THE TIMES POLL : Cost May Be Key to Whether Health Reforms Win Support

Although nearly two-thirds of Americans are satisfied with the quality and choice of health care they receive, most are sufficiently anxious about the nation’s health care system that they welcome proposals to overhaul it, according to a Times Poll.

The findings suggest, and experts agree, that the President and First Lady Hillary Rodham Clinton so far have adroitly exploited such pervasive public anxiety. That, in turn, has made health care reform likely--provided it doesn’t cost too much.

To a solid majority, adopting Clinton’s reforms looks better than letting the health care system continue to evolve on its own. Asked which was the greater danger, 18% chose the Clinton proposal and 71% chose doing nothing.

But the poll also suggests that the cost of health care is as big a concern to respondents as security of coverage, and the public appears reluctant to pay significantly more to extend care to everyone.

“There’s no doubt in my mind that we’ll see a bill enacted next year called ‘comprehensive reform,’ ” said Drew Altman, president of the Henry J. Kaiser Family Foundation. “But I have my doubts whether that bill will deserve the accolade ‘comprehensive.’ ”

In the Times Poll, 56% of the respondents said that their health care coverage has changed during the last five years. Of this group, 60% said their medical costs have gone up and another 30% said they have lost some health benefits. And 47% of all poll respondents cited as their greatest health care worry the prospect of being priced out of the market, while 12% cited a lack of health care security. Half fear they would not be adequately covered if they became critically ill.

Such findings may help to explain why Americans give initial support to President Clinton’s health care reform agenda by a greater than 2-to-1 margin, as The Times reported when it published the poll results Thursday. About six in 10 respondents expect Congress and the Clinton Administration to make “substantial progress” on the issue in 1994.

As an admiring Sen. Donald W. Riegle Jr. (D-Mich.) told Mrs. Clinton during her congressional testimony last week: “You raise a level of hope for people across the nation that something good can happen by giving it this intense personal leadership as you have.”

Overall, 27% of the respondents to The Times Poll cited health care as the country’s most pressing problem, second only to the economy and unemployment, which were named by 37%.

The public does not buy into all of Clinton’s arguments, however. Despite his many efforts to portray the insurance industry as the major culprit in the health care crisis, the public believes there is plenty of blame to go around.

Asked to name the groups most responsible for skyrocketing health care costs, 35% cited physicians, followed by insurers (19%), government (14%), malpractice lawsuits (14%), hospitals (13%) and drug companies (12%). Only 3% cited patients.

The Times Poll, supervised by John Brennan, surveyed 1,491 adults from Sept. 25 to 28; it has a margin of sampling error of plus or minus 3 percentage points.

Health policy analysts and pollsters were not surprised that the poll turned up strong public support for comprehensive reform.

But they warned that the degree of support could weaken if, after details of Clinton’s proposals are known, the public concludes that it must make too great a sacrifice.

“I think there is a growing concern out there, and it’s getting greater and greater as time goes on,” Brennan said. “But I’m still not convinced there’s riotous clamor out there for health care reform.”

He noted, for instance, that 26% in the survey said they are unwilling to pay any additional taxes to help fund universal coverage, while 25% are willing to pay only $199 or less a year.

“Those numbers are not a call for great national sacrifice,” said Robert Blendon, a Harvard health policy analyst and public opinion expert. “People are looking for solutions that require modest sacrifice.”

In the poll, 10% said they expect to spend less for health care after reform; 30% said they do not expect their bills to change, and half expect their costs to rise. At the same time, 24% said they expect their coverage to improve, while 17% expect their coverage to worsen and 46% foresee no change.

About one in 10 of the respondents said they or a family member holds a job they would like to leave if they were not afraid of losing their health insurance. The Clinton Administration has made “job lock,” as it calls this phenomenon, an important motivation for making health coverage universal.

Similarly, 15% said they or a family member has been refused health coverage because of an existing medical condition.

And although Americans endorse the idea of sweeping change--70% consider the current system “unsound”--they are characteristically uncertain about whether it should be done quickly. By a 51%-44% margin, they said changes should be phased in rather than implemented quickly.

“There are limits to how fast the public wants this done,” Brennan said.

Although 76% said their own personal care is generally sound now, they were not so sure about the future. Asked to assess their own chances of keeping their health insurance and never losing it, 47% replied good while 45% answered not good.

“People are absolutely scared to death about the future, and it’s become a middle-class issue,” said Altman. “They are worried that it could happen to them.”

Twenty percent of the respondents said they had not had health insurance coverage at some time during the last 12 months. A forthcoming survey by the Kaiser Foundation of Menlo Park, Calif., will report that one out of three Americans had no insurance at some point during the last two years.

“It’s not a problem of just 37 million uninsured Americans on any given day,” Altman said.

THE TIMES POLL: How Americans View Their Health Care Now

Americans rate their own health care coverage as basically sound but still cite expense as a major worry. If they couldn’t have everything in a health care plan, most would sacrifice convenience but few would give up security or quality.

How would you rate the health coverage for you and your immediate family: Essentially good: 48% Needs some improvements: 27% Needs many improvements: 11% Needs fundamental overhauling: 11% Don’t know: 3% +

Responses by selected groups

Needs some Needs many Needs Don’t Good improvement improvements overhaul know Anglos 53% 25% 9% 10% 3% Blacks 26% 34% 24% 14% 2% Latinos 33% 34% 17% 10% 6% Medicare recipients 57% 26% 6% 8% 3% Small business workers 42% 23% 21% 12% 2% The uninsured 15% 19% 21% 37% 8% 18-29 yr olds 39% 34% 13% 13% 1%

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If you had to sacrifice one of the following in a health plan, what would it be? (up to two answers accepted) Convenience: 63% Choice: 31% Promptness: 23% Affordability: 16% Security: 11% Quality: 3% +

How would you rate the nation’s health care system: Essentially good: 5% Needs some improvements: 22% Needs many improvements: 20% Needs fundamental overhauling: 50% Don’t know: 3% +

Is the health care coverage you and your immediate family have getting better or worse? Getting better: 8% Getting worse: 18% Staying same: 71% Don’t know: 3% +

Asked of those with no private insurance: Why do you have no private insurance? Can’t afford it: 66% Companies won’t insure: 5% Getting along OK without it: 28% Don’t know: 1% +

What the greatest concern you have these days about health care coverage for you and your immediate family?* Too expensive: 47% Lack of security: 12% Coverage has gaps: 9% Won’t cover catastophic illness: 6% +

Who or what do feel is most responsible for spiraling health care costs?* Doctors: 35% Insurance companies: 19% Government: 14% Malpractice suits: 14% * Only top four responses listed. Up to two answers accepted.

HOW THE POLL WAS CONDUCTED: The Times Poll interviewed 1,491 adult Americans nationwide, by telephone, from Sept. 25 to 28. Telephone numbers were chosen from a list of all exchanges in the nation. Random-digit dialing techniques were used so that listed and non-listed numbers could be contacted. Interviewing was conducted in English and Spanish. Results were weighted slightly to conform with census figures for sex, race, age, education and labor force participation. The margin of sampling error is plus or minus 3 percentage points for the total sample; for other sub-groups it may be somewhat higher. Poll results can also be affected by other factors such as question wording and the order in which questions are presented.