THE TIMES POLL : Majority Favors Reform of U.S. Health Care System

A solid majority of Americans favor fundamental reforms in the nation’s health care system, such as a comprehensive national health insurance plan, mandatory employer-based coverage and long-term nursing home insurance, even if such changes required an increase in taxes, the Los Angeles Times Poll has found.

While more than 90% of the 2,046 Americans interviewed in the national poll expressed satisfaction with their personal health care, more than half said the entire system needs “many improvements” or “fundamental overhauling.”

The twin causes of this dissatisfaction appear to be skyrocketing costs of health care and a lack of insurance or inadequate coverage for millions of Americans.

Despite these problems, 69% of those surveyed believe that medical costs “can be substantially reduced” without affecting the quality of health care. And a similar majority believe the government should take the lead in both controlling costs and improving coverage and access to care.

“There is widespread exasperation with what is perceived as truly unmanageable health care costs,” said Times Poll Director I. A. Lewis. “But the public still thinks that overall, Americans receive the best health care in the world.”

While about 37 million Americans, or about 15% of the population, lack health insurance, the nation spent close to $600 billion on health care in 1989, or about 11.5% of the gross national product. The total expenditure, about $2,400 per person per year, is one of the highest in the world.

Writing in the New England Journal of Medicine last year, health economists Alain Enthoven and Richard Kronick of Stanford University termed the situation “a paradox of excess and deprivation.”

To reform the system, 72% of those surveyed in the Times poll said they would favor a comprehensive national health insurance plan; 66% voiced support for mandatory employer-based health insurance supplemented by government-sponsored health insurance for small business employees and the unemployed. Support for the proposals was broad-based, with the highest favor found among blacks, Latinos, the uninsured and those with incomes between $20,000 and $40,000 a year.

In January, Gov. George Deukmejian proposed employer-paid health insurance for every California worker. The plan would provide coverage to about 4 million of the estimated 5.2 million people without health insurance in the state today. Some of those not covered by the plan include the unemployed, homeless and students who are not dependents of their parents.

In addition, 65% of respondents to the Times poll said they favor long-term nursing home care coverage for all people over 65 years of age, regardless of their wealth.

Those interviewed said they would be willing to pay an average of $107 in additional taxes to support expanded health insurance coverage for all Americans and an average of $154 in additional taxes to pay for long-term nursing home care.

Three-fifths of those polled said “good health care is something all Americans are entitled to receive from the government.” One-quarter of respondents said health care was “something people ought to pay for themselves” and 14% said they did not know.

Nearly three-fifths of the respondents said the federal government should spend more on health care; one-third said it should spend about the same as it does now, and 4% said it should spend less.

Over the last decade, medical care leaders and politicians have frequently proposed restructurings of the health care delivery system, but relatively few of the proposals, such as changes in the way physicians and hospitals are paid under the federal Medicare program, have been enacted. And, last year, Congress repealed one of the most far-reaching reforms, catastrophic illness coverage for the elderly and disabled under the Medicare program, in response to strong protests from some senior citizens who balked at their higher tax bills.

The Times poll, a nationwide telephone survey of 2,046 Americans ages 18 and older, was conducted Jan. 21 to 24. The sampling error for a survey this size is three percentage points either way. This means that the results could vary three percentage points in either direction if every adult in the country had been interviewed in the same way.

The poll showed that although a majority of Americans believe they have some control over the quality of their health care, relatively few believe that they can control the cost of care.

When asked “How much control do you feel you personally have over the cost of the health care you receive?” 58% responded “hardly any” and 21% “not much.” Only 13% said “some” and 6% “a lot.”

Respondents cited a number of reasons why health care in the United States is so expensive. The most frequent explanation, cited 39% of the time, was malpractice suits, followed by large doctors’ fees (34%) and high hospital costs (32%). Other frequent explanations, cited by about one-fifth of respondents, were inadequate cost controls and unnecessary treatments and operations.

The poll results also reflected some apparently contradictory views about the American health care system.

For example, nearly two-thirds of those interviewed said Americans receive health care that is the “best in the world” or better than in most industrialized nations. And when informed that the United States spends substantially more of its national wealth on health care than Canada, West Germany and Great Britain, a similar majority said it is “worth the extra money.”

But when furnished with a description of the Canadian system of national health insurance, 66% of respondents said they preferred that; 25% said they preferred the American system and 9% did not know.

Under the Canadian system, the government pays most of the cost of health care out of taxes, and it sets fees charged by doctors and hospitals; people can choose their own doctors and hospitals. Per-capita health care spending in Canada is about two-thirds what it is in the United States, although life expectancy is longer and infant mortality less in Canada.

Lewis said the poll was measuring “two fairly strong opinions”--”national pride,” including the belief that American physicians practice good medicine, and “costs which are driving people crazy.”

On a more personal level, respondents said that only about half of the time do doctors diagnose ailments correctly on the first visit to the office. By the second visit, four out of five doctors find out what is actually wrong, and by the third visit, nine out of 10 doctors have gotten it right.

Moreover, many people seem to lack confidence in their doctors’ ability to treat ailments. More than half think doctors are too quick to prescribe drugs. One in 10 thinks a doctor too often withholds drugs. Only about 22% think doctors prescribe the right amount.

In other findings:

* Health care ranked fifth when respondents were asked to identify the most important problem facing the United States today. The most frequently identified problems were drug abuse, cited by 64% of respondents, and crime, cited by 26% of respondents. The federal deficit was cited by 19% of those interviewed, the economy by 16% and health care by 14%.

* President Bush received substantially higher marks for overall performance than for his performance on health care issues. In total, 77% of respondents said they approved “strongly” or “somewhat” of “the way George Bush is handling his job as President.” Fifteen percent voiced disapproval and 8% did not know. By contrast, only 34% of respondents voiced approval for Bush’s performance on health care issues; 35% said they disapproved and 31% did not know.

VIEWS ON HEALTH CARE These are results from a Los Angeles Times Poll of 2,046 residents nationwide between Jan . 21 and Jan . 24. Do you think the nation’s health care system is basically sound? Needs fundamental overhauling or many improvements: 55% Needs some improvements: 28% Good: 11% Don’t know: 6% Do y ou think good health care is something all Americans are entitled to receive from the government or something people ought to pay for themselves? Receive from the government: 61% Pay for themselves: 25% Don’t know: 14% Even if it meant an increase in taxes, would you favor or oppose: The government taking responsibility for making hospital emergency room care available to everyone?

Favor: 83%

Oppose: 13%

Don’t Know: 4%

Long-term nursing home care for all people over 65 years of age, regardless of their wealth?

Favor: 65%

Oppose: 27%

Don’t Know: 8%

Mandatory employer-based health insurance supplemented by government-sponsored health insurance for small-business employees and the unemployed?

Favor: 66%

Oppose: 23%

Don’t Know: 11%

A comprehensive national health insurance plan?

Favor: 72%

Oppose: 20%

Don’t Know: 8%

Source: Los Angeles Times Poll