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ABSTRACT
Costly and unexpected medical bills have led many Americans to deplete their savings or put off medical care. This study examines how the public attributes blame for the costly health care system and how these blame attributions vary according to an individual’s own personal experiences with medical expenses. The results from multiple nationally representative surveys show that blame for health care costs is diffuse. Insurance companies and health care providers, such as hospitals, share a significant portion of the blame for these costs, and this is especially true among those who have firsthand experience with health care costs. Personal experience also somewhat reduces the likelihood that partisans concentrate blame for health care costs on the opposing party. Even though the costs of unexpected medical bills are tangible and the stakes are high, more visible and proximate actors in the health care system may shield government from some of the blame for costs incurred in the current system.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Notes
1 While the U.S. is hybrid with public and private health care provision, two-thirds of Americans have private insurance and more than 80% of short-term acute care hospitals are private (Tikkanen et al. Citation2020).
2 See Online Appendix p. 2 for sample details.
3 Republicans and Democrats are offered as separate options because health care has been highly polarized in recent years and for a benchmark with a KFF poll conducted in August 2018, which included Republican and Democratic actors as separate options (Appendix Table A1).
4 These include nationally representative surveys from the Kaiser Family Foundation from July 2011, February 2014, and August 2018; a Politico/Harvard School of Public Health survey from August/September 2016 (PHS); and an NPR/Robert Wood Johnson Foundation/ Harvard School of Public Health survey from March 2012.
5 While not the focus of this study, drug companies and general waste and fraud in the system were also response options provided that received high levels of blame (Appendix Table A1).
6 Likewise, in the March 2012 NPR survey, respondents who recently had a serious problem with medical care costs were about 10 percentage points more likely to indicate insurance companies, doctors, or hospitals charging too much as major reasons for rising costs.
7 As an alternative modeling specification, Appendix Table A15 and Figure A3 display results from a single multinomial logistic regression with “None” as the baseline outcome. Results are similar.
8 The frequency of personal experiences is not additively related to blame attribution (Table A14).
9 Results are generally not sensitive to the inclusion of different subsets of covariates (Online Appendix Table A10-11) or the use of matching methods as an alternative to regression (Online Appendix p. 20-21).
10 In a regression model with covariates, having some personal experience decreases the likelihood of blaming the opposing party (Appendix Table A17, p < 0.10).
11 For example, Congress passed the No Surprises Act, which began implementation in 2022, and limits the potential that consumers face unexpected out-of-network charges. Even with public support, Hacker (Citation2004) describes how powerful private interests have previously stymied major government actions in health care.