Public opinion, knowledge, and medicare reform

Health Affairs

Volumn 18, Issue 1, 1999, Pages 180-193

  Bernstein, Jill ^a,b,c   Stevens, Rosemary A ^d  

^a National Academy of Social Insurance   (United States)

^b Managed Care Research   (United States)

^c Agy for Hlth Care Plcy/Research   (United States)

^d UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ATTITUDE TO HEALTH; HEALTH CARE POLICY; HUMAN; LEGAL ASPECT; MEDICARE; PUBLIC OPINION; UNITED STATES;

ATTITUDE TO HEALTH; HEALTH CARE REFORM; HUMANS; MEDICARE; PUBLIC OPINION; UNITED STATES;

EID: 0032622219     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.18.1.180     Document Type: Article

References (51)

1. L.R. Jacobs and R.Y. Shapiro, "Public Opinion's Tilt against Private Enterprise,"Health Affairs (Spring 1994): 285-298; R.J. Blendon et al., "What Do Americans Know about Entitlements?"Health Affairs (September/October 1997): 111-116; and R.J. Blendon, "Public Opinion and Medicare Restructuring,"in Medicare: Preparing for the Challenges of the 21st Century, ed. R.D. Reischauer, S. Butler, and J.R. Lave (Washington: Brookings Institution Press, 1998), 288-293. Results of a 1998 poll by the Kaiser Family Foundation/Harvard School of Public Health, "National Survey on Medicare: The Next Big Health Policy Debate?"(Menlo Park, Calif.: Kaiser Family Foundation, 20 October 1998) was released as this article went to press. The findings were quite consistent with those presented here.
2. L.R. Jacobs and R.Y. Shapiro, "Public Opinion's Tilt against Private Enterprise,"Health Affairs (Spring 1994): 285-298; R.J. Blendon et al., "What Do Americans Know about Entitlements?"Health Affairs (September/October 1997): 111-116; and R.J. Blendon, "Public Opinion and Medicare Restructuring,"in Medicare: Preparing for the Challenges of the 21st Century, ed. R.D. Reischauer, S. Butler, and J.R. Lave (Washington: Brookings Institution Press, 1998), 288-293. Results of a 1998 poll by the Kaiser Family Foundation/Harvard School of Public Health, "National Survey on Medicare: The Next Big Health Policy Debate?"(Menlo Park, Calif.: Kaiser Family Foundation, 20 October 1998) was released as this article went to press. The findings were quite consistent with those presented here.
3. L.R. Jacobs and R.Y. Shapiro, "Public Opinion's Tilt against Private Enterprise,"Health Affairs (Spring 1994): 285-298; R.J. Blendon et al., "What Do Americans Know about Entitlements?"Health Affairs (September/October 1997): 111-116; and R.J. Blendon, "Public Opinion and Medicare Restructuring,"in Medicare: Preparing for the Challenges of the 21st Century, ed. R.D. Reischauer, S. Butler, and J.R. Lave (Washington: Brookings Institution Press, 1998), 288-293. Results of a 1998 poll by the Kaiser Family Foundation/Harvard School of Public Health, "National Survey on Medicare: The Next Big Health Policy Debate?"(Menlo Park, Calif.: Kaiser Family Foundation, 20 October 1998) was released as this article went to press. The findings were quite consistent with those presented here.
4. L.R. Jacobs and R.Y. Shapiro, "Public Opinion's Tilt against Private Enterprise,"Health Affairs (Spring 1994): 285-298; R.J. Blendon et al., "What Do Americans Know about Entitlements?"Health Affairs (September/October 1997): 111-116; and R.J. Blendon, "Public Opinion and Medicare Restructuring,"in Medicare: Preparing for the Challenges of the 21st Century, ed. R.D. Reischauer, S. Butler, and J.R. Lave (Washington: Brookings Institution Press, 1998), 288-293. Results of a 1998 poll by the Kaiser Family Foundation/Harvard School of Public Health, "National Survey on Medicare: The Next Big Health Policy Debate?"(Menlo Park, Calif.: Kaiser Family Foundation, 20 October 1998) was released as this article went to press. The findings were quite consistent with those presented here.
5. C. Jajich-Toth and B.W. Roper, "Americans' Views on Health Care: A Study in Contradictions,"Health Affairs (Winter 1990): 149-157; LR. Jacobs, R.Y. Shapiro, and E.C. Schulman, "The Poll - Poll Trends: Medical Care in the United States - An Update,"Public Opinion Quarterly 57 (1993): 394-427; R.J. Blendon et al., "The Beliefs and Values Shaping Today's Health Reform Debate,"Health Affairs (Spring I 1994): 274-284; and DYG, Inc., Social Security and Medicare: An Ongoing Study of Public Values and Attitudes, Social Security and Medicare Anniversary Study for the American Association of Retired Persons (Washington: AARP, Fall 1996).
6. C. Jajich-Toth and B.W. Roper, "Americans' Views on Health Care: A Study in Contradictions,"Health Affairs (Winter 1990): 149-157; LR. Jacobs, R.Y. Shapiro, and E.C. Schulman, "The Poll - Poll Trends: Medical Care in the United States - An Update,"Public Opinion Quarterly 57 (1993): 394-427; R.J. Blendon et al., "The Beliefs and Values Shaping Today's Health Reform Debate,"Health Affairs (Spring I 1994): 274-284; and DYG, Inc., Social Security and Medicare: An Ongoing Study of Public Values and Attitudes, Social Security and Medicare Anniversary Study for the American Association of Retired Persons (Washington: AARP, Fall 1996).
7. C. Jajich-Toth and B.W. Roper, "Americans' Views on Health Care: A Study in Contradictions,"Health Affairs (Winter 1990): 149-157; LR. Jacobs, R.Y. Shapiro, and E.C. Schulman, "The Poll - Poll Trends: Medical Care in the United States - An Update,"Public Opinion Quarterly 57 (1993): 394-427; R.J. Blendon et al., "The Beliefs and Values Shaping Today's Health Reform Debate,"Health Affairs (Spring I 1994): 274-284; and DYG, Inc., Social Security and Medicare: An Ongoing Study of Public Values and Attitudes, Social Security and Medicare Anniversary Study for the American Association of Retired Persons (Washington: AARP, Fall 1996).
8. C. Jajich-Toth and B.W. Roper, "Americans' Views on Health Care: A Study in Contradictions,"Health Affairs (Winter 1990): 149-157; LR. Jacobs, R.Y. Shapiro, and E.C. Schulman, "The Poll - Poll Trends: Medical Care in the United States - An Update,"Public Opinion Quarterly 57 (1993): 394-427; R.J. Blendon et al., "The Beliefs and Values Shaping Today's Health Reform Debate,"Health Affairs (Spring I 1994): 274-284; and DYG, Inc., Social Security and Medicare: An Ongoing Study of Public Values and Attitudes, Social Security and Medicare Anniversary Study for the American Association of Retired Persons (Washington: AARP, Fall 1996).
9. L.R. Jacobs and R.Y. Shapiro, "Pollwatch: The Media's Reporting and Distorting of Public Opinion toward Entitlements"(Presented at the American Science Association meeting, Washington, D.C., September 1997).
10. Roper Center for Public Opinion Research, DIALOG® file, Dialog Corporation, 1998. Review of File 468: Public Opinion, limited to polls including questions about Medicare, yielded 1,226 "hits"between January 1990 and April 1998, when the analysis was done. There were 404 polls included under Medicare and Public Opinion between January 1996 and April 1998.
11. Many of the relevant polls were designed as random-digit dialing telephone polls; most had samples of approximately 1,000 and thus were generally estimated to be accurate within 3-4 percent at the 95 percent confidence level. Some surveys included larger sample sizes that allow for some subgroup analysis. The NASI poll, conducted between 27 May and 7 June 1997 by National Research, Inc., for the Study Panel on Medicare's Larger Social Role, asked 1,000 respondents a battery of questions about Medicare and, more broadly, how Americans assess collective and individual responsibility for health insurance. Respondents also were asked about a set of broad policy alternatives directed at shoring up or restructuring Medicare.
12. The focus-group project was supported by the California HealthCare Foundation. Five were held in the Los Angeles area, three in San Jose, and two in the Sacramento area. Seven focus groups were made up of Medicare beneficiaries age sixty-five or older; of these, two were conducted in Spanish and one in Chinese (Cantonese); three groups were made up of persons ages fifty to sixty-four (predominantly nonbeneficiaries but including several disabled persons in each group who were receiving Medicare benefits). The groups included low- and middle-income beneficiaries (about one-third with annual incomes under $9,000). A description of the methodology is included in Medicare Choices in California, Report to the California HealthCare Foundation, Grant no. 97-501, submitted by NASI (Washington: NASI, June 1998).
13. R.J. Blendon et al., "The Public's View of the Future of Medicare,"Journal of the American Medical Association (22/29 November 1995): 1645-1648.
14. DYG, Social Security and Medicare.
15. See K. Bowman, "Public Opinion and Medicare Restructuring,"in Medicare: Preparing for the Challenges of the 21st Century.
16. Hart-Teeter, Study no. 4085, NBC News/wall Street Journal, December 1997, fax communication from Hart-Teeter, Washington, D.C., 11 August 1998.
17. Gallup polls sponsored by the Employee Benefit Research Institute (EBRI) from 1990 through 1993 consistently showed that a majority (56 percent in 1990, 60 percent in 1991, 63 percent in 1992, and 58 percent in 1993) believed that the federal government should guarantee health insurance for all Americans. See Jacobs and Shapiro, "Public Opinion's Tilt against Private Enterprise."
18. A national survey conducted for the National Coalition on Health Care in early 1997 found that 72 percent completely agreed or somewhat agreed that the federal government can play an important role in making health care more affordable, and 69 percent, that government can play an important role in making health care better. In contrast, 40 percent agreed with the statement that the government should stay out of health care altogether, compared with 57 percent who disagreed. International Communications Group, How Americans Perceive the Health Care System: Report on a National Survey, conducted for the National Coalition on Health Care (Washington: NCHC, January 1997).
19. Jacobs et al., "The Poll - Poll Trends; "and EBRI, Public Attitudes on Health Care System Changes, Report G-33 (Washington: EBRI, May 1992).
20. Jacobs et al., "The Poll - Poll Trends; "and EBRI, Public Attitudes on Health Care System Changes, Report G-33 (Washington: EBRI, May 1992).
21. DYG, Social Security and Medicare.
22. Jacobs et al., "The Poll-Poll Trends."
23. M.L. Berk, "Should We Rely on Polls?"Health Affairs (Spring I 1994): 299-300.
24. Blendon et al., "The Public's View of the Future of Medicare."
25. In nine National Opinion Research Center (NORC) General Social Surveys conducted between 1975 and 1991, about one-third of respondents agreed strongly that it is the responsibility of the government to help people pay for doctor and hospital bills and that people should take care of themselves. Jacobs et al., "The Poll-Poll Trends."
26. EBRI, Public Attitudes on Health Care System Change.
27. A 1989 survey conducted by Mathematica Policy Research for the Physician Payment Review Commission (PPRC) found that about 9 percent of beneficiaries had paid bills themselves rather than filing claims. Among those stating that they had not filed claims for bills of $75 or more, the most commonly cited reasons were that filing the claim was too complicated or time consuming. PPRC, "Assignment and the Participating Physician Program: An Analysis of Beneficiary Awareness, Understanding, and Experience,"Background Paper no. 89-1 (Washington: PPRC, September 1989). See also Institute of Medicine, Improving the Medicare Market: Adding Choice and Protections, ed. S.B. Jones and M.E. Lewin (Washington: National Academy Press, 1996).
28. A 1989 survey conducted by Mathematica Policy Research for the Physician Payment Review Commission (PPRC) found that about 9 percent of beneficiaries had paid bills themselves rather than filing claims. Among those stating that they had not filed claims for bills of $75 or more, the most commonly cited reasons were that filing the claim was too complicated or time consuming. PPRC, "Assignment and the Participating Physician Program: An Analysis of Beneficiary Awareness, Understanding, and Experience,"Background Paper no. 89-1 (Washington: PPRC, September 1989). See also Institute of Medicine, Improving the Medicare Market: Adding Choice and Protections, ed. S.B. Jones and M.E. Lewin (Washington: National Academy Press, 1996).
29. Blendon et al., "The Public's View of the Future of Medicare."
30. HMO officials interviewed about Medicare consumer issues for an IOM study all pointed out that "the first task of the health plan in communicating with Medicare beneficiaries is to 'educate them about Medicare'."IOM, Improving the Medicare Market.
31. Thirty percent of Medicare beneficiaries knew almost nothing about managed care; only 11 percent could answer most questions developed to assess adequate knowledge for making decisions about Medicare health plan options. J.H. Hibbard et al., "Can Medicare Beneficiaries Make Informed Choices?"Health Affairs (November/December 1998): 181-193.
32. In several sessions the only way to ascertain who was enrolled in an HMO was for the moderator to ask participants to pull out their insurance cards and look.
33. See IOM, Improving the Medicare Market; Focus Group Research on Medicare Beneficiary Education, Summary of Videotape Analysis (Bethesda, Md.: Enterprises for New Directions, July 1991); J. McGee, S. Sofaer, and B. Kreling, Findings from Focus Groups Conducted for the National Committee for Quality Assurance (NCQA) Medicare and Medicaid Consumer Information Projects, Final Report (Washington: NCQA, July 1996); and Frederick/Schneiders, Inc., Analysis of Focus Groups concerning Managed Care and Medicare, prepared for the Henry J. Kaiser Family Foundation, Pub. no. 1050 (1 May 1995).
34. See IOM, Improving the Medicare Market; Focus Group Research on Medicare Beneficiary Education, Summary of Videotape Analysis (Bethesda, Md.: Enterprises for New Directions, July 1991); J. McGee, S. Sofaer, and B. Kreling, Findings from Focus Groups Conducted for the National Committee for Quality Assurance (NCQA) Medicare and Medicaid Consumer Information Projects, Final Report (Washington: NCQA, July 1996); and Frederick/Schneiders, Inc., Analysis of Focus Groups concerning Managed Care and Medicare, prepared for the Henry J. Kaiser Family Foundation, Pub. no. 1050 (1 May 1995).
35. See IOM, Improving the Medicare Market; Focus Group Research on Medicare Beneficiary Education, Summary of Videotape Analysis (Bethesda, Md.: Enterprises for New Directions, July 1991); J. McGee, S. Sofaer, and B. Kreling, Findings from Focus Groups Conducted for the National Committee for Quality Assurance (NCQA) Medicare and Medicaid Consumer Information Projects, Final Report (Washington: NCQA, July 1996); and Frederick/Schneiders, Inc., Analysis of Focus Groups concerning Managed Care and Medicare, prepared for the Henry J. Kaiser Family Foundation, Pub. no. 1050 (1 May 1995).
36. Medicare paid health plans in Los Angeles $622 per month in 1997.
37. Blendon et al., "What Do Americans Know about Entitlements?"
38. Blendon et al., "The Public's View of the Future of Medicare."
39. A Kaiser Family Foundation/Harvard University/Princeton Research Associates 1997 postelection survey found that 50 percent of those under age sixty-five believed that they will get some but not all of the current benefits when they become eligible, and an additional 30 percent thought that they will get none of the current benefits. Kaiser-Harvard Program on the Public and Health/Social Policy, "Post-Election Survey of Voters' 1997 Health Care Agenda"(Reprint, January 1997). The NASI poll conducted six months later, and worded somewhat differently, found a slightly less pessimistic view: 13 percent of respondents under age sixty-five thought that eligible people will get most of the current benefits twenty years in the future, 60 percent thought that beneficiaries will get some of the current benefits, and 25 percent believed that future beneficiaries will get none of the current benefits.
40. Blendon et al., "Beliefs and Values; "Blendon et al., "The Public's View of the Future of Medicare; "and DYG, Social Security and Medicare.
41. Blendon et al., "Beliefs and Values; "Blendon et al., "The Public's View of the Future of Medicare; "and DYG, Social Security and Medicare.
42. Blendon et al., "Beliefs and Values; "Blendon et al., "The Public's View of the Future of Medicare; "and DYG, Social Security and Medicare.
43. NASI, "Restructuring Medicare: Values and Policy Options,"Research Brief (Washington: NASI, July 1997); J. Peterson, "The Times Poll: Seniors More Inclined to Accept Increases in Medicare,"Los Angeles Times, 14 September 1997, or on the World Wide Web at www.latimes.com/HOME/NEWS/POLLS/ story12.htm (18 February 1998); D.W. Moore, "Public Supports Higher Medicare Costs for Wealthier Senior Citizens: Opposes Raising Age of Eligibility"(Princeton, N.J.: Gallup Organization, June 1997), or on the Web at www. gallup.com/POLL_ARCHIVES/1997/970704.htm; and Pew Research Center for the People and the Press, "Public Divided on Medicare Means-Testing, Eligibility Age"(Press Release, 27 June 1997).
44. NASI, "Restructuring Medicare: Values and Policy Options,"Research Brief (Washington: NASI, July 1997); J. Peterson, "The Times Poll: Seniors More Inclined to Accept Increases in Medicare,"Los Angeles Times, 14 September 1997, or on the World Wide Web at www.latimes.com/HOME/NEWS/POLLS/ story12.htm (18 February 1998); D.W. Moore, "Public Supports Higher Medicare Costs for Wealthier Senior Citizens: Opposes Raising Age of Eligibility"(Princeton, N.J.: Gallup Organization, June 1997), or on the Web at www. gallup.com/POLL_ARCHIVES/1997/970704.htm; and Pew Research Center for the People and the Press, "Public Divided on Medicare Means-Testing, Eligibility Age"(Press Release, 27 June 1997).
45. NASI, "Restructuring Medicare: Values and Policy Options,"Research Brief (Washington: NASI, July 1997); J. Peterson, "The Times Poll: Seniors More Inclined to Accept Increases in Medicare,"Los Angeles Times, 14 September 1997, or on the World Wide Web at www.latimes.com/HOME/NEWS/POLLS/ story12.htm (18 February 1998); D.W. Moore, "Public Supports Higher Medicare Costs for Wealthier Senior Citizens: Opposes Raising Age of Eligibility"(Princeton, N.J.: Gallup Organization, June 1997), or on the Web at www. gallup.com/POLL_ARCHIVES/1997/970704.htm; and Pew Research Center for the People and the Press, "Public Divided on Medicare Means-Testing, Eligibility Age"(Press Release, 27 June 1997).
46. NASI, "Restructuring Medicare: Values and Policy Options,"Research Brief (Washington: NASI, July 1997); J. Peterson, "The Times Poll: Seniors More Inclined to Accept Increases in Medicare,"Los Angeles Times, 14 September 1997, or on the World Wide Web at www.latimes.com/HOME/NEWS/POLLS/ story12.htm (18 February 1998); D.W. Moore, "Public Supports Higher Medicare Costs for Wealthier Senior Citizens: Opposes Raising Age of Eligibility"(Princeton, N.J.: Gallup Organization, June 1997), or on the Web at www. gallup.com/POLL_ARCHIVES/1997/970704.htm; and Pew Research Center for the People and the Press, "Public Divided on Medicare Means-Testing, Eligibility Age"(Press Release, 27 June 1997).
47. Peterson, "The Times Poll."
48. Blendon et al., "The Public's View of the Future of Medicare; "and Bowman, "Public Opinion and Medicare Restructuring,"in Medicare: Preparing for the Challenges of the 21st Century, 281-287.
49. Blendon et al., "The Public's View of the Future of Medicare; "and Bowman, "Public Opinion and Medicare Restructuring,"in Medicare: Preparing for the Challenges of the 21st Century, 281-287.
50. There was a belief among a number of participants in many of the groups that wealthier seniors did not actually need to use Medicare at all. In some of the sessions the moderator needed to explain that most Americans on Medicare use it as their primary insurance and that their private or retiree insurance supplements Medicare, so that the discussion could proceed usefully.
51. This level would include about 18 percent of beneficiaries. Urban Institute, unpublished analysis based on data from the Current Population Survey, 1998.