The economy, the economy, and the economy — and a dash of Iraq and health care — are on American citizens’ minds when it comes to what they want President Obama to address when he takes office.

Kaiser Family Foundation (KFF) and the Harvard School of Public Health (HSPH) have come together once again — as they’ve done since 1992 — to gauge Americans’ interest in health as a priority for the President and Congress.

In this poll, conducted in December 2008, health is seen by people as integral to the economy. The chart illustrates that 30% of people had a serious problem getting a good-paying job or a raise in pay; 29% reported a serious problem losing money in the stock market, 27% paying for gas; and 25% paying for health care and health insurance.


This last problem, paying medical bills, is a growing problem. When KFF/HSPH first polled Americans in March 1992, 21% said they or someone in their family had a problem paying medical bills. Since then, 18 years later, 32% of Americans said they are having problems paying medical bills. That’s 1 in 3 citizens. Drew Altman points out that that 1/3 will go up before it begins to fall given the nation’s economic downturn in 2009.

The ripple effects on health, Altman says, are significant: 47% of Americans said that they have sacrificed on their health care in some way: for example, skipping recommended medical tests, delaying seeking care or postponing a prescription refill. Thus, health has become a pocketbook issue, not simply a ‘medical’ issue, for Americans, as the table illustrates.

You can view the webcast here.


Health Populi’s Hot Points: Drew

Altman introduced this webcast with the Clint Eastwood construct, The Good, the Bad, and the Ugly. There is a whole lot of good which are forces that optimists would see as a perfect storm for health reform ASAP: Obama has made health reform a top priority; leaders in Congress, such as Senators Kennedy and Wyden, are already crafting reform plans; the public is very concerned about health as a kitchen-table issue; key interest groups, including strange bedfellows like Labor and Big Business, are playing nice with each other on health reform broadly brushed.

There seems, then, to be a window of opportunity…”if leaders move fast,” Altman warns.

That’s where The Bad comes into play. The health reform naysayers see that there are serious partisan divides on health reform priorities, such as ensuring universal care and how to contain costs (such as prescription drug prices). More Democrats are more concerned about the economy than Republicans, who put terrorism and Iraq higher on the priorities list; broadly speaking, the Dems are more about the “butter” and the Republicans more about the “guns” in the guns v. butter economics paradigm.

And then, there is the tiny issue of how to pay for health reform with the prospect of a $1 trillion deficit and a public hardly enthusiastic about raising taxes (at least on those with household incomes below $250K).

The Ugly? Well, that’s letting the window of opportunity close on this unprecedented moment where a majority of ducks seem to be in a row to support significant health reform.


A majority of Americans make the connection between the macroeconomy and health care. Popular elements on which to base reform include building on the existing employer-based system, expanding coverage to children and veterans, and making sure unemployed people have access to coverage.

In this post-Lehman and -Madoff era where regulation was seen as de minimis, more regulation is now seen as a good thing–over drug costs, health care costs, and insurance companies.

The Ugly issues have to do with tax preferences, individual mandates (that is, forcing citizens to buy into or accept health insurance) and employer mandates (especially among smaller businesses and those is low-margin industries).

If stakeholders keep in mind, front-and-center, that health care is the #1 driver of long-term debt in the U.S., we can get to “yes” on health reform in this very tight window of opportunity. 61% of Americans think we can; President Obama will no doubt say, “Yes, We Can.”

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