New York, January 28, 2008—When asked to consider the health reform proposals of the 2008 presidential candidates, most leaders in health care and health policy favor plans that build on the nation's current mixed system of public and private group insurance, a new survey finds. Proposals relying on tax incentives that help individuals purchase coverage themselves, however, are viewed by these same experts as ineffective strategies for either achieving universal health care coverage or containing spiraling health care costs.
Key elements of the mixed private–public proposals—which have been put forward by senators Hillary Clinton, Barack Obama, and former Sen. John Edwards—received widespread support in the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey. For instance, more than four of five (83%) of the opinion leaders surveyed said they favor requiring that all individuals obtain health insurance, with premium assistance available for low- and moderate-income Americans. Most (71%) respondents also support requiring employers to either offer coverage to employees or pay a percentage of their payroll to help finance expanded coverage. Support for a "pay-or-play" requirement is strong even among opinion leaders in the business community, with 66 percent approving such a feature.
Other features of candidates' health reform proposals received less support. For example, only 45 percent of respondents favor eliminating the employer benefit tax exemption and replacing it with a standard income tax deduction, an element of some of the plans proposed by the leading Republican candidates.
Questions included in the Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey were based on the strategies for reforming the U.S. health care system proposed by the leading Democratic and Republican presidential candidates. Opinion leaders surveyed included experts from four broad health care sectors: academia and research organizations; health care delivery; business, insurance, and other health industry; and government and advocacy groups. Elected officials and media representatives were excluded.
"Achieving universal coverage is key to improving the overall performance of the health system," said Karen Davis, president of The Commonwealth Fund. "A majority of health care opinion leaders believe that the most effective way of achieving that goal is by building on the current system with a shared responsibility for financing among individuals, employers and the government."
A large majority of opinion leaders support implementing market regulations against risk selection—that is, requiring insurance companies to offer coverage to all who apply at affordable rates regardless of health status or age. Other changes in the private market that garnered support include allowing public insurance plans to compete with private insurance plans (65%) and creating an insurance "connector" (61%)—similar to the one Massachusetts recently established as part of its health reform plan—in the private market. There is little support for replacing the private market with public insurance (37%), and little support for allowing private insurance markets to operate with reduced regulation (11%).
Financing health reform would require a substantial investment by federal and state governments, employers, households, and other stakeholders. Opinion leaders overwhelmingly support a so-called "sin tax" on tobacco or other potentially harmful products to pay for expanded coverage (88%). They also agree that tax breaks for families with incomes above $200,000 should be repealed or allowed to expire (75%), a financing mechanism that has been advanced by the leading Democratic candidates, though some would set the income level at $250,000 or higher.
In addition to questions of cost and financing, the survey asked respondents about the equally important goal of improving health care quality. Seventy percent voiced support for increased and more effective use of information technology. Another 65 percent are in favor of the increased use of "medical home" models of care—a primary care practice that provides accessible, continuous, and coordinated care—and 61 percent think rewarding practitioners who provide higher-quality care is an effective strategy for raising the overall quality of care.
The next U.S. president will likely have a full and complex health care agenda, with many competing goals and priorities. Seven of 10 health care opinion leaders believe the next president should pursue the goal of universal coverage at the same time he or she develops policies to improve quality and efficiency and control costs.
The survey of leading health care experts representing a diverse range of professional and ideological perspectives is the 13th in a series from The Commonwealth Fund, and the fifth conducted in partnership with the publication Modern Healthcare. Commentaries on the survey results by Dallas L. Salisbury, president and CEO of the Employee Benefit Research Institute and a member of The Commonwealth Fund Commission on a High Performance Health System and Darrell Kirch, M.D., president and chief executive officer of the Association of American Medical Colleges appear in the January 28 issue of Modern Healthcare. The commentaries are also posted on the Fund's Web site, along with a Commonwealth Fund Commission on a High Performance Health System Data Brief discussing the survey findings.
Methodology: The Commonwealth Fund Health Care Opinion Leaders Survey was conducted online by Harris Interactive between November 29, 2007, and December 31, 2007. The survey was administered via e-mail to a panel of 1,080 opinion leaders in health policy and innovators in health care delivery and finance. The final sample included 221 respondents from various industries. Typically, samples of this size are associated with a sampling error of +/– 6.6 percent. However, that does not take other sources of error into account. This online survey is not based on a probability sample and therefore no theoretical sampling error can be calculated. The sample was developed by The Commonwealth Fund, Modern Healthcare magazine, and Harris Interactive. Data from this survey were not weighted.