Americans divided on government involvement in health insurance

Researchers from Indiana University's Center for Health Policy and Professionalism Research (CHPPR) have found that support for government-sponsored health insurance for individuals under age 65 remains virtually the same regardless of how the plan is described or how involved the government would be.

Many have argued that public support of a government-sponsored health insurance option, such as that being proposed by President Barack Obama, can be significantly influenced by changing how the plan is described or by varying the description of the role government would play.

To test this idea, researchers from CHPPR developed three scenarios that each described a government health insurance plan for individuals under age 65 regardless of employment status. One scenario described an optional "public health insurance plan," another scenario described an optional "health insurance program similar to Medicare," and a third described a scenario where, similar to other countries, everyone received government insurance with an option to supplement with private insurance. Forty-three percent of respondents found the "public health insurance plan" appealing compared to 44 percent for the Medicare-like plan and 39 percent for the single-payer option. The differences between the three options fell within the margin of error.

Support for the public option was strongest among Democrats with 63 percent finding a "public health insurance" plan appealing, 64 percent finding a "Medicare like" plan appealing, and 69 percent finding a single-payer option appealing. On the other hand these options garnered far less support among Republicans with only 29 percent finding a "public health insurance" plan appealing, 30 percent finding a "Medicare like" plan appealing, and 12 percent finding a single-payer option appealing.

Reasons cited for the appeal of the "public health insurance" and "Medicare like" plans included larger numbers of Americans who would be covered by health insurance, increased choice of insurance options, and lower costs. For the single-payer option the overwhelming reason for its appeal was the increased number of Americans who would be covered by health insurance.

For those finding the three plans to be unappealing, reasons cited included expected inefficiency with government run programs, a general dislike of government involvement in health care, and concerns that this would cause increased health care costs. Republicans demonstrated the strongest opposition to these three plans with 45 percent finding the "public health insurance" plan unappealing, 37 percent finding the "Medicare-like" plan unappealing, and 56 percent finding the single-payer plan unappealing. In contrast only 11 percent of Democrats found the "public health insurance" plan unappealing, 8 percent found the "Medicare-like" plan unappealing, and 10 percent found the single-payer plan unappealing.

Age also played a role in the evaluation of these scenarios. Respondents 18 to 34 years of age found the single-payer plan (53 percent) to be the most appealing of the three scenarios, while those over age 75 favored the "Medicare-like" plan (51 percent).

"Many in Washington have spent a great deal of time finessing the descriptions and level of government involvement in the proposed options for health care reform," said CHPPR director Aaron E. Carroll, M.D., IU School of Medicine associate professor of pediatrics, a Regenstrief Institute affiliated scientist and a Riley Hospital for Children physician. "These results suggest, however, that while support for different descriptions or levels of government involvement may shift amongst certain demographics, the overall levels of support do not differ greatly when dealing with a 'public option,' 'Medicare-like' plan, or a single-payer plan. It may be that people have already decided if they support or oppose government involvement in reform, no matter what the specifics or level of such reform are."