Summary and Implications: The Conversations Americans are Ready for on Health Care

This Hidden Common Ground research suggests that there is a strong foundation for a fruitful public conversation on health care and provides direction for framing, focusing and informing the conversation so it has the best chance of achieving what the American people want.

Proof that shared priorities are in place for productive conversation is evident in several findings, starting with the fact that health care is an issue that the American public cares about. It is very hard to engage the public on a topic if it is not a strongly felt priority. The findings make it clear that people are highly concerned about this issue. This is evident in the shared and strong agreement across political affiliations and demographic groups that significant changes to the system are badly needed. Barely anyone is arguing for a continuation of the status quo. Instead, people are ready for change toward a system that better aligns with their needs and values.

That health care is a bottom-line issue for the nation as well as for individuals and families makes it an even riper issue for public conversation. Nationally, health care spending accounts for nearly 18 percent of the federal budget and nearly 18 percent of gross domestic product. On a state level, Medicaid alone accounts for nearly 30 percent of all state government spending.[2] For families as well as government, high health care spending contributes to debt and crowds out other priorities.

Finally, there is shared agreement among the public on where the health care system needs to improve. These include making it more affordable, covering pre-existing conditions and long-term care, and making sure all communities have access to doctors and hospitals.

The widely shared agreement on the need for substantial change and on the goals to be achieved provide a foundation for the conversation that is most needed today, which is on the means for achieving the results that a strong majority of Americans want.

This research uncovered ideological partisan leanings or natural “comfort zones,” regarding how to change the health care system. For example, Democrats tend to be more comfortable with a larger federal government while Republicans tend to be more resistant to taxes. But these differences do not constitute major gaps between the parties in the survey data — nor did heated arguments erupt in the focus groups, which included participants from a range of political affiliations. We believe there is room for conversation and compromise on these differences so long as the goals Americans agree on are front and center.

The data also suggest that the opinions of many Americans on health care are not set in stone. A quarter of Americans say they do not yet know enough to have an opinion about the various plans tested in this survey. Furthermore, we found that people themselves say that their support for various health care reform plans may change as they consider the implications of those plans. This signals substantial room for people’s views to evolve as they learn and deliberate, suggesting a crucial role for the news media in bringing forth the best evidence on what works to achieve America’s shared health care goals.

Finally, the research suggests that people will be best able to engage productively on health care solutions if the debate can be stripped of politicized language and focus squarely on solutions as much as possible. This is how the Hidden Common Ground research approaches health care and other issues. Our survey questions use plain language rather than political jargon. We believe doing so provides a more accurate read of what people actually want and where lasting support lies than if we frame questions in the kind of partisan language so common in national politics today.

The focus, then, should be less on ideology and more on what, practically speaking, will deliver on the goals driven by public consensus. We believe such a conversation can energize what has been called the “exhausted middle” of the American public with respect to making progress on health care and create hope and forward momentum toward the future that people really want for themselves, their families, their communities and the nation.