Marttila Strategies

Health Care

Marttila Strategies has extensive experience measuring American attitudes to a variety of health care issues—and brings a special expertise to understanding American values about health care.

National health care clients have included: IMS Health, PhRMA, The American Cancer Society, The Harvard School of Public Health, The Robert Wood Johnson Foundation and The Kaiser Family Foundation.

Between March 2009 and May 2010, the company has conducted three in-depth national surveys measuring American reaction to the debate about health care reform and other health care topics. This analysis has been supported by multiple focus groups in different regions in the country.

In 2007, the company provided strategic research for the coalition of organizations that helped launch the groundbreaking Massachusetts program to bring health insurance coverage to all citizens of the Commonwealth. Other Massachusetts health care clients have included: Prescription Advantage (the MA prescription program for seniors, which in many ways was a precursor for the national Medicare D program), Harvard Pilgrim Health Care (a leading HMO), the MA Hospital Association, the MA Extended Care Federation (nursing homes), and the MA Department of Public Health. In 1992, the company produced the award winning advertising for the original MA campaign to increase the tobacco tax, which funded Massachusetts’ highly regarded tobacco control campaign.

Marttila Strategies has developed clear views about how Americans think about the issue of health care: Most people—even the best educated—have a minimal understanding of the key policy details that have been part of the current debate about health care reform, and it is doubtful they ever will. They do, however, have very strong beliefs about their own health care, and what they hope/fear it will look like in the future. Therefore, when making the case for health care reform—it is essential that the public case for reform be anchored by values that are understandable to average Americans.

For example:

  • Americans don’t believe any family should be financially devastated by catastrophic illness.

    This belief crosses ideological and party lines.
  • Americans don’t believe anybody should be denied insurance coverage because of a pre-existing medical condition.

    This belief also crosses ideological and party lines.
  • Americans want all American kids to have health care coverage.

    This is a rock-solid moral value. Most Americans don't know how many kids are uninsured (they guess more kids do not have coverage, than actually do).
  • Americans want their doctors, nurses, and medical colleagues to make their medical decisions.

    There is enormous hostility to the perceived ability for “insurance bureaucrats” to make medical decisions that adversely effect patients and their families.
  • Americans hold nurses in particularly high regard.

    Nurses are almost always the most highly rated medical professionals. The public has great admiration for their hard work and dedication—and sympathy for their long hours.
  • Americans also trust and admire their doctors.

    Americans also respect and admire doctors. They want them making their key medical decisions. They also believe that insurance company procedures are squeezing their doctors so that they have less and less time for spending quality time with patients.
  • Americans want to choose their own doctors, specialists and hospitals.

    This is less of a burning issue than it used to be because health consumers were furious about these restrictions and they demanded change. As a result, many of the health plans have folded/limited their managed care hand on the selection of medical personnel. This may be less of a practical consideration these days; but it is still a deeply held value.
  • Americans don’t want the government involved in dispensing health care, but they definitely want government health guarantees, e.g., patients’ bill of rights, prescriptions for seniors, full coverage, etc.

    This is a distinction too many Democrats have failed to grasp since the Clinton health debacle. Americans believe government has a role to play—they want government guarantees for certain health rights—and they most certainly would want the government to crack down on health care companies that are taking advantage of consumers. But they don’t want “government” dispensing health care services, per se.
  • The issue of health care costs is back on the front burner. Americans believe/know/worry that they will be paying more and more, for less and less insurance coverage. Few, if any, believe their premiums will/can be reduced in the future.

    The issue of health care costs is once again a major concern—after lying relatively dormant for many years. Americans are looking for ways to control rapidly raising costs—but they do not believe a dramatic reduction is very likely. Thus, preventing future health care cost increases would be a huge political victory—actually reducing costs would be seen as a political miracle.
  • Americans believe/know/worry employers are likely to cut back health care benefits even further—a development they see as being largely inevitable. They also believe that in the ideal world, all employers should provide health care coverage—but employer mandates, while initially appealing, rarely survive a lengthy discussion.

    There is not a tremendous amount of anger directed at employers because of their decision to increase the share employees must pay for their own premiums. Sympathy would be the wrong word—resignation is probably more accurate. Anti-corporate populism does not currently exist on this issue.
  • There is a widespread belief that patients have to be their own advocates in new era of managed care. But this is not a happy thought to many vulnerable audiences.

    Surprisingly, this is not always a top-of-the-mind consideration, but with a little prodding, people first express dissatisfaction/resignation to their health care future, and second, bemoan the loss of greater medical oversight in their lives. This is a very tough circumstance for many vulnerable people.
  • Americans believe seniors should have prescription drug coverage, but this issue has less political salience among the general population than many Democrats might believe.

    Democrats have over-valued the political power of this issue among the general population in past elections (particularly 2002). And, they have frequently misunderstood senior attitudes: Almost all of the research on the issue shows that most seniors on Medicare D are very happy with the coverage. Further, while most American support importation in polling, few would go to the political barricades for the issue—its real political salience is highly dubious. Very, very few older Americans have actually pursued the Canadian option.
  • Americans continue to be sharply critical of what they believe is the pharmaceutical industry focus on profits at the expense of curing disease. However, Americans who take at least one prescription per day, consider these medications vital to their health.

    The hostility that is oftentimes directed at pharmaceutical companies during health care focus groups can be startling. The instant visceral reaction is strikingly negative and focuses on what is seen to be the issue of massive pharmaceutical profits. Americans appreciate the pharmaceutical breakthroughs, but after discussing the contribution of these pharmaceuticals, they remain deeply suspicious of the motives of the industry.

    In our March IMS survey, 58% of American voters said they take at least one prescription medication per day. When asked to rank the importance of this medication to their overall health, 78% ranked the medication an 8, 9 or 10 on a ten-point scale. 55% rated their medicine a 10. These are extraordinary ratings.
  • Americans are antagonistic toward insurance companies, organizations who they believe are totally motivated by profit and have gained too much decision-making power in health care.

    This observation unites Americans of all political persuasions—even though they consistently give excellent ratings to their own insurance coverage.
  • Americans believe the current health care system is driven by the desire for profits, even among not-for-profit hospitals.

    Even though many providers are losing their shirt, most Americans believe the health care system is driven by the desire for profits. For example, there is limited public understanding between the differences in for-profit, and not-for-profit hospitals. They believe all hospitals are for-profit institutions.

    There is also almost no understanding of the inadequate rates of reimbursements hospitals receive from Medicare and Medicaid.
  • Americans don’t know much about Medicaid, especially those parts of the program that provide coverage for poor seniors, seniors in nursing homes and for people with disabilities.

    When discussing the reasons to support Medicaid, one should assume people have a minimal understanding of the program—even though it takes up a huge part of most state budgets (e.g., 25% in Massachusetts). Many Americans believe that some Medicaid recipients take advantage of the system (some do), which causes them to call into question the worth of the entire program. Still others believe fraud is rampant.

    The surest way to de-bunk some of these prejudicial perceptions is to describe the Medicaid population: 50% are kids (18% of the costs), with 70% of the money going to poor seniors, seniors in nursing homes and the disabled. Skeptics have a hard time disagreeing with the desirability of helping these audiences.
  • Many Americans believe Medicare is at risk, and many younger Americans doubt it will be there when they need it. Also, Medicare's freestanding gold standard identity may be eroding somewhat.

    Among Americans over 65, Medicare is still beloved, but the relentless attack by Republicans on Medicare's stability may be taking its toll on the Medicare brand. Younger Americans no longer believe Medicare will be there when they need it.
  • Americans support universal coverage, but, not surprisingly, they have no idea how to make it happen. Support for universal coverage crosses party and ideological lines. Americans want universal coverage because they worry about the loss of their own coverage—but support for universal coverage is also a morally based concern—Americans genuinely worry about what happens to people without coverage.

    Americans should be continually reminded of their shared moral belief on the issue, no matter what the audience.

    Also, they need to better understand the practical benefits the country will derive if all Americans are insured—e.g., profound benefits for American economic competitiveness, a dramatically more effective health care system, etc.
  • There is increased public resonance on the issue of universal coverage because of the extraordinary churn in the health insurance system: Stable, enduring insurance protection is becoming increasingly important to Americans of all political persuasions.

    In our March 09 IMS survey, 32% of all Americans said they had changed insurance policies during the past three years, and of those, 57% said the change was not voluntary. This churn is making Americans very nervous—and it is becoming a disincentive for health care plans to build serious wellness programs because they know many of their clients will be quickly passing through.

    When asked, Americans vastly over-estimate the number of the uninsured, but Americans are never good on statistics. Also, to the extent that individual mandates become the center of this discussion, it must be managed very carefully: mandates can be surprisingly controversial. A majority of Americans do not support individual mandates.