A new survey conducted by Gallup in early November covered Americans’ thoughts on the health care system generally and on their own health care coverage and health care services. (Gallup Poll) There is a clear divergence in perspectives on the national system and the respondents’ personal situations. In regard to health care coverage, 69% rate theirs as excellent or good but only 32% think it is that high for the country overall. There has been virtually no change in this over a 12 year period, with 68% rating their health care coverage and 30% the nation’s this high in 2002. The rating of individual health insurance has been impressively stable, but the national one showed an uptick during the health reform debate that now has sunk back. Somewhat surprisingly, there is a similar divergence in regard to cost, with 59% saying they are generally satisfied with the cost of their health care services and 24% saying they are satisfied with the total cost of health care in the US. Going back to 2002 again, the personal rating was 64% and the national one was 28%, but in 1993, the first time major health reform was proposed, the national figure was only 8%. Both personal and national numbers have been fairly stable over time. In regard to the quality of care, 79% rate their personal care as excellent or good, a number that has varied little since 2002’s 80%. And 54% say the overall quality of health care in the country is excellent or good, again very similar to 2002’s 53%, but as with health care coverage, there was an uptick in 2009 which has since declined. Most Americans say the system has major problems, but only 20% say it is in a state of crisis and only 19% believe it is the most important problem facing the country, although that number has doubled in the last few months.
The results probably reflect the intense discussion of health care policy over the last decade and especially during the current Administration, and to some extent the recent coverage of the flawed implementation of the health insurance exchanges, although it is surprising how consistent the public’s responses have been over the last decade. It would be interesting to see the responses broken out by type of coverage–Medicare, Medicaid, commercial and uninsured/self pay. One would suspect that those covered by the public programs where there tends to be less cost-sharing would be more satisfied than those in commercial plans, where cost-sharing, both in terms of higher premium contributions and higher deductibles and copays, has tended to rise substantially. And it is apparent that many people getting coverage on the exchanges as well as from their employers are going to see much higher cost-sharing over the next year or so. Since cost is already the most substantial concern Americans have about the system, it is likely that this trend may cause a decline in satisfaction.