Published June 24, 2009
As the Obama administration pushes for a national health care plan, studies show that most Americans are overwhelmingly happy with their own health care -- but they are dissatisfied with the country's overall system, because most Americans who have insurance believe that those who don't have it are not receiving care.
Those same studies, however, show that a surprisingly large 70 percent of the estimated 46 million Americans who don't have insurance say they do, in fact, receive health care, and that a vast majority of them are satisfied with it.
A survey conducted jointly by the Kaiser Family Foundation, ABC News and USA Today, released in October 2006, found that 89 percent of Americans were satisfied with their own personal medical care, but only 44 percent were satisfied with the overall quality of the American medical system. The survey is the only recent poll for which data is publicly available that allows for a comparison of the satisfaction of insured and uninsured Americans. (The data from a just-completed New York Times/CBS poll won't be publicly available for several months; the results that have been reported so far don't make the comparisons discussed in this article.)
Those with recent serious health problems, possibly the people with the best knowledge of how health care is working, were generally the most satisfied. Ninety-three percent of insured Americans who had recently suffered a serious illness were satisfied with their health care. So were 95 percent of those who suffered from chronic illness.
President Obama, in his press conference on Tuesday, seemed to understand that degree of satisfaction. While promising to help people who are "out of luck" on insurance, he said: "If you like your plan and you like your doctor, you won't have to do a thing. You keep your plan; you keep your doctor. If your employer's providing you good health insurance, terrific. We're not going to mess with it."
But while insured Americans say overwhelmingly that they are satisfied, more than half of them -- 52 percent -- believe that becoming uninsured poses a "critical problem," 36 percent view the threat as "serious but not critical," and another 7 percent see it as a "problem, but not serious." Only 4 percent view it as "not much of a problem."
Uninsured Americans, not surprisingly, are not as satisfied as people who have insurance. Nonetheless, 70 percent of the uninsured who indicated their level of satisfaction said they were either "satisfied" or "very satisfied" with their health care, and only 17.5 percent said they were "very dissatisfied."
Analysts say legislators should pay close attention before enacting a national health care plan.
"If the insured come to believe that the uninsured are not that dissatisfied with their health care, it is extremely important. It could throw a real wild card into the whole health care debate," Jack Calfee, a resident scholar at the American Enterprise Institute, told FOXNews.com.
"It is a common finding in public opinion research," Henry Aaron, a senior fellow for economic studies at the Brookings Institution, told FOXNews.com. "People are satisfied in the small, but dissatisfied in the large. People are satisfied with their child's teachers or school, but dissatisfied with schools generally.... They are satisfied with their doctor or their last visit to the hospital, but they are dissatisfied with what they perceive is happening with medical care as a whole. This finding is just one additional example."
The Kaiser/ABC News/USA Today survey found that about 13.4 percent of Americans were uninsured (a number slightly smaller than the 15.5 percent estimate used in policy debates from a Department of Labor survey). In crunching the numbers, since 13.4 percent multiplied by the 17.5 percent of the uninsured said that they were "very dissatisfied," it follows that out of all Americans, only 2.3 percent are both uninsured and "very dissatisfied" with the care they receive. The number rises to 3.9 percent when you include all the uninsured who are dissatisfied in any way with their health care.
To put those numbers differently, 5 million uninsured Americans are very dissatisfied with their health care. Including those dissatisfied in any way raises that to 8.4 million.
The survey of patient satisfaction also asked about the aspects of health care that dissatisfy Americans. The uninsured were most dissatisfied with their "ability to get the latest, most sophisticated medical treatments" (35 percent were "very dissatisfied"), followed by their ability to get non-emergency medical treatments without having to wait" (32 percent), and their "ability to see top-quality medical specialists, if you ever need one" (31 percent). At the other end, only 10 percent of the uninsured felt "very dissatisfied" with "the quality of their communication" with their doctor.
A majority of the uninsured are not desperately poor; about 60 percent of them have personal incomes over $50,000 per year and pay out of their own pockets when necessary, rather than paying for insurance. Others manage to obtain care at highly discounted rates as charity cases.
But there are two other reasons why most uninsured are satisfied: About 14 million of the "uninsured" qualify for Medicaid, and pre-existing conditions do not exclude people from joining the government program. As a result, many who are eligible for Medicaid wait until they need care to register, so they are effectively insured at all times even when they are not formally enrolled in the program.
In addition, once those who are already effectively covered by Medicaid are excluded, nearly 70 percent of the remaining uninsured are without insurance for less than four months. The large majority may be uninsured for such short periods of time that being uninsured is never relevant for their ability to get health care.
Under Obama's proposal, the government will provide insurance and determine the compensation doctors receive for different services, but doctors' offices and hospitals will still technically be privately run. Many Republicans claim that the subsidies and other advantages provided to government insurance would drive private insurance companies out of business. If so, Obama's proposal would be identical to Canada's health insurance program, so it is useful to compare Americans' satisfaction to Canadians'.
A May 2008 survey by Harris/Decima TeleVox asked Canadians the same questions that appeared in the Kaiser/ABC News/USA Today survey two years earlier. In most comparisons, Canadians were more satisfied than uninsured Americans, but just barely, and they were nowhere as satisfied as insured Americans. Canadians are most similar to insured Americans in terms of their happiness with their ability "to get non-emergency care without having to wait." While 77 percent of insured Americans and 41 percent of uninsured Americans were satisfied with timely non-emergency care, the figure for all Canadians was 60 percent.
Among the biggest differences between percentage of Canadians and insured Americans who were satisfied were the "ability to see top-quality medical specialists, if you ever need one" (26 percentage points difference) and the "ability to get emergency care" (24 percentage points difference).
Another comparison between the U.S. and Canada can be made in terms of how egalitarian the two systems are. That is, is there much difference in levels of happiness between people based on race, education, income, marital status, age, political views, or income? For both Americans and Canadians, higher incomes don't buy higher levels of satisfaction with their health care. In the U.S., there is no difference in happiness by race; blacks are just as satisfied as whites or Asians or Hispanics. Canadians do experience greater differences in happiness across provinces than Americans face across states.
There are certainly some cases in the U.S. where uninsured individuals end up spending much of their life-savings on health care. But only a very small minority of Americans are not covered by insurance and are simultaneously "very dissatisfied" or "dissatisfied" with the health care that they receive.
-Uninsured Americans vs. Insured Canadians: Who is More Satisfied with Their Health Care? Oct. 15, 2008
-ABC News/USA TODAY/Kaiser Family Foundation health care poll Apr. 27, 2009
-President Obama press briefing June 23, 2009
-Household Income Rises, Poverty Rate Declines, Number of Uninsured Up Aug. 28, 2007
-Health-Reform Traps: Universal What? June 22, 2009
-Harris/Decima TeleVox poll on Canadian health care May 14, 2008