Lowering health care costs overall seen as top U.S. health priority

The public favors reducing jury awards in malpractice lawsuits and allowing drugs to be imported from Canada, but ranks them relatively low on a list of 12 health care priorities for President Bush and Congress to address this year, according to a new post-election survey conducted by the Kaiser Family Foundation and the Harvard School of Public Health.

Just over a quarter (26%) of the public cite reducing malpractice jury awards as a top priority for the President and Congress, ranking 11th on the list, just ahead of increasing federal funding for stem cell research (21%). Just under a third (31%) cite allowing drugs to be imported from Canada as a top priority, ranking eighth on the priority list.

At the top of the list, almost two thirds (63%) of U.S. adults cite lowering the costs of health care and health insurance as a top priority for the President and Congress, followed by making Medicare more fiscally sound for the future (58%) and increasing the number of Americans with health insurance (57%).

Overall, U.S. adults rank health care issues third when asked to name the single most important priority for the President and Congress to address. Fewer Americans cite health care issues (10%) than the war in Iraq (27%) or economic issues (17%). Terrorism/national security (10%) tied with health care as the third-most cited issue. The survey is based on a nationally representative sample of 1,396 adults and was conducted from Nov. 4-28, 2004.

Malpractice reforms

The survey finds that the public sees malpractice lawsuits as a significant factor in rising health care costs and generally sees the number of lawsuits as a bigger problem than the size of jury awards.

“The public isn’t pushing hard for malpractice reform, but will be happy to have it if the lawyers, doctors, Administration and Congress can agree to a plan,” Foundation President Drew E. Altman, Ph.D., said.

Almost a third (32%) of people say that the most important factor in causing rising malpractice insurance rates is too many lawyers filing unwarranted lawsuits, while 15% say it is the high profits of malpractice insurers, 14% say it is too many patients making unwarranted claims against doctors, and 11% say it is too many doctors making mistakes. While most of the policy debate has focused on putting caps on jury awards, 9% cite “too many juries making excessive awards” as the most important reason malpractice costs are rising.

More than seven in 10 (72%) people say they would favor legislation to prohibit people from filing medical malpractice lawsuits unless a qualified independent medical specialist reviewed the claim and thought it was reasonable. More than six in 10 (63%) say they would favor legislation that would limit the amount of money that can be awarded as damages for pain and suffering to someone suing a doctor for malpractice.

Among the 63% who support a cap on damages for pain and suffering, most favor a relatively high cap; 30% of this group favors a cap of $1 million or higher, 23% favor a $500,000 cap, 16% favor a $250,000 cap, and 15% favor a cap of less than $250,000. (The remaining 17% say they either don’t know or wouldn’t say what cap they would favor.)

Most of the public also believe that both damage caps and requiring independent medical review would have at least some impact on the overall cost of health care in the United States. About seven in 10 say that a law limiting pain and suffering awards would help a lot (32%) or some (37%) in reducing the overall cost of health care, while a quarter (25%) say it would not help much or not at all. Similarly, about three-quarters say that a law requiring independent medical review of claims would help a lot (32%) or some (43%) in lowering overall health costs, while about a quarter (23%) say it would not help much or not at all.

Republicans (37%) are more likely than Democrats (17%) to say that reducing jury awards in malpractice lawsuits should be a top priority, and they are also more likely to favor various malpractice reforms and to think that these reforms would help in reducing the overall cost of health care in the U.S.

Health care costs

Lowering the cost of health care and insurance was named as a top priority for the President and Congress by 63% of the public, and by an equal share of Republicans (61%) and Democrats (61%). Asked about the causes of rising health care costs, 29% of Americans say that high profits made by drug and insurance companies are the most important factor, while 22% say the number of malpractice lawsuits and 15% say the amount of greed and waste that occurs in the health care system. In comparison, 7% cite the costs of medical technology and drugs, a factor many health care experts cite as a major driver of higher health care costs.

Specific proposals to lower prescription drug costs

The survey finds that the public continues to support two prominent policy proposals for lowering the cost of prescription drugs: allowing the importation of drugs from Canada, and having the federal government negotiate with drug companies for lower prescription drug prices for people with Medicare.

Almost three quarters (73%) say they favor changing the law to allow Americans to buy prescription drugs imported from Canada if they think they can get a lower price, with nearly as many (69%) agreeing that the change would make medicines more affordable without sacrificing safety or quality. Seven in 10 (70%) disagree that allowing imported drugs from Canada would lead U.S. drug companies to do less research and development, and more than half (57%) disagree that it would expose Americans to unsafe medicines from other countries.

Eight in 10 (80%) say they favor changing the law to allow the federal government to use its buying power to negotiate with drug companies to try to get a lower price for prescription drugs for people with Medicare.

Majorities say that such a change would make medicines more affordable for people on Medicare (77%), and that it makes sense because the government already negotiates prices for the Departments of Defense and Veterans Affairs (67%). While 54% say such a change will mean government price controls on prescription drugs, a smaller share (29%) say it would lead U.S. drug companies to do less research and development.

Majorities also believe that each of these measures would provide at least some help in reducing prescription drug costs overall. More than three-quarters say that allowing Americans to buy prescription drugs imported from Canada would help a lot (33%) or some (44%) in reducing prescription drug costs in the United States, while 18% say it would not help much or not at all. Similarly, eight in 10 say that allowing the federal government to negotiate with drug companies for lower drug prices for people on Medicare would help a lot (28%) or some (53%) in reducing prescription drug costs, while 17% say it would not help much or not at all.

“People are really worried about their drug costs, and they want the government to do something about it,” said Robert J. Blendon, Sc.D., Professor of Health Policy at the Harvard School of Public Health.

Expanding health coverage for the uninsured

The public places a relatively high priority on increasing the number of Americans with health insurance. More than half (57%) cite the issue as a top health care priority for the President and Congress – making it the third most-cited health-care priority behind lowering health-care costs and making Medicare more financially sound for the future.

However, the public does not agree on a single best approach and is relatively evenly divided on a number of potential policy approaches. When asked to choose their most preferred option to increase the number of Americans with health insurance, 23% say offering businesses tax deductions or other financial assistance to help them provide health insurance to their employees, while 17% say offering tax deductions or other financial assistance to help individuals pay for private insurance and 17% say expanding state government programs such as Medicaid. Smaller shares (between 12% and 15%) say they most prefer other options, such as a national government health plan, expanding Medicare to cover people under age 65, and requiring businesses to offer health insurance for their employees.

Americans are also divided on whether they are willing to pay more, either in taxes or in higher health insurance premiums, to expand coverage to the uninsured – with 51% saying they would not be willing to pay more, and 45% saying they would be willing to pay more. Another 4% were unsure. Democrats (59%) are significantly more likely to be willing to pay more than Republicans (36%).

Findings on other key health topics

• The survey finds that seniors remain significantly more likely to say they have an unfavorable (46%) than a favorable (29%) view of the Medicare law enacted in December 2003, while one in four (25%) say that they don’t know enough to offer an opinion. Seven in 10 seniors (70%) say that lawmakers in Washington should work to fix problems in the law. Much smaller numbers favor repealing the law (12%) or leaving the law as is (16%). These numbers are essentially unchanged from the results of a July 2004 survey of people with Medicare.
• When asked about the term “health savings account,” three in 10 U.S. adults (30%) say they have heard the term and know what it means, while another 17% have heard the term and don’t know what it means, and more than half (53%) say they have not heard the term. Four percent of the public overall say they are currently enrolled in a health savings account.
• At a time when there is growing debate about employer-based health insurance, the survey finds that the public is still attached to this system to which it has become accustomed. Three-quarters (75%) of the public say that most people would be better off if they got their health insurance through their employer, compared with 17% who say they would be better off purchasing their own policy. Among those with employer-sponsored coverage, half (50%) say they would prefer to have their employer pay for their insurance at work, while just 8% say they would rather have their employer give them the cash to buy a policy on their own (40% say it wouldn’t make much difference).