1. America’s Agenda Report from a quantitative study of voter attitudes on health care delivery system reforms. 1726 M St., NW Suite 1100 Washington, DC 20036 Phone: 202-776-9066 Fax: 202-776-9074 214 North Fayette Street Alexandria, Virginia 22314 Phone: 703-836-7655 Fax: 703-836-8117

2. 2Methodology Lake Research Partners and Public Opinion Strategies designed and administered this survey that was conducted by telephone using professional interviewers between July 6-9, 2009. The survey reached a total of 1000 likely voters nationwide. Telephone numbers for the sample were generated by random digit dial (RDD) methodology. The margin of error for this survey is +/- 3.1%.

3. 3 Key Findings Voters across the political spectrum support health care delivery system reforms that will improve quality of health care and lower costs. Democrats, Republicans, and independents find common ground in supporting the specific set of health care reform proposals tested in the survey, including: –Placing greater emphasis on prevention –Eliminating co-pays and deductibles for chronic disease treatment –Developing a national health information technology network of electronic medical records –Establishing personal medical teams of health professionals coordinated by a primary care physician

4. 4 Key Findings While other areas of health care reform remain controversial, this research shows that voters broadly agree on the need to move forward with key changes to improve quality and control costs. The broad bipartisan unity on these issues suggests these specific proposals should be a major part of any health care reform legislation. Voters see the specific elements of this reform agenda as working together to increase prevention and prevent chronic diseases, to increase the quality of health care, and to effectively get the rising costs of health care under control.

5. 5 Key Findings Both Democratic and Republican voters favor the health care reform proposal. Fully 71% of voters support the health care reform proposal tested—including 85% of Democrats and 60% of Republicans. HEALTH CARE DELIVERY SYSTEM REFORM PROPOSAL: Now I would like to read you a proposal that is being considered to reform health care. This proposal aims to reduce costs and improve quality of health care in the following ways: Make health coverage more affordable and accessible for all Americans; Eliminate co-pays and deductibles for recommended chronic disease treatment prescribed by your doctor; Eliminate co-pays and deductibles for recommended preventive services and emphasize disease prevention including reducing obesity and smoking; Ensure that doctors have accurate and updated information on the most effective treatments; Ensure that patients receive highly coordinated, personalized treatment plans based on the latest medical evidence; Would you favor or oppose this proposal, or are you undecided?

6. 6 Key Findings Many of the proposal’s key components receive high levels of support: –Fully 75% of the voters gave establishing personal medical teams of health professionals coordinated by a family doctor a rating of 6 or greater on a scale of 0 to 10 (7.4 mean rating). –73% of voters rate developing a national health information technology network of electronic medical records a rating of 6 or greater (7.2 mean). –63% of voters provide a rating of 6 or higher for eliminating co-pays and deductibles for chronic disease treatment (6.6 mean).

7. 7 Key Findings  After hearing about the reforms, 62% of voters would be more likely to support a member of Congress who supported these reforms. Democrats are net +72 points more likely to support such a member of Congress, with Republicans a net +22 points more likely.  Voters believe the current health care system places far less emphasis on prevention than it should.  While only half of all voters (49%) say that a lot (14%) or some emphasis is placed on prevention in our current health care system, 88% say that a lot (65%) or some should be placed on it—including 65% of Democrats and 62% of Republicans who believe that a lot of emphasis should be placed on prevention.

8. 8 Key Findings  Voters across the political spectrum agree that:  Rising health care costs are undermining the living standards of working families  The epidemic of chronic diseases is driving up health care costs  Americans are receiving the most expensive care, but not always the best care  American businesses are at a disadvantage when competing in the global economy because health care costs are rising so dramatically.  On a scale of 0-10, the mean agreement with each of these statements is at least 6.9 overall, at least 7.0 among Democrats, and at least 6.7 among Republicans.

9. Attitudes toward Health Care Voters think much more emphasis should be placed on prevention, and are interested in practical means to bringing down costs while improving quality.

10. 10 Nearly two-thirds of voters think that the current health care system needs a complete overhaul or major reform. In your opinion, does the health care system need a complete overhaul, major reform, minor reform or no reform at all? 65% * * Numbers do not appear to sum due to rounding

11. 11 Over two-thirds of voters report following the recent health care debate in Congress, even if they may not have a clear idea of what is actually being proposed. Have you been following the recent debate in Congress about health care reform?

12. 12 More than three-quarters of voters say affordability of health care in this country is only fair or poor, though concern about health care costs is much greater among Democrats than Republicans. * Asked of half of sample. How would you rate the affordability of health care in this country? Would you rate it as excellent, good, just fair, or poor?* 77%

13. 13 However, when it comes to the affordability of their own health care, voters are less dissatisfied. * Asked of half of sample. How would you rate the affordability of health care you personally receive? Would you rate it as excellent, good, just fair, or poor?* 44% ** ** Numbers do not appear to sum due to rounding

14. 14 Voters believe the current health care system places far less emphasis on prevention than it should. Prevention Questions How much emphasis do you think should be placed on prevention in our health care system? A lot, some, a little, or not much at all?* How much emphasis do you think is placed on prevention in our current health care system? A lot, some, a little, or not much at all?* * Asked of half of sample. Democrats (65%) and Republicans (62%) agree that a lot more emphasis should be placed on prevention.

15. 15 A large plurality of both Democrats and Republicans agree that we should place greater emphasis on prevention. Total Democrats Republicans There are two approaches to health and sickness: one approach – treatment – which seeks to cure sickness, and another approach – prevention – which seeks to prevent sickness. At the moment, do you think that our health care system has the right balance between treatment and prevention, or should we be giving more emphasis to treatment, or more emphasis to prevention?

16. 16 Voters agree that rising health care costs are undermining the living standards of working families, and that we should reform our health care system now to improve quality and reduce costs. Mean Now I’m going to read you some statements people might make about health care. For each one, please rate how much you agree or disagree for that statement on a scale of zero to ten, where ten means you strongly agree with this statement, and zero means you strongly disagree with this statement, and you can choose any number in between. 7.8 7.2 7.0 Rising health care costs are undermining the living standards of working families and increasing their struggles to make ends meet To keep businesses competitive, improve our economy, and expand access to affordable health care for all Americans, we should reform our health care system now to improve quality and help reduce costs.* The epidemic growth of chronic diseases like heart disease, diabetes, and cancer is driving up health care costs sharply. * Asked of half of sample. American businesses are at a huge disadvantage competing in the global economy because health care costs are rising so dramatically in this country.

17. 17 Voters are more concerned about the impact high health care costs have on themselves and their families than they are on their effect on state budgets. Mean Now I’m going to read you some statements people might make about health care. For each one, please rate how much you agree or disagree for that statement on a scale of zero to ten, where ten means you strongly agree with this statement, and zero means you strongly disagree with this statement, and you can choose any number in between. 6.9 6.6 6.3 Americans are receiving more expensive care but the most expensive care isn’t always the best. The rising cost of health care is contributing to budget shortfalls for state governments and long- term fiscal challenges for the federal government. Reforming our health care system will help slow the growth in costs. * * Asked of half of sample. Americans have a once-in-a-lifetime opportunity to make meaningful changes to our health care system, and Congress should pass reforms this year that will help the economy and benefit future generations.

18. Support for the Health Care Delivery System Reform Proposal Democrats, Republicans, and independents find common ground in supporting the specific set of health care reform proposals tested in the survey.

19. 19 Both Democratic and Republican voters favor the health care delivery system reform proposal. Now I would like to read you a proposal that is being considered to reform health care. This proposal aims to reduce costs and improve quality of health care in the following ways: Make health coverage more affordable and accessible for all Americans; Eliminate co-pays and deductibles for recommended chronic disease treatment prescribed by your doctor; Eliminate co-pays and deductibles for recommended preventive services and emphasize disease prevention including reducing obesity and smoking; Ensure that doctors have accurate and updated information on the most effective treatments; Ensure that patients receive highly coordinated, personalized treatment plans based on the latest medical evidence; Would you favor or oppose this proposal, or are you undecided?

20. 20 By solid margins, both Democrats and Republicans would be more likely to vote for a member of Congress if they supported the reforms in this health care proposal. Having heard all of these reforms, would you be more or less likely to vote for a member of Congress if they supported these reforms, or would it not make a difference?

21. 21 Differences in support for these reforms by gender, age and region are fairly modest, largely reflecting differences in party identification. Now I would like to read you a proposal that is being considered to reform health care. This proposal aims to reduce costs and improve quality of health care in the following ways: Make health coverage more affordable and accessible for all Americans; Eliminate co-pays and deductibles for recommended chronic disease treatment prescribed by your doctor; Eliminate co-pays and deductibles for recommended preventive services and emphasize disease prevention including reducing obesity and smoking; Ensure that doctors have accurate and updated information on the most effective treatments; Ensure that patients receive highly coordinated, personalized treatment plans based on the latest medical evidence; Would you favor or oppose this proposal, or are you undecided?

22. 22 Developing a national health information technology network of electronic medical records, establishing personal medical teams of health professionals coordinated by a primary care physician, and eliminating co-pays and deductibles for the treatment of chronic diseases all receive strong bipartisan support. Mean Now I’m going to read you some individual components of the proposal I just read to you. For each one, please rate your support for that item on a scale of zero to ten, where ten means you strongly support this component of the proposal, and zero means you strongly oppose this part of the proposal, and you can choose any number in between. 7.2 7.3 7.4 Develop a national health information technology network of electronic medical records to reduce the medical errors and costs associated with paper records, with protections for personal privacy. Establish personal health teams of health professionals, like nurses, nutritionists, and preventive care specialists coordinated by a primary care physician or family doctor, to support patient management and prevention of chronic diseases like diabetes, heart disease, and cancer, at a lower cost to patients.* Establish personal medical teams of health professionals, like nurses, nutritionists, and preventive care specialists coordinated by a primary care physician or family doctor, to support patient management and prevention of chronic diseases like diabetes, heart disease, and cancer, at a lower cost to patients.* * Asked of half of sample. 7.1 Provide incentives in public and private health plans to reward active patient involvement in preventing obesity and related chronic diseases like diabetes, heart disease, and cancer.

23. 23 Voters provide solid support for providing incentives to strengthen the primary care workforce and reward patient involvement in preventing obesity and chronic disease. Mean Now I’m going to read you some individual components of the proposal I just read to you. For each one, please rate your support for that item on a scale of zero to ten, where ten means you strongly support this component of the proposal, and zero means you strongly oppose this part of the proposal, and you can choose any number in between. 7.0 6.7 6.5 Strengthen the primary care workforce by providing incentives such as increased reimbursements, forgiveness of education loans, and tuition assistance to encourage more primary care family doctors and nurses to enter the field. Establish a public-private National Commission on Chronic Disease Management, which will identify ways to improve treatment of chronic disease like diabetes, heart disease, and cancer, and sponsor research on which treatment work best. * Asked of half of sample. 6.6 Eliminate co-pays and deductibles for necessary chronic disease treatment prescribed by a doctor.* Create incentives, such as bonuses for doctors and hospitals, and insurance discounts for patients who follow best practices for preventing and treating chronic diseases, like diabetes, heart disease, and cancer.*

24. 24 Voters provide less support for establishing Federal funding for a national anti-smoking campaign—but every element of the proposal rates at least a 5 on a 0 to 10 scale. Mean Now I’m going to read you some individual components of the proposal I just read to you. For each one, please rate your support for that item on a scale of zero to ten, where ten means you strongly support this component of the proposal, and zero means you strongly oppose this part of the proposal, and you can choose any number in between. 6.5 5.7 6.0 5.1 Establish federal funding for a coordinated national campaign to prevent obesity.* Create incentives, such as bonuses for doctors and hospitals who follow best practices for preventing and treating chronic diseases, like diabetes, heart disease, and cancer.* Establish federal funding for a coordinated national anti- smoking campaign.* * Asked of half of sample. Eliminate co-pays and deductibles for necessary chronic disease treatment prescribed by a doctor in national health programs like Medicare.*

25. 25 Key components of the proposal enjoy broad bipartisan support, including establishing personal medical teams, using electronic medical records, and providing incentives to reward patient involvement in preventing obesity and chronic disease. Democrats Republicans Now I’m going to read you some individual components of the proposal I just read to you. For each one, please rate your support for that item on a scale of zero to ten, where ten means you strongly support this component of the proposal, and zero means you strongly oppose this part of the proposal, and you can choose any number in between. Establish personal medical teams of health professionals, like nurses, nutritionists, and preventive care specialists coordinated by a primary care physician or family doctor, to support patient management and prevention of chronic diseases like diabetes, heart disease, and cancer, at a lower cost to patients.* Develop a national health information technology network of electronic medical records to reduce the medical errors and costs associated with paper records, with protections for personal privacy. Provide incentives in public and private health plans to reward active patient involvement in preventing obesity and related chronic diseases like diabetes, heart disease, and cancer. * Asked of half of sample. Democrats Republicans Mean 8.1 6.9 8.0 6.3 7.9 6.5

26. 26 In terms of effectiveness in reducing costs and improving quality, the highest rated components include establishing personal medical teams, and a national information technology network of electronic medical records. Mean Now I’m going to read you some individual components of the proposal I just read to you. For each one, please rate how effective that item will be in reducing costs and improving quality on a scale of zero to ten, where ten means this component of the proposal will be extremely effective in reducing costs and improving quality, and zero means this part of the proposal will be completely ineffective at reducing costs and improving quality, and you can choose any number in between. 7.3 7.0 6.9 6.8 Establish personal medical teams of health professionals, like nurses, nutritionists, and preventive care specialists coordinated by a primary care physician or family doctor, to support patient management and prevention of chronic diseases, like diabetes, heart disease, and cancer, at a lower cost to patients.* Develop a national health information technology network of electronic medical records to reduce the medical errors and costs associated with paper records, with protections for personal privacy. Establish personal health teams of health professionals, like nurses, nutritionists, and preventive care specialists coordinated by a primary care physician or family doctor, to support patient management and prevention of chronic diseases, like diabetes, heart disease, and cancer, at a lower cost to patients.* Strengthen the primary care workforce by providing incentives such as increased reimbursements, forgiveness of education loans, and tuition assistance to encourage more primary care family doctors and nurses to enter the field. * Asked of half of sample.

27. 27 Eliminating co-pays and deductibles for chronic disease treatment and establishing a National Commission on Chronic Disease Management are also seen as effective ways to control costs and improve quality. Mean Now I’m going to read you some individual components of the proposal I just read to you. For each one, please rate how effective that item will be in reducing costs and improving quality on a scale of zero to ten, where ten means this component of the proposal will be extremely effective in reducing costs and improving quality, and zero means this part of the proposal will be completely ineffective at reducing costs and improving quality, and you can choose any number in between. 6.7 6.5 6.4 Establish a public-private National Commission on Chronic Disease Management, which will identify ways to improve treatment of chronic disease like diabetes, heart disease, and cancer, and sponsor research on which treatment works best. Provide incentives in public and private health plans to reward active patient involvement in preventing obesity and related chronic diseases like diabetes, heart disease, and cancer. Eliminate co-pays and deductibles for necessary chronic disease treatment prescribed by a doctor.* * Asked of half of sample. Create incentives, such as bonuses for doctors and hospitals, and insurance discounts for patients who follow best practices for preventing and treating chronic diseases, like diabetes, heart disease, and cancer.*

28. 28 Federal funding for anti-smoking and obesity prevention are seen as less effective means of controlling health care costs. Mean Now I’m going to read you some individual components of the proposal I just read to you. For each one, please rate how effective that item will be in reducing costs and improving quality on a scale of zero to ten, where ten means this component of the proposal will be extremely effective in reducing costs and improving quality, and zero means this part of the proposal will be completely ineffective at reducing costs and improving quality, and you can choose any number in between. 6.2 5.9 5.3 4.7 Create incentives, such as bonuses for doctors and hospitals who follow best practices for preventing and treating chronic diseases, like diabetes, heart disease, and cancer.* Establish federal funding for a coordinated national anti- smoking campaign.* Establish federal funding for a coordinated national campaign to prevent obesity.* * Asked of half of sample. Eliminate co-pays and deductibles for necessary chronic disease treatment prescribed by a doctor in national health programs like Medicare.*

29. 29 For the most part, those components with the highest support are also seen as the most effective in reducing cost and improving quality. Component of Proposal Support (% rating 6+ on scale of 0-10) Effective at reducing cost and improving quality (% rating 6+ on scale of 0-10) Establish personal health teams of health professionals, like nurses, nutritionists, and preventive care specialists coordinated by a primary care physician or family doctor, to support patient management and prevention of chronic diseases, like diabetes, heart disease, and cancer, at a lower cost to patients.* 76%73% Establish personal medical teams of health professionals, like nurses, nutritionists, and preventive care specialists coordinated by a primary care physician or family doctor, to support patient management and prevention of chronic diseases, like diabetes, heart disease, and cancer, at a lower cost to patients.* 75%74% Develop a national health information technology network of electronic medical records to reduce the medical errors and costs associated with paper records, with protections for personal privacy. 73%69% Provide incentives in public and private health plans to reward active patient involvement in preventing obesity and related chronic diseases like diabetes, heart disease, and cancer. 72%67% * Asked of half of sample.

30. 30 Across the board, voters provide somewhat higher levels of support for elements of the proposal relative to how effective they believe each will be in controlling cost and improving quality. Component of Proposal Support (% rating 6+ on scale of 0-10) Effective at reducing cost and improving quality (% rating 6+ on scale of 0-10) Strengthen the primary care workforce by providing incentives such as increased reimbursements, forgiveness of education loans, and tuition assistance to encourage more primary care family doctors and nurses to enter the field. 72%68% Establish a public-private National Commission on Chronic Disease Management, which will identify ways to improve treatment of chronic disease like diabetes, heart disease, and cancer, and sponsor research on which treatment works best. 67%63% Create incentives, such as bonuses for doctors and hospitals, and insurance discounts for patients who follow best practices for preventing and treating chronic diseases, like diabetes, heart disease, and cancer.* 64%60% Eliminate co-pays and deductibles for necessary chronic disease treatment prescribed by a doctor.* 63%58% * Asked of half of sample.

31. 31 Federal funding for preventing obesity and anti-smoking not only receive lower levels of support, but are also seen as the least effective means to control costs and improve quality. Component of Proposal Support (% rating 6+ on scale of 0-10) Effective at reducing cost and improving quality (% rating 6+ on scale of 0-10) Eliminate co-pays and deductibles for necessary chronic disease treatment prescribed by a doctor in national health programs like Medicare.* 61%59% Create incentives, such as bonuses for doctors and hospitals who follow best practices for preventing and treating chronic diseases, like diabetes, heart disease, and cancer.* 61%53% Establish federal funding for a coordinated national campaign to prevent obesity.* 55%46% Establish federal funding for a coordinated national anti- smoking campaign.* 46%41% * Asked of half of sample.

32. 32 Even Republicans who want little or no health care reform (17% of the sample) still support many of the proposal’s key components, albeit less strongly than other groups. Mean Now I’m going to read you some individual components of the proposal I just read to you. For each one, please rate your support for that item on a scale of zero to ten, where ten means you strongly support this component of the proposal, and zero means you strongly oppose this part of the proposal, and you can choose any number in between. 5.7 5.6 5.0 Develop a national health information technology network of electronic medical records to reduce the medical errors and costs associated with paper records, with protections for personal privacy. Establish personal medical teams of health professionals, like nurses, nutritionists, and preventive care specialists coordinated by a primary care physician or family doctor, to support patient management and prevention of chronic diseases like diabetes, heart disease, and cancer, at a lower cost to patients.* * Asked of half of sample. Provide incentives in public and private health plans to reward active patient involvement in preventing obesity and related chronic diseases like diabetes, heart disease, and cancer. Strengthen the primary care workforce by providing incentives such as increased reimbursements, forgiveness of education loans, and tuition assistance to encourage more primary care family doctors and nurses to enter the field. Republicans favoring minor/no reform

33. 33 Republicans who favor health care reform, or 15% of the sample, show the strongest support for electronic medical records, eliminating co-pays for chronic disease treatment, and establishing person health teams coordinated by a family doctor. Mean Now I’m going to read you some individual components of the proposal I just read to you. For each one, please rate your support for that item on a scale of zero to ten, where ten means you strongly support this component of the proposal, and zero means you strongly oppose this part of the proposal, and you can choose any number in between. 8.1 7.8 Develop a national health information technology network of electronic medical records to reduce the medical errors and costs associated with paper records, with protections for personal privacy. * Asked of half of sample. Republicans favoring overhaul/major reform Eliminate co-pays and deductibles for necessary chronic disease treatment prescribed by a doctor.* Establish personal health teams of health professionals, like nurses, nutritionists, and preventive care specialists coordinated by a primary care physician or family doctor, to support patient management and prevention of chronic diseases, like diabetes, heart disease, and cancer, at a lower cost to patients.*

34. America’s Agenda Report from a quantitative study of voter attitudes on health care delivery system reforms. 1726 M St., NW Suite 1100 Washington, DC 20036 Phone: 202-776-9066 Fax: 202-776-9074 214 North Fayette Street Alexandria, Virginia 22314 Phone: 703-836-7655 Fax: 703-836-8117