Why is reforming health care so hard?

By Sean E. Flaherty

and Joseph J. Karlesky

The American health-care system is widely perceived as too expensive, rigid, and inaccessible. Yet the results of a recent Franklin and Marshall College poll on health care conflict with that perception.

A substantial majority of those polled expressed satisfaction with the health-care system. In fact, nearly eight in 10 said the system meets their needs "very well" or "pretty well," while three out of four insured respondents rated their coverage as "good" or "very good."

Furthermore, fewer than one in seven said an insurer had refused to cover a doctor-recommended treatment or procedure, and fewer than one in 15 said an insurer had denied a request to see a specialist.

These numbers help explain the substantial political difficulties faced by those proposing major changes in a health-care system that satisfies many Americans, even though it excludes a minority of them. That most people are relatively satisfied with what they have increases their anxiety about change.

Medicare, for example, has enormous support among seniors, many of whom worry that it could be adversely affected by health-care reform. The poll found that Medicare recipients are significantly less likely than those with private insurance to have been denied coverage of doctor-recommended treatments. About 16 percent of the privately insured have been denied coverage for a specific test or procedure, while the figure among Medicare recipients is just 4 percent.

Only a minority of respondents told the Franklin and Marshall survey that the health-care system is not serving them well. But this minority could grow if more companies forgo offering health-insurance benefits to their employees, or if more Americans experience long-term unemployment.

Can those proposing change persuade Americans that the health-care benefits most of them enjoy are at risk of being overwhelmed by growing costs? Just below the surface of the apparently broad satisfaction with health care, a substantial majority (79 percent) believes the system is in need of reform. But consensus on the appropriate focus and scope of this reform remains elusive.

Of those who support reform, 43 percent say the system works "pretty well" and needs only minor changes. But an almost equal number (47 percent) say the system has so many problems that it should be completely rebuilt.

Among those who would like to see only minor changes, Republicans outnumber Democrats by almost 2-to-1. Among those who want major changes, Democrats outnumber Republicans by 4-to-1.

With fewer moderate Northeastern Republicans and Southern Democrats in Congress today, the leavening effects of intraparty differences are much weaker. The sharp partisan divide, the dominant marker of contemporary American politics, is mirrored in our survey responses.

In September, U.S. Rep. Joe Wilson (R., S.C.) shouted "You lie!" during President Obama's address to Congress on health care. In a speech several weeks later in the same chamber, Rep. Alan Grayson (D., Fla.) charged that the Republican health-care plan is "Don't get sick, and if you do get sick, die quickly."

Such harsh, unforgiving, and partisan rhetoric is reflected in the deep split between our survey respondents. No wonder change is so difficult.