Health Care Reform, Public Opinion, and Personal Experience as Information

James Surowiecki describes an interesting recent shift in public opinion about the health care system in the United States. Last year, polling found that only 29 percent of Americans rated the health care system as “good” or “excellent,” but when asked the same question today, the percentage of the public giving the same answer now has jumped up to 48 percent. Why the sudden increase given that, as Surowiecki notes, “[t]he American health-care system didn’t suddenly improve over the past eleven months”? Surowiecki attributes the rapid increase to the endowment effect. Now that health care reform is actively under consideration, people are focused on “what we might lose rather than on what we might get.” When people encounter uncertainty about trading what they already have for something else, psychologists have shown that people tend to overvalue what they already have and gravitate toward a natural instinct to keep things as they are.

The endowment effect is a plausible explanation for the suddenness of the shift in public opinion, but I have a different intuition than Surowiecki. Although I have not studied public opinion these days with respect to the current debate on health care reform, I have done empirical research about public opinion during the health care reform debates of the early 1990s that could be relevant. Political scientists find generally that people do not normally infer about national conditions directly from their own personal situations. For instance, people who are struggling financially do not assume that their personal situation indicates that the national economy is doing poorly overall as a more general matter. Just so, during the late 1980s and early 1990s, people who had undergone unpleasant experiences with their personal health care did not necessarily assume that the health care system was in bad shape. Their evaluations of the health care system as a whole did not vary from everyone else’s nearly as much as you might expect. However, when Democrats began championing health care reform during the early 1990s and arguing that there was an unaddressed crisis in American health care, people who had undergone negative experiences in their personal health care suddenly began to credit those negative experiences as a source of information for evaluating the system overall. Accordingly, compared to their fellow citizens, their overall views of the system changed very abruptly in a negative direction once political leaders substantiated the perceived reasonableness of that inference.

Although I cannot say definitively, it’s worth considering whether the abrupt shift in public opinion today that Surowiecki identifies is actually a mirror image of what happened during the early 1990s. Remember that, as I mentioned in an earlier post, the American public by and large report positive feelings about their personal health care today. Surowiecki, in fact, observes in the article that a clear majority of the public reports satisfaction with their insurance coverage, and public satisfaction with health care costs in particular has increased from the early 1990s into this decade. A year ago, Democratic supporters of reform probably had the edge in leading public perceptions about the system as a whole in a negative direction. But now with Republican opponents of health care reform touting the virtues of the American health care system, people who are happy with their health care situation now may be crediting their personal situation as a source of information about the system overall in a positive direction. The abrupt shift in public opinion may be less about the endowment effect than a portion of the public suddenly drawing stronger connections between their good personal experiences with health care and their sociotropic evaluations of the system as a whole. Such inferences from personal experience could explain not only the direction of the shift in public opinion about the health care system, but also the speed with which it occurred.

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2 Responses

  1. Jessica says:

    The Health Care system needs much more than just financial considerations and availability.

    Much more needs to be done to see that the professionals providing the care are actually qualified professionals and they are using their skills to HEAL, not just line their own pockets at the expense of hurting others.

    In addition to my own bad experiences attempting to gain quality care, as well as others whom I know and thousands of others seen on the internet, I’ve recently been emailed a link to a new blog with a story far worse than my own, and he/she has apparently only begun to tell their tale. There was a bit in his/her tale that reminded me of several known situations, so perhaps it might spark some recognition and contribute to any venue of improvement: .

    Something must be done.

  2. A.J. Sutter says:

    Apropos of anecdotal evidence: I lived in California until early 2007. I was self-employed, and used an asthma inhaler slightly more than 1x per 2 weeks, including an inhaled steroid. (I’ve had asthma for > 40 years, and have never been hospitalized.) For a while I had COBRA coverage from my previous employer, for which I paid > $1,200 per month (preferred provider plan). After that ran out, I was DENIED all health insurance coverage I tried to get on my own, because of my asthma. Best I could get was to get on waiting list for “indigent” coverage; at the time, wait was about 4 years.

    Cut to Japan, where I now live. A couple days after entering on valid visa, I got national health insurance coverage (“public option”). Cost ~US$50/month (¥4,700). Later that year, I had trouble with my leg; walked (limped) into neighborhood clinic. Doctor who examined me was head of orthopedic surgery at best med school in Tokyo region. I had full blood panel, X-ray, two office consultations. My co-pay: ~US$30.

    As asthma sufferer in Tokyo, cost of care for asthma = US$0.00, thanks to class-action settlement that set up privately-funded program with contributions from various polluting companies.

    Also, within the last 6 months, my wife’s aunt had coronary bypass surgery with mandatory 30-day stay in hospital. Her co-pay for surgery and stay: ~US$2,920 (¥280,000). My wife’s company’s president had back surgery earlier this month. His cost for surgery and 1-week stay in hospital: ~US$1,060 (¥100,000).

    BTW, ambulances here are free (cf. $4,000 ambulance charge paid by a friend of ours to get from downtown San Jose to Stanford Hospital). And most doctors here oppose cutting back on health care benefits.

    I’m happy to hear that so many Americans are satisfied with their healthcare. I’m satisfied with mine, too. Personally, I’d still be happy with it if my co-pays went up by 40% or even 100%, though I expect that the endowment effect you mention will make that politically difficult in Japan, despite the huge gap in relative prices compared to US.