“U.S. healthcare costs—and not merely prescription-drug prices—have risen to the top of the national health agenda. More than two thirds (69 percent) of the U.S. public has said that reducing these costs should be a top priority for President Donald Trump and Congress in 2019, ranking it behind only strengthening the economy (70 percent) on a list of 18 possible priorities,” note a team of healthcare policy researchers, in an article published online on May 29 in The New England Journal of Medicine. But consumers’ understanding of the underlying causes of healthcare costs remains flawed, based on their responses in public surveys, the researchers conclude.
In an article entitled “The Upcoming U.S. Health Care Cost Debate—The Public’s Views,” Robert J. Blendon, Sc.D., John M. Benson, and Caitlin L. McMurtry examine public perceptions of U.S. healthcare cost issues, and the policy and political implications of those perceptions—including misunderstandings of how the healthcare system works. As they note, based on their review of recent public polls, “[T]he driving force for concern” among consumers “is the belief that health care services are unreasonably priced and that what people pay for care harms their household’s financial situation. More than half (53 percent) of Americans say the cost of health care affects their own household’s financial situation “a lot” (Pew, March 2018). Forty percent say they’re dissatisfied with the total amount they pay for care (Gallup, 2018). So why, according to the public, are health care costs so high? When given lists of 12 or more possible reasons identified by policy experts and the media, respondents focus on charges by pharmaceutical companies (78 percent in one survey, 79 percent in another), insurance companies (70 percent, 75 percent), and hospitals (71 percent, 74 percent) as the main causes (KFF, 2018; Politico–HSPH, 2019).”
One of the public policy challenges, the researchers note, is that, “Unlike many experts, the public does not see overuse of services as a significant contributor to the cost problem that concerns them. Some 60 percent of Americans attribute high costs to unreasonably high prices for services and drugs; 23 percent believe that Americans are getting more health care and prescription drugs than they need; and 11 percent consider these two factors equally responsible (Politico–HSPH, 2019). About three fourths (76 percent) of the public believes that Americans are paying too much for most care they receive, relative to its quality. A majority also believes that health insurance premiums are increasing primarily either to boost profits for insurance companies (47 percent) or to accommodate high prices for care (16 percent), not because care is better (21 percent) or coverage is broader (13 percent) (West Health–Gallup, 2019).”
When it comes to public policy prescriptions for change, the researchers see problems with public perceptions. They note that “More than half the public supported five of the seven such proposals they were asked to consider: making greater efforts to prevent disease and ensure that people live healthier lives (84 percent), having the government facilitate competition among health care professionals and hospitals based on price and quality (67 percent), having the government establish limits on what health care professionals and hospitals can charge (65 percent), allowing people 50 to 64 years of age to buy into Medicare (61 percent), and changing our health care system so that most people have Medicare and there is little or no private health insurance (52 percent) (Politico–HSPH, 2019).”
But they note two big challenges: first, “Although experts see competition and government regulation as fundamentally different ways of controlling health care costs, Americans are nearly equally supportive of both.” And second, they write, “The two proposals the public does not favor would restrict patient access to treatments and prescription drugs: allowing payers not to cover some services deemed by experts not to be beneficial enough to justify their high cost, and giving individuals tax incentives to buy high-deductible plans. Each proposal was favored by only 37% of the public (Politico–HSPH, 2019). The public’s opposition to allowing experts to make decisions based on cost-effectiveness was similar in 2019 (56 percent) to what it was in 2012, when 43 percent were in favor and 54 percent opposed.”
A fundamental problem, the researchers note, is that “The public sees the issue of health care costs primarily as a price problem, rather than one of overutilization. Thus, proposals focused principally on reducing overuse of care are likely to be less popular than those that address high prices directly. People are likely to support candidates who talk about increasing overall health spending, not reducing it. In addition, it’s important to recognize that the public has not reached a judgment about whether increased competition or government regulation is more effective in controlling health care costs.”
