National Survey and ReMesh Findings

As you may have seen from one of our previous updates, United States of Care has been engaged in an ongoing intensive listening initiative over the past two years. This listening initiative is aimed at uniquely and deeply understanding people’s health care needs in order to achieve more durable, people-centered policy solutions.

Today, we are pleased to share an update on our listening initiative with findings from our two newest pieces of research: a national survey that allowed us to begin to explore some of the solutions to our health care challenges, and a hybrid quantitative/qualitative research tool known as ReMesh, which allowed us to engage with a live audience to test various questions in real time. 

National Survey

Our new national survey re-affirmed one key point that we found in our previous public opinion research: the cost of health care is the overarching concern that people have across demographic, geographic, and ideological lines. According to our findings, a majority (69%) said the high cost of health care is the single biggest issue facing the health care system today, ranking above access to care, navigating a confusing system, access to resources like food and transportation, dependable health care coverage, and personalized care. The majority of every subgroup ranked costs as the top issue, including respondents of color (64%), low income respondents (69%), and rural respondents (71%). 

As we’ve seen throughout our research, the high cost of care impacts every step of people’s experience with the health care system—rising premiums create a roadblock to access, high deductibles mean unpredictable, or at worst unaffordable, doctor’s office and hospital visits, and expensive prescriptions mean that even if the care itself is within reach, the treatment may not be. When asked to choose one or two items from a list of things in the health care system that some people say cost too much, their choices were mostly split among prescription drugs (29%), hospital costs (28%), deductibles (26%), premiums (25%), and unexpected medical bills (21%). This finding shows that there isn’t one specific out-of-pocket cost that is most troublesome, but instead costs across the board.

While people want to lower the cost of health care, preserving access and quality in the health care system also remains especially important. Overall, 92% of respondents agree with the idea that everyone—regardless of health status, social need, race or ethnicity, residential location, or income—deserves to have access to quality affordable health care. As we move forward with policy solutions, it is critical that people not have to choose between access to care and quality of care. The US health care system can and should have both features. 

In addition, we used the national survey to test the four goals for our health care system that have been developed over the course of our listening initiative. As in previous research, nearly everyone—90% of all voters nationwide—agrees that these goals accurately capture their own goals for the health care system. The goals are: 

• People have the certainty that they can afford their health care,
• People have the security and freedom that dependable health care coverage provides as life changes,
• People can get the personalized care they need, when and how they need it, and 
• People experience a health care system that’s understandable and easy to navigate.

When asked to envision a world in which the above goals were facets of our health care system, participants noted that the goals would give them peace of mind (87%), improve the health care system (83%), and are reasonable (82%).

Finally, we used the national survey to test a series of potential policy solutions for the health care system. Every solution we tested received greater than 70% support among respondents overall, and a majority across political ideologies, highlighting the hunger among people of all stripes for targeted improvements to the system. USofCare is using our findings to develop a set of policy solutions that we look forward to sharing in the near future.

ReMesh

Following the national survey, we launched directly into our next phase of research, known as ReMesh. ReMesh allowed us to have a virtual conversation with participants on a large scale (in our case, with 110 participants, all at the same time). The system uses artificial intelligence to engage with participants and to analyze and group responses in real time, elevating insights and common trends as the conversation unfolds.

The findings from our ReMesh session were fascinating. In addition to reiterating, once again, that health care costs are too high and that participants were eager for solutions to bring down those costs, participants also expressed the view that not everyone currently has the same access to health care and recognized (without prompting) inequities in the system. Participants described the goals noted above as a manageable way to make sure that everyone has the opportunity to get the care they need. 

We also used the ReMesh system to test support for potential policy solutions to current health care challenges. In addition to expressing support, ReMesh participants underscored the urgency around the need for policy changes. Among those tested, a policy solution to create a system of universal catastrophic care tested particularly high, as did solutions for long term care and controlling prescription costs.

Of note, there is a significant level of cynicism that much will change in the health care system. Although demand for improvements is high, many participants expressed doubt that straightforward solutions could be achieved, often using terms like “in a perfect world…” or asking “what’s the catch”? As USofCare and our partners move forward in advocating for commonsense health care reforms, it is critical that we keep in mind the weariness that people have related to our current system and past efforts for change. But there is massive agreement that USofCare is heading in the right direction – ReMesh found that 67% of participants agreed with the characterization of USofCare’s goals as leading to a system of “affordable, manageable health care.”

Conclusion

“EXPENSIVE” is the word that arises over and over again to describe the American health care system. At more than two years into our intensive listening work, we know that the public clearly wants:

• Affordable coverage that allows them to get the care they need when and how they need it.
• Not to worry that unexpected costs from seeking the care they need will lead to financial devastation or ruin, and
• Targeted fixes that preserve the high quality of health care they currently enjoy while also protecting choice and innovation.

Simply put, people want a quality system of health care that doesn’t risk financial hardship or ruin. We don’t believe that’s too much to ask.

USofCare is now in the process of developing a set of commonsense health care solutions for policymakers that takes into account all we’ve learned from our research to date. We look forward to wrapping findings from our new national survey and our ReMesh session into that set of recommendations so that they are responsive to the needs and desires of the public. Our goal is to end with a well-balanced set of improvements to the system that addresses affordability and people’s lived experiences, and respects the wariness that people feel toward past efforts for reform. Rooting our recommendations in the needs of real people is our “secret sauce” to finding solutions that are actionable, realistic, and achievable.