Senator Edward Kennedy (l) and Robert Blendon at the summit

A definitive answer to Johnston’s query is unknown but some clues may be found in a survey conducted by Robert Blendon, professor of health policy and management in the Department of Health Policy and Management, and a team of HSPH researchers for the BCBSMA Foundation.

The survey results were released at "Taking the Public’s Pulse: A Summit on Access," a half-day program convened by the BCBSMA Foundation that hosted elected officials, including Massachusetts Senator Edward M. Kennedy; key figures in the insurance industry, major businesses and unions; health care providers; and leaders of patient advocacy groups, research organizations and academic institutions. The report on the survey is called "The Uninsured in Massachusetts: An Opportunity for Leadership."

In September, Blendon’s team surveyed 1,000 randomly selected adults in Massachusetts on their understanding of the reasons for and consequences of the state’s expanding group of people without health insurance. The surveyors examined attitudes toward the uninsured, as well as respondents’ interest in solving the problem of lack of universal and affordable health care in the state.

The team uncovered a compassionate and conflicted citizenry. "We found there was huge commitment [to providing insurance] but not a lot of factual knowledge," lead author Blendon explained.

• Fifty-nine percent of those asked say the problem of the uninsured has gotten worse in the last two years. However, they rank health care issues as the fifth most pressing problem in the state, after the economy, education, state finances and taxes.

• An almost equal number of people (35%) believe lack of health insurance and the cost and coverage of prescription drugs (34%) are the most important health care issues for the state to address.

• Fifty-seven percent believe the government should pay most of the cost of helping the state’s uninsured.

• More than 75 percent of those asked could not correctly estimate the number of the state’s uninsured, which is between 400,000 to 600,000, or roughly seven percent of the population.

Data were weighted to accurately reflect the demographics of the state population, as described by the US Census. The margin of error of the findings is ± three percentage points.

Based on the survey’s findings, Blendon offered attendees practical suggestions to address the problem of having so many uninsured people in the state. He pointed out that people in Massachusetts overwhelmingly support universal health care and want the chance to show that support in a referendum.

"Even though we are in a recession, people will sign on to a moral principle," he suggested.

However, there is no single current proposal that will capture the majority of the voters in the state. The survey found that every plan had the support of about 20 percent of the people interviewed.

Blendon suggested a hybrid proposal, incorporating a mix of employment-based plans, direct subsidies, tax credits and an expansion of state programs for low-income people. Such a plan would have the best chance for voter approval, he said, even if it increased taxes. Blendon added that there is strong support to increase so-called "sin" taxes on items such as cigarettes to aid the uninsured, and even some support for a small increase in the state’s income tax, especially if it can be shown that the money would make a real difference.

Respected leaders need to get on board in supporting options for extending affordable health care to the uninsured, he said. People take their cues from those they trust, said Blendon, in part because they do not have the time, education or interest to study a plan themselves. A lack of balanced information leaves citizens vulnerable to extremist groups that often emphasize negative aspects of issues, he said.

Howard Koh, former state public health commissioner and now head of the Division of Public Health Practice at HSPH, attended the summit. He said that the problem of the uninsured "is one of the most challenging public health crises of our time, in Massachusetts and in the U.S."

Sen. Kennedy echoed Koh’s sentiments, adding: "To every problem there is a solution, and for every solution there is a moment. Few issues are more important than access to health care, and this is the moment to solve this problem."

A copy of "The Uninsured in Massachusetts: An Opportunity for Leadership" is available at http://www.bcbsmafoundation.org/foundationroot/index.jsp.

--PHC