Americans Speak on Health Reform: Report on Health Care Community Discussions

III. Concerns About the U.S. Health Care System

A. Prioritization of Concerns

The Participant Survey asked participants, "What do you perceive is the biggest problem in the health system?" The response options included:

• Cost of health insurance;
• Cost of health care services;
• Difficulty finding health insurance due to pre-existing condition;
• Lack of emphasis on prevention and quality of health care; and
• Quality of care

Cost represented the primary concern for 55 percent of the approximately 30,000 Participant Survey respondents: 31 percent of respondents worried the most about the cost of health insurance, and 24 percent were most concerned about the cost of health care services. One in five respondents reported concern about a lack of emphasis on prevention. About 13 percent of participants worried about preexisting conditions limiting access to health insurance, and 12 percent raised concerns about the quality of care (see Figure 2).

Participants concerns about the health care system were strikingly similar across the nation. For example, 24 percent of respondents in the Midwest, the South, and the West and 25 percent in the Northeast said cost of health care services was the biggest problem. Thirty-one percent of large metropolitan areas, 29 percent of small cities, and 30 percent of rural participants said that cost of health insurance was the largest problem. Two slight differences did emerge. Participants in the West were more concerned about finding health insurance due to pre-existing conditions than those in the Northeast (Map 2). In addition, 32 percent of participants in communities with a per-capita income under $25,000 said that cost of health insurance was the greatest problem, compared with only 29 percent of those in places with per-capita income between $25,000 and $44,000. Surprisingly, participants in communities with an average income above $45,000 expressed the same level of concern about health insurance costs as those in lower income communities (see Appendix Table 1). Similarly, people living in higher-than average unemployment communities shared the same concerns as those in communities with lower-than average unemployment rates (Map 3).

It was clear from the Participant Surveys that, throughout the country, the cost of both insurance and health care services was on everyone's mind. At over 90 percent of the meetings, at least one person chose cost of insurance as the biggest problem and at 85 percent of the meetings at least one person named cost of health services.

The Health Care Community Discussion group reports offered additional insight into participants' concerns. The majority of reports (52%) conveyed concern about the structure of the system – ranging from its misplaced emphasis on acute care versus prevention to its complexity. The second most-often discussed problem was cost (48%), followed closely by access concerns (43%) (see Figure 3). The nature of these concerns is detailed below.