What People Think

Harvard's Robert Blendon continues his superlative work in measuring public opinion around health care issues in a new study of the attitudes of Massachusetts residents about that state's health reforms. [link]

One of the findings is how opinion changes once people are made aware of the costs and consequences of a reform proposal. Mr. Blendon tested attitudes towards various reform ideas in 2003. He found that 82% of respondents favored "expanding existing state programs," but when told that "these programs would require raising taxes to pay for the cost" support dropped to 55%.

Similar results obtain for other questions:

• 76% supported an employer mandate, but that dropped to 35% when told that employers might have to lay off workers.
• 70% supported tax credits and deductions for the uninsured, but that dropped to 36% when people were told it might not cover the full cost of the coverage.
• 56% supported an individual mandate, but that dropped to 22% were told it will cause financial hardship for the people affected.
• 50% supported single payer, but that dropped to 30% when people were told that might have to wait longer for hospital and specialist care.

This is part of the reason Massachusetts developed an approach that included a little bit of everything. There was no consensus on a single best approach. Of these various approaches, the one with the least support, once the trade-offs were made clear, was the mandate on individuals. Mr. Blendon's article notes that the mandate was the "most politically controversial" part of the legislation, gaining only 52% support. Only 37% of those directly affected now support the mandate, as opposed to 62% of those not affected.

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