March 11, 2010
A Partisan Divide On The Uninsured
By Tara Sussman Oakman, Robert J. Blendon, Andrea L. Campbell, Alan M.
Zaslavsky and John M. Benson
Abstract
The partisan split in Congress over health reform may reflect a broader
divide among the public in attitudes toward the uninsured. Despite expert
consensus over the harms suffered by the uninsured as a group, Americans
disagree over whether the uninsured get the care they need and whether
reform legislation providing universal coverage is necessary. We examined
public perceptions of health care access and quality for the uninsured over
time, and we found that Democrats are far more likely than Republicans to
believe that the uninsured have difficulty gaining access to care. Senior
citizens are less aware than others of the problems faced by the uninsured.
Even among those Americans who perceive that the uninsured have poor access
to care, Republicans are significantly less likely than Democrats to support
reform. Thus, our findings indicate that even if political obstacles are
overcome and health reform is enacted, future political support for ongoing
financing to cover the uninsured could be uncertain.
Attitudes Toward Universal Coverage
Creating a national health insurance system to pay for most forms of health
care was significantly more popular among people who perceived that the
uninsured are unable to get care (72 percent) or able to get care with great
difficulty (75 percent) than it was among those who perceived that it is not
too difficult (38 percent) or not at all difficult (31 percent) for the
uninsured to get care. Similarly, 63 percent of respondents who perceived
that the uninsured do not get the same quality of care as the average
insured person also favored national health insurance, as compared to a
minority (43 percent) of respondents who said that there is no difference in
the care obtained by uninsured and insured people.
These associations persisted even after political party and demographic
characteristics were controlled for in multivariate analysis. As expected
from prior literature, political party is still a significant predictor of
support for reform. The effect of partisanship does not appear to be
mediated by the perceptions of how difficult or not it is to obtain care.
Republicans are less favorable toward national health insurance than
Democrats, even after perceptions of care access or quality for the
uninsured are controlled for.
http://content.healthaffairs.
Comment: Since the failure of the Clinton effort at reform there has been
an intense campaign by innumerable entities to educate the nation on the
problems with our health care system and the potential impact of the various
solutions. The results of the surveys reported in this Health Affairs
article are sobering, if not depressing.
A proliferation of studies has demonstrated beyond all doubt that uninsured
individuals have difficulty gaining access to health care, and the results
of those studies have been widely disseminated. Yet these surveys show that
far too many individuals do not believe this is true in spite of the
overwhelming evidence presented to them through the years.
This study demonstrated that those less likely to believe the facts about
impaired access for the uninsured included Republicans, males, seniors, and
the wealthy. What is perhaps most disconcerting of all is that even
Republicans who do understand that lack of insurance impairs access still
are opposed to creating a national health insurance system. They simply
don't care about the fate of those who must do without adequate health care.
Those supporting the current proposal before Congress should take note of
this quotation from the article:
"Even among those who perceive that the uninsured have poor access to care,
Republicans are significantly less likely than Democrats to support reform.
Further, the elderly, who are a politically influential group because of
their high political participation rates, are not cognizant of the problems
faced by the uninsured. Thus, our findings indicate that even if President
Barack Obama signs health reform into law, its future political support
could be uncertain. A shift from Democratic to Republican control of either
congressional body could mean the reduction or elimination of funding for
insurance subsidies. Subsidies are essential to a coverage expansion that
these critical constituencies ultimately deem unnecessary."
The proposed private insurance subsidies are already so modest that RAND
predicts that 25 million people will remain uninsured. When Republicans take
control, under the proposed model of reform they wouldn't even have to
repeal the program. All they would have to do is slash the premium subsidies
to wipe out the effectiveness of this legislation. Then the next step would
be to reduce the actuarial value of the plans supported, thereby requiring
sick and injured individuals to pay even more out of pocket than these plans
already require.
Try that with a single publicly-financed and publicly-administered program
that belongs to the people. The Republicans have already tried that with
Medicare, and though they caused some damage, the program barely budged.
We desperately need a single program built on a solid foundation, a program
that belongs to all of us - an improved Medicare for all.
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