An article posted at The Huffington Post yesterday, Poll: 73% of Voters Think Health Care Reform Must Include Choice of a Public Health Insurance Plan, drew attention to a recent poll commissioned by HCAN (Healthcare for America Now) that suggests strong grassroots support for the Obama-supported Healthcare reform plan. It is indeed an interesting survey, though not a particularly candid or objective one, and if one reads between the lines, the survey strongly suggests that the one option respondents were not asked to consider, the Single-Payer option, would have resoundingly defeated the others if it had been included in the survey questionnaire.
The survey, conducted this past January, questioned “likely voters" utilizing a random digit dial telephone sample. Unfortunately that methodology excludes all non-telephone and cell-phone-only households (cell phone numbers are not included in random-digit phone samples). These two demographics now account for about one in five U.S. households, and there is a growing body of research suggesting that any health care survey that excludes these constituencies is likely to produce skewed results since these households tend to be larger, poorer, and more likely to be uninsured than the population as a whole (see: here and here). They also tend to be at higher risk health wise than the general population. One also wonders why people unlikely to vote were excluded from the survey. What does having an intention to vote have to do with personal health issues? Is it conceivable that HCAN excluded non-voters because they might also, like non-phone households and cell-phone only households, be more likely to be disadvantaged minorities more in need of reform that provides universal, comprehensive coverage to all than the population as a whole? Whether by design or not, this methodology almost certainly resulted in a sample that severely under-represented lower income, largely minority, households more likely than the general population to lack any kind of insurance and to be most at risk in the current environment where millions lack access to health care. It is also worth noting up front that polls suggest that while the majority of Americans are strongly in favor of major healthcare reform, most with health insurance are personally satisfied with their coverage. A February 2007 New York Times/CBS poll found that while 57% of respondents were dissatisfied with the quality of healthcare in this country (a number that has grown considerably since then) 77% were personally satisfied with the quality of health care they personally received (Karen Ignani, president and CEO of America’s Health Insurance Plans/AHIP, the advocacy organization for the U.S. health insurance industry, has consistently and inaccurately cited that poll, upping the number of satisfied insurance customers to 87% while ignoring the fact that the poll revealed widespread dissatisfaction with our healthcare system and the health insurance industry her organization represents). It also bears mentioning that a person’s personal satisfaction with their own healthcare coverage does not necessarily suggest that they have adequate coverage. It simply suggests that they have not been in a situation where they experienced significant medical expenses that their insurance provider later balked at paying. Remember, Michael Moore’s “SiCKO” focused upon people who thought they had generous health insurance benefits until they got sick and discovered otherwise.
The HCAN survey asked respondents whether they preferred health care reform with "everyone getting health insurance through private health insurance plans;" or "everyone getting insurance through a public health insurance plan;" or “everyone having a choice of private health insurance or a public health insurance plan?"
15% favored private only: 9% public only: 73% a choice of public or private.
Survey respondents were given a description of the reform plan proposed by AHIP (American Health Insurance Providers, the PR/Lobby arm of the health insurance industry, as noted above) and the Obama plan supported by HCAN.
The AHIP Plan would require all private health insurers to offer at least a set amount of health coverage to all who wanted to be covered (regardless of pre-existing conditions) through a high-deductible plan whose cost would be determined by the insurance companies. The Government would then subsidize the cost of insurance for low income and some middle-income families. Everyone would be required to buy health insurance under this plan (a windfall outcome for the already very profitable health insurance industry).
The Obama plan would require all insurers to offer at least one standard comprehensive health plan with guaranteed benefits, with the cost determined by a family's income. Denial of coverage for pre-existing conditions would be prohibited, and restrictions would be imposed on how much people with pre-existing conditions could be charged. Everyone would be able to keep the insurance they have, or have a choice of a private insurance or a public insurance plan. (Note: nothing in this plan guarantees comprehensive coverage or affordability)
A Single-Payer system, privately administered but publicly financed was not included as a third possible option in the survey, even though such a system has widespread national support and has been endorsed by numerous mainstream organizations from both inside and outside the medical community (see, for example: here, here, here, here, here, here, and here).
Not surprisingly, given only the Obama Plan option or the AHIP Plan option in the survey, 67% chose the former and 24% the latter.
The next question is a bit tricky. It asked respondents if they favored or opposed providing access to affordable quality healthcare for all Americans even if it means raising taxes (tricky because in reality neither the Obama Plan nor the AHIP Plan guarantees this). 60% favored comprehensive universal health care (which only a Single-Payer plan can deliver) even if it resulted in higher taxes. 31% were opposed.
The next question is interesting, and the response to it fascinating: "Do you favor or oppose providing access to affordable quality healthcare for all Americans even if it means a major role for the federal government?” 71% favored a major government role versus 21% opposed. Once again this suggests that a third option in which the government financed a privately delivered healthcare system (Single-Payer) would have been warmly endorsed in this poll if the respondents had been offered that option.
By a 62% to 28% margin respondents rejected the notion that a public health insurance plan would be a big government bureaucracy that would increase costs to taxpayers.
The respondents to the survey hold a dim view of private insurance companies. 60% agreed with this statement:
Private health insurers will always find ways to put profits before people. That’s why we need an independent non-profit public health insurance plan that is not driven by making higher profits, in order to control costs and guarantee access to quality affordable health care.
Respondents were read 7 different names that could be used to describe "the public insurance plan option" and asked to rank each one on a scale of 0 to 5 based on how favorably disposed they felt to toward each name.
The choices were: