Before addressing the adverse incentives and outcomes from the current U.S. health care system, it is worthwhile to quickly summarize its most important strengths. According to the U.S. Census, 45.7 million people in the U.S. did not have health insurance in 2007 (down from 47.0 million in 2006).5 Another way of putting it: 255.6 million people (or 85 percent of the population) had insurance in 2007, up from 251.4 million in 2006.6 A majority of these people are satisfied with their current coverage, which is offered by one of the approximately 1,300 separate health insurance companies that operate in the U.S.7
According to a recent CNN poll:
"Most Americans like their health care coverage but are not happy with the overall cost of health care...
More than eight in 10 Americans questioned in a CNN/Opinion Research Corp. survey released Thursday said they're satisfied with the quality of health care they receive.
And nearly three out of four said they're happy with their overall health care coverage.
But satisfaction drops to 52 percent when it comes to the amount people pay for their health care, and more than three out of four are dissatisfied with the total cost of health care in the United States.8
Such feelings are not new. A 2004 Harris Interactive poll found:
For the fifth time in six years, Harris Interactive has asked the insured public to rate their own insurance plans. Two-thirds of them continue to give their plans an A or a B, with only 10% giving them a D or an F. Substantial but not overwhelming majorities continue to say that they would recommend their own health plans to family members who are basically healthy (76%) or who have a serious or chronic illness (68%).9
Using the latest CNN and Census data, if 85 percent of Americans have health insurance, and 80 percent of Americans are satisfied with their current health quality, then approximately 70 percent of Americans are satisfied with their current arrangements. Care must be taken to ensure that changes to help 15 percent of Americans do not make the vast majority of Americans worse off.
The fact that such large percentages of the population are insured, and at the same time are satisfied with their insurance, is clear evidence that the U.S. health care system does not face a crisis of coverage or quality. Reforms that treat access to health care or health insurance coverage as if they were in crisis fundamentally misread the positive aspects of the current health care system and, consequently, risk breaking the parts of the health care system that are currently working.
5 DeNavas-Walt, Carmen, Bernadette D. Proctor, and Jessica C. Smith (2008) Income, Poverty, and Health Insurance Coverage in the United States: 2007 U.S. Census Bureau (August 2008) Current Population Reports, 60-235.
6 Author calculations based on total population estimates from the U.S. Census, www.census.gov/popest.
7 The approximate number of health insurance companies in the U.S. is derived from America's Health Insurance Plans, America's Health Insurance Plans (AHIP) is the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans.; www.ahip.org.
8 Steinhauser, Paul (2009) Poll: Health care costs too expensive, Americans say CNN Politics.com, http://www.cnn.com/2009/POLITICS/03/19/health.care.poll/index.html.
9 Harris Interactive (2004) Satisfaction with Own Health Insurance Remarkably Stable (March 29, 2004) http://www.harrisinteractive.com/news/allnewsbydate.asp?NewsID=781.
