SUMMARY: Health care is playing a prominent role at the start of the 2020 presidential primary season with Democratic candidates offering competing proposals aimed at expanding coverage to more Americans but what do American’s really think about healthcare?

According to the KFF health tracking poll “the latest KFF Health Tracking Poll finds a larger share of Democrats and Democratic-leaning independents preferring approaches that expand coverage building on the Affordable Care Act (55%) rather than replacing the ACA with a national Medicare-for-all plan (39%).

The poll also finds a slight dip in overall favorability of the idea of a national Medicare-for-all plan. About half (51%) of the public now say they favor such a proposal compared to 56% in April 2019. On the other hand, nearly two-thirds of the public (65%) favor a public option, which would compete with private health insurance plans and be available to all Americans. But as with polling on Medicare-for-all, attitudes toward this change to the current health care system can be swayed by common arguments. For example, net favorability towards such a plan ranges as high as +53 and as low as -18 after hearing arguments either in favor of or against a public option.

The survey finds that, while a majority of the public hold favorable views of Medicare (83%), the public also has largely favorable views of employer-sponsored insurance (76%) and Medicaid (75%). In addition, both those with Medicare coverage (95%) and employer coverage (86%) rate their own health insurance coverage positively.

Government surveys show that about 90% of the population has coverage, largely preserving gains from President Barack Obama’s years. Independent experts estimate that more than one-half of the roughly 30 million uninsured people in the country are eligible for health insurance through existing programs.

A report this year by the Commonwealth Fund think tank in New York found fewer uninsured Americans than in 2010 but more who are “underinsured,” a term that describes policyholders exposed to high out-of-pocket costs, when compared with their individual incomes. The report estimated 44 million Americans were underinsured in 2018, compared with 29 million in 2010 when the law was passed. That’s about a 50% increase, with the greatest jump among people with employer coverage.

Then there is from Axios “a very small group of patients with major illnesses is responsible for an outsized share of health care spending, and new data show that prescription drugs are a big part of the reason their bills are so high.

Among people who get their coverage from a large employer, just 1.3% of employees were responsible for almost 20% of overall health spending, averaging a whopping $88,000 per year. Between the lines: “Persistently high spenders” are people who have accumulated big health care bills for at least 3 consecutive years.

 Prescription drugs account for about 40% of this group’s costs, not counting rebates — compared with just 10% for the country as a whole. Their bills just for prescription drugs average out to about $34,000 per year. That’s much more than the average premium for family coverage.

Nearly 45,000 annual deaths are associated with lack of health insurance, according to a new study published online by the American Journal of Public Health. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002.

The study, conducted at Harvard Medical School and Cambridge Health Alliance, found that uninsured, working-age Americans have a 40 percent higher risk of death than their privately insured counterparts, up from a 25 percent excess death rate found in 1993.

What it all mean?

There is a huge gap on perception versus reality when it comes to healthcare and healthcare costs. U.S. life expectancy of 78.8 years ranks 27th yet we are first in healthcare costs per person of over $9,000. It has the fourth highest infant mortality rate in the OECD, the sixth highest maternal mortality rate and the ninth highest likelihood of dying at a younger age from a host of ailments, including cardiovascular disease and cancer.

The U.S. is also the most obese country in the OECD, leads in drug-related deaths and ranks 33rd in the prevalence of diabetes. Yet 88 percent of Americans say they are in good or very good health, according to OECD statistics. Only 35 percent of Japanese, who have the highest life expectancy in the OECD, regard themselves as healthy or very healthy.

Until our healthcare system addresses the root causes of preventable chronic health conditions and finds ways to reduce healthcare costs we are going to be paying more while getting less. Which candidates will have the courage to say that the problem of healthcare is also due to our poor health?