Across the nation Americans are deeply worried about the affordability of health care and uncertain about how plans for reform will affect them. The anxiety about their rising health costs is palpable, especially in the context of an economic downturn. They believe that better information has the power to help improve the quality and efficiency of health care, and they are clear about the kinds of changes they would like to see and the role government should play.

These are some of the key findings of a new Gallup poll and a report released today by the Council for Excellence in Government in collaboration with the Accenture Institute for Public Service Value and expert guidance from the Institute of Medicine at the National Academies.

The report—The American Public on Health Care: The Missing Perspective—is the culmination of an eight-month initiative that explored the challenges facing health care in America—the problems and trade-offs—through the public’s perspective. A national poll was conducted in June 2008, following three town hall meetings and local metropolitan area polls conducted between February and June 2008 (Miami, Detroit and San Francisco). The report releases new national poll results and includes messages for the presidential candidates, government leaders, health care providers, insurers, employers, and the public.

Among the key findings of the project:

There is a palpable anxiety about costs. We learned through our town hall discussions – and confirmed it through local and national opinion research – that there is palpable anxiety about the affordability of health care among Americans from all walks of life, including people who have health coverage and those who do not.

• More than one in four Americans (26 percent) have put off some sort of medical treatment within the past year because they couldn’t pay for it, including 58% of those who are currently uninsured and 20% of those currently with insurance.
• Cost (51 percent) rather than Quality (30 percent) or Being Able to Get Care (9 percent) dominate health care concerns, with those ages 40 to 64 more concerned about cost (56 percent) than their younger (18-39) or older (65+) counterparts.
• Nearly two-thirds of Americans (65 percent) rate the affordability of health care in their area or community as Fair or Poor. For those surveyed in the metropolitan areas where the town hall meetings were held, the percentages are even higher.
• Those without coverage cite cost as the top reason they do not have insurance, with 57 percent saying they cannot afford it. In addition, 14 percent point to unemployment, and 9 percent say their employer does not offer coverage.

American’s believe in the power of information and want accountability for results. The people – health care consumers – believe that information has the power to help improve the quality and efficiency of the health care system, and they want to know more about both the cost of care and the performance of their providers. They are willing to share their health information among their doctors and researchers to improve the quality of care.

• When evaluating the criticality of information about doctors and hospitals, the American public puts two performance measures above others: their records of medical mistakes (62 percent) and whether they consistently follow standards and guidelines when diagnosing and treating patients (54 percent).
• Most Americans see the benefits of sharing health data. Three-quarters of those polled (78 percent) favor giving physicians the means to share access to their medical records, while two-thirds (66 percent) see the value in including their own information anonymously in a large database to help researchers.
• Although less than a quarter (23 percent) of Americans are currently using an electronic health record (EHR) system, nearly twice as many (44 percent) would be interested in using an EHR system if it was available.

Changes America Wants and the Role of Government. While many worry about the unknown and unintended consequences of health care reforms, a majority of Americans voice support for a number of reform concepts:

• PORTABILITY: 78% favor allowing Americans to take their health care coverage with them when they leave a job.

When it comes to the role of government in reforming the system, America’s voice is clear:

• PERFORMANCE RATINGS: 81% agree that government should require that performance ratings of doctors and hospitals be publicly available (60% strongly agree).
• PUBLIC MENU OF COSTS: 75% agree that government should require that healthcare providers publish their costs (58% strongly agree).
• PRE-EXISTING CONDITIONS: 75% agree that government should require healthcare providers to cover pre-existing conditions (54% strongly agree).
• EMPLOYER-BASED CARE: 72% agree that government should require all large employers to provide health insurance coverage to all full-time employees (54% strongly agree).
• COMPETITION ACROSS STATE LINES: 71% agree that government should create national or regional healthcare exchanges to allow insurance to be purchased across state lines (52% strongly agree).
• ASSISTANCE FOR LOW-INCOME: 69% agree that government should provide assistance to low income individuals and families to buy health insurance (52% strongly agree).

Americans also favor the adoption of electronic health records systems and are willing to share their health information under certain conditions:

• HEALTH INFORMATION SHARING: 78% of Americans favor giving doctors the ability to share access to their medical records, if it is done with their permission.
• EVIDENCE-BASED MEDICINE: 66% favor having health information shared in a large database to help researchers understand and compare the effectiveness and possible side effects of various treatments or prescription drugs, if no patient names were used in the database.

Priorities for Presidential Candidates:

• Roughly half (48 percent) of those surveyed are paying close attention to the presidential candidates’ positions on health care, with 31 percent paying very close attention.
• Providing insurance for all children (83 percent), controlling costs (81 percent) and improving the quality and safety of care (77 percent) should be the top health care priorities for the candidates.
• When asked if they would be willing to pay more in taxes to cover the uninsured, most (57 percent) respondents are not. Although willingness to pay more in taxes varies by both age and income with younger people and those with annual incomes over $75k the most willing to pay more.