If you saw ABC News or USA Today during the week of October 16, 2006, you probably got the impression Americans want government health care and oppose health savings accounts (HSAs). But data from the survey the
news was reporting do not support those claims.

According to the ABC News/Kaiser Family Foundation/USA Today Health Care in America 2006 Survey, 44 percent of respondents were satisfied with the
quality of health care in the country, but just 18 percent were satisfied with its cost.

However, 89 percent were satisfied with their own health care quality and 57 percent with their personal costs. Losing insurance is a concern for 56 percent of respondents with private care, and 60 percent of those with any
form of health coverage worried about their ability to afford insurance over the
next few years.

The three organizations jointly developed the questionnaire for the nationally
representative survey of 1,201 adults, conducted by TNS of Horsham,
Pennsylvania between September 7 and September 12, 2006. The survey had a margin of error for the total sample of plus or minus three percentage points.

Misleading Reports

Despite the increasing popularity of HSAs—more than 3 million are now
open—and the amount of scholarly research dedicated to them, the survey
all but ignored them.

The poll focused primarily on how people feel about the nation’s health care situation, whether they are satisfied with their own coverage, who’s to blame for high costs, and what they consider effective remedies.

“We didn’t ask specifically about HSAs on this survey,” said Mollyann Brodie, Kaiser Family Foundation’s vice president and director of public opinion and media research, “But what the survey does show is that people don’t like the idea of bearing their own [financial] risk in their health care.”

Brodie’s simple message, however, did not get through to the ABC News reporters. An October 16 story on the ABC News Web site stated: “Making more consumers more aware of the cost of care is a motivating force behind proposals such as ‘health savings accounts.’ This poll finds that two-thirds oppose the idea, including as many conservatives as liberals, and six in 10 Republicans along with 73 percent of Democrats.”

ABC then mentioned some of the benefits that define HSAs, but which were
not asked about in the survey questionnaire: tax breaks, lower premiums, and
the ability to roll unspent funds over from year to year and job to job.“Still,” ABC reported, “the risk associated with these arrangements appears to be a significant hurdle for consumerdriven health plans to overcome.”

Skewed Question

“The KFF survey question on HSAs is designed to get a negative response,”
said Greg Scandlen, president and CEO of Consumers for Health Care Choices, a membership group based in Maryland.“It is awkward, complicated, and is an inaccurate description of HSAs. There is no mention that HSA funds are tax-free, or that they can roll over and build up over time, or that they always belong to the consumer.”

Despite this, 79 percent of respondents said allowing consumers to shop
around would be an effective way to control health care costs—more than
the 62 percent who thought government regulations or the current system would be effective.

‘Universal’ Health Care

Although two-thirds of respondents said providing health care for all Americans is more important than holding down taxes, support slipped to 56 percent when a choice between the current employer-based system and a government- run universal health insurance program was presented, even without asking about a consumer-based system.

Support for universal government provided coverage fell further when the survey suggested the possibility of higher costs of taxes (35 percent), waiting
lists (33 percent), limited choice of doctors (28 percent), or loss of coverage
for some treatments (18 percent). ABC News’ coverage did not call any of these a “significant hurdle” for supporters of universal coverage to overcome.

But trying to set policy based on surveys is a problem in itself.

“In most survey research, people agree on the goals for public policy, but
not the methods,” Brodie explained.“Each individual item may get a majority
on its own, but when you try to force a choice, you often end up splitting the
group roughly evenly—halves, thirds, quarters—based on the number of
choices available.”

Limited Advantages Seen

A larger hurdle that supporters of universal coverage face is the limited
advantage respondents expected from it.“People don’t necessarily see benefits of universal coverage for themselves and their family personally,” Brodie said.

Roughly half of the survey’s respondents expected no change in cost, quality,
availability, or choice of doctors under a government-run universal health care
system, but 30 percent expected their family’s quality of care to worsen, 31
percent thought they would have less health care available, and 36 percent
thought they would lose their choice of doctors.

Respondents split evenly on whether government-run universal health care
would lessen the cost of care—26 percent thought it would, 26 percent disagreed.

Joseph Coletti (jcoletti@johnlocke.org) is a fiscal and health policy analyst
for the John Locke Foundation, a public policy think tank in North Carolina.