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Journal Issue: Health Care Reform Volume 3 Number 2 Summer/Fall 1993

Public Opinion and Health Care Reform for Children
Authors: Susan Nall Bates

Key Findings from Recent Surveys

The data upon which the pollsters drew are admittedly recent and spotty. Until very recently, children were not the focus of much opinion research. While many polls have been conducted to test the popularity of various approaches to health care reform, few of these polls specifically address children's health. With the exception of the National Commission on Children and its recommendations,4 children continue to be postscripts to much health-oriented policy research.

Despite the historic oversight given to children's concerns in public opinion polling, since 1990 a substantial body of literature has formed, supported by corporations, policy think tanks, independent commissions, and children's advocacy groups, from which some significant areas of consensus can be identified. These recent polls strongly suggest: (1) that children are among the public's prime concerns; (2) that health is prime among other children's issues; (3) that government should do more to advance children's health; and (4) that the mandate to do more holds true even if it costs more.

Consider the following key findings from the recent survey literature:

  • The public wants children to be a top priority for government spending. (See Figure 1.) Sixty-one percent of Americans list guaranteeing all children health care, quality education, safe neighborhoods, and economic security among their top three priorities for their tax dollars, and 24% chose it as their top priority, more than any other option, including lowering taxes, fighting crime and drugs, and promoting job training and economic development.5
  • Children's access to health care is more important to the public than other key children's issues. From a range of proposed measures to help children, voters named their first three policy choices to be: (1) guaranteed health insurance for all children (26%); (2) more family-oriented business practices (20%); and (3) a refundable tax credit for families with children (18%).6
  • There is a clear mandate for government to do more for children. An overwhelming 85% of American voters agree that "our political leaders are not doing enough to help solve the problems facing children today."5 It is clear that the public views government attention to children's needs as a "pay now or pay later" proposition. In a poll conducted in summer 1991, the public was asked to indicate agreement with a series of approaches to children's problems. Some of the strongest agreement was in response to this statement: "When it comes to children, we're going to have to pay now or pay later; it's better to put our tax dollars into programs that lift children out of poverty than to pay more later to correct children's health and education programs." Almost three-quarters (73%) of the public agreed strongly with the preceeding idea, compared with only 44% who strongly agreed with the argument that "we can't afford to raise taxes, so if more money is going to be spent on children it is going to have to come from existing programs."7
  • Americans are so concerned about children that they will even support new taxes. Two-thirds of voters (67%) say they would be more likely to vote for a candidate who supported increased spending for children's programs even if it meant an increase in their taxes.5

This emerging public mandate to do more for children is tempered by a number of factors which combine to limit this support. These include: (1) a belief that children's issues are primarily private concerns; (2) a profound skepticism about government's intentions and efficacy; and (3) concern that the money needed to ameliorate children's problems may not be there. Consider the following findings from the survey literature:

 

  • Children's issues continue to be regarded as largely private concerns. The public still holds parents primarily accountable for their children's condition. In one survey, Americans were asked to identify, from among several choices, the biggest obstacle to improving the situation of children in this country. Parental guidance was the choice of three in ten respondents, beating economic pressures (25%), government waste (19%), and politicians (6%).7

In this context, some particular issues suffer more than others because their solution has not been exclusively or even traditionally public in nature. For example, children's health is often overlooked by the public because the public does not automatically link children's health to the public or political arena. Americans are more likely to connect children's issues to education or the fight against drugs, issues already squarely in the public domain. For example, when asked what single issue concerning children would you like to see a presidential candidate support, improved school quality beat better health care by more than 3 to 1 (29% to 8%).7

 

  • The public remains extremely skeptical about government's ability to resolve problems for children. An overwhelming 76% of Americans believe that most of the money that is supposed to go to children through government programs never gets to them.7 Only 4% of voters are very confident that government will do what is right for children most of the time; fully half of the voters say they are not at all confident.5 (See Figure 2.)

In this context, there appears to be public support for new initiatives in which children are designated the first priority for existing tax revenues and held harmless from budget cuts. With the passage in 1991 of the Children's Amendment, better known as Proposition J, San Francisco became the first city in the nation to guarantee funds for children in its city charter. Under the initiative, mandated set-asides will be applied to property taxes in future years. The set-asides are designed to expand children's services beyond past levels of support and to establish a base of support for children which the city must maintain.8 In 1991 the Michigan legislature considered a bill which would have created a yearly review of all tax exemptions to determine whether they continued to warrant special treatment. Presumably, as some exemptions are lost and taxes recovered, additional funds could be directed toward such pressing concerns as children's programs.9 Both the San Francisco and Michigan initiatives were tested in a recent survey and received high marks from voters, 65% and 83% of whom agreed with these approaches, respectively.5

 

  • The public's concern for children is linked to its concern for the country's economic viability, and voters worry whether there is enough money to solve real problems. In many polls, Americans' concern for their children translates into a strong response about the future of the country, the economy, or the "wrong track" of current political leadership. An overwhelming 70% of American voters said in 1991 that the situation for children in the United States had gotten worse over the past five years.5

The welfare of children is linked in the public mind with the overall state of the nation, and thus mandates for new government programs for children will be tempered by growing concern about the overall economy and the financial solvency of state and federal governments. This is evident in the existing polls, as support for individual taxes to fund children's programs eroded from 1990 to 1991, driven at least in part by the recession. For example, the same question about willingness to finance health care for all poor children when asked in July 1990 found 59% of the public ready to pay an additional $100 in taxes;10 by November 1991, that support had eroded to 45% in favor and 45% opposed.5 (See Figure 3.)