Who's Better at Health Care?

October 30, 2013, 9:00 PM GMT+0

Many Americans consider the recent health care reform law a failure, while others think that the coverage provided by private health insurance companies is better than that of the federal government.

The federal government’s current problems with it's healthcare website (healthcare.gov), which allows people to purchase health insurance coverage, may have prompted Americans to think of the law as a failure in its entirety, and encouraged negative views of the federal government. Overall, feelings have not changed in terms of what should be done with the law, healthcare costs, and where to buy insurance, and private insurance companies don’t necessarily have an advantage. Americans do, however, think private insurance companies would do a better job than the government in providing care.

In the latest Economist/YouGov Poll, nearly half the country would categorize the Affordable Care Act as a failure, with only 15% calling it even a partial success.

Nearly all Republicans (85%) look on Obamacare as a failure (as might be expected), but so do 58% of Independents and even 15% of Democrats. Only a third of Democrats call it a success. Even among those currently without health insurance, opinions are not much different.

The website problems may have been especially difficult for those without health insurance, as three in ten without insurance say they have tried to use healthcare.gov.

It may be no surprise that 42% of all Americans want the law repealed, but positions on the ACA have been solid for a long time. These positions have not been affected by the health care website problems. In May, a similar percentage reported wanting to repeal the new health care law.

Among the uninsured, opinion is similar. More than four in ten of those who are uninsured would favor repeal.

For the most part, those without health insurance are less well-off and younger than those who do (nearly all of those 65 and older are covered by government-funded Medicare). Most of the uninsured say they don’t have health insurance because it costs too much, although one in five (and more of those who are under 45) also say that they are healthy and believe they don’t need coverage. Few say an insurance company has refused to cover them.

Given the events of the last month, including the partial government shutdown and the health care website problems, views about government in general are not good. Two in three have an unfavorable view of the federal government – a negative assessment that crosses party lines, but it is especially pronounced among Republicans. 90% of Republicans have an unfavorable view of the federal government. Among Democrats, 50% are unfavorable, and 38% are favorable.

This doesn’t mean the public happily accepts all private insurance company claims, just as they don’t accept government claims. In general, Americans see no difference between the government and private insurance companies when asked who would do a better job controlling health care costs – something 86% say they are concerned about. One in four believes that neither the government nor private insurers control costs.

Those currently without insurance agree, although they are somewhat more likely to say the government, not private insurers, are better at controlling health care costs.

Similarly, when Americans are asked where they would prefer to buy insurance, nearly as many say they’d prefer to buy it from the government as buy from private insurers, but even more would prefer to get their insurance at work. Most Americans in the past have received health care coverage from thier places of employment. 8% would prefer not to buy health insurance at all – and that figure is even higher among younger adults.

Those without health insurance are slightly more likely to favor the government over private insurers when it comes to where they would buy insurance, but nearly one in five of those currently not covered would prefer not having any insurance at all, and one in four aren’t sure.

Where private insurers have a clear advantage is in the perception of providing health care quality. By more than two to one, Americans say that private insurers would provide better coverage than the government. Democrats disagree. Those currently uncovered also favor private insurers.

Since the debate over the Affordable Care Act began, the public worried that their quality of care would worsen. That is still true: 43% say it will get worse, while just 15% think it will improve. Even those currently without health insurance coverage are more likely to say care will get worse (38%) than say it will get better (21%).

Full results can be found here.

Economist/YouGov poll archives can be found here.

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