which leaves us with a distorted sense of how much our health care actually costs.
It's perhaps no surprise that the majority of Americans are happy with their insurance. Once you're in the system, most health care providers do a good job. And a large proportion of people in the U.S. are pretty healthy. They don't need to use their insurance that much, and when they see a doctor every few months, the experience is as good as can be expected. I'd also bet that most people have heard serious horror stories about health insurance, so when they think about whether they're happy with their own situation, they believe that, in comparison, they're doing pretty well. Regardless, whether insured people are happy with their insurance isn't part of the rationale for health care reform. It has, however, one of the reasons it could fail.