Health care is the top issue facing the U.S. today, one in three Americans says, with another one-fourth pointing to the economy. Together, health care + the economy rank the top issues for 62% of Americans.

Health care and the economy are, in fact, intimately tied in every American’s personal household economy I assert in my book, HealthConsuming: From Health Consumer to Health Citizen. This poll from RealClear Politics, conducted in late April/early May 2019, makes my point that the patient is the consumer and, facing deductibles and more financial exposure to footing the medical bill, the payor.


Fully two-thirds of Americans say the health care system isn’t work well, at best; at worst, the system is broken, needing an entirely new approach, shown in the poll’s data in the second chart. Only 4% of people say American health care is “working well.”

RealClear Politics’ analysts cleverly mined what’s underneath these macro numbers to identify four distinct segments of health consumers based on data below-the-surface and political party ID.

The Satisfied and Savvy make up 24% of Americans, generally happy with their health care quality and value. They self-advocate and shop for prices before getting health care and research providers online. Still, half feel burdened by health care costs. These are the most affluent health consumers in the U.S., and tend to be younger.

The Skeptical and Searching are 19% of the U.S. population, engaged in health care decisions but more cost-conscious and less satisfied. This group has more Millennials, less income and the lowest proportion of over-65s. They tend to be more politically engaged and have the largest group of Independents across the four segments. Over one-half of the Skeptical and Searching believe that the U.S. is on the right track, and are least likely to vote for President Trump in 2020.

The Unhappy and Unplugged are one-fourth of America. This group is less likely to support universal health care or the guarantee of pre-existing condition coverage, yet are more keen on access to treatment for drug and alcohol service. These folks are largely disengaged and dissatisfied, are less educated, and have lower income than the three other cohorts. They were less likely to have voted in the 2016 Presidential election, but if they did vote, they were marginally more in favor of Donald Trump and Hillary Clinton for President. For 2020, this group is less likely to vote for Donald Trump, and more likely to support either Joe Biden or Bernie Sanders.

The Coasting and Contented comprise nearly one-third of Americans. They don’t tend to shop around for health care or be super-engaged in their care, probably because they tend to be older and more likely to be covered by Medicare. They may be threatened by a call for “Medicare for All” given their affection for the program. This group is made up disproportionately of Democrats (35%), 28% Republicans, and 21% Independents.

RealClear concludes that, “health care is more than a political issue; it is also deeply personal,” and therefore the politics of health care reform, “requires understanding differences in consumer priorities and designing policies to meet their most pressing needs.”

Health Populi’s Hot Points:  RealClear asked people to consult their forecasting tea leaves to consider which industries and organizations would improve the quality of health care for Americans 20 years into the future.

Technology, biotech, hospitals, and life science companies would be the health care improvers, most Americans told RealClear pollsters.

Less likely to help were at the bottom, Fortune 500 companies (27%), then GOP members of Congress (30%), the health insurance industry (36%), pharma (37%), and then the Democrats in Congress at 40%.

Ironically, Big Tech like Amazon, Apple, Google and Microsoft are all members of that Fortune 500 cohort which ranked at the bottom of this list. That’s an interesting conundrum to consider.

This finding, of trust in tech for helping manage health, echoes another study I often quote in this moment, from Strategy& (PwC) which found that equal proportions of Americans (roughly 40%) trust digital companies, large retailers, and health care providers to help them manage their health.

We don’t have to look 20 years out in front of us to know that tech companies and retailers are already playing growing roles in our local and virtual personal health/care ecosystems. For more on that phenomenon, see HealthConsuming‘s chapters on digital health and the new retail health. It’s our role as health care payors and consumers that’s supporting this phenomenon which is the real consumer-driven health.