Health-Care Reform: No Consensus, Little Optimism

As with much of the public, NABE members are divided in their evaluation of current proposals for health-care reform and hesitant to wholeheartedly endorse any of them. Fewer than half (46 percent) agree that the major proposals now under consideration would bring a net improvement in the access to, and quality and cost of, health-care services in the United States.

The survey results reflect little in the way of consensus in terms of how best to expand access to health care. Asked to rank their top choices between a “single-payer” system, and “individual mandate” to purchase insurance, an “employee mandate” to purchase insurance and a “public insurance option,” all of these responses are outvoted by “other,” which is the top choice of 29 percent of respondents. Among those that do name one of the four named proposals as their top choice, the responses are nearly evenly divided between “individual mandate” and “public insurance option,” with “single-payer system” trailing just behind. However, roughly 60 percent felt that a combination of these measures would be more effective than any single reform in expanding access. Still, fewer than half of respondents (49 percent) expect that reforms will be effective in expanding access to quality health care to more Americans.

In terms of the trade-off between the quality and cost of health-care services, 47 percent of NABE respondents expect that reforms intended to expand access will serve to “decrease quality and increase cost.” And, as in the case of expanding access, there is little consensus as to how best to cut health-care costs. Asked to rank a series of costcutting reforms, in terms of potential effectiveness, 25.6% of respondents rank “reforming the tax treatment and deductibles of private insurance plans” first, while the second most popular choice, tort reforms, was ranked first by 20.7% of the panel. Nearly 40 percent of the panelists list patent limitations on pharmaceutical products as a cost-cutting measure that should not be considered, the same proportion as those that would nix regulation of pharmaceutical prices. Almost as many (37 percent) say they would not consider the single-payer concept.

The apparent lack of consensus on health-care reform measures is accompanied by pessimism about their potential to limit long-term growth in health-care costs. While a narrow plurality of respondents (45 percent to 41 percent) say that current proposals are more likely to raise long-term costs than to reduce them, just over a third of all respondents see these proposals resulting in “significantly higher” health-care costs in the long run.

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