With 6 months until the mid-term elections, and media coverage of polls increasing, it’s important that healthcare stakeholders understand public views of the system, and more important, the beliefs that underly these views.
Healthcare Polling: Uniquely Challenging
Every independent polling organization—KFF, Pew, Gallup, Harris, Ipsos, NYT/Siena, Washington Post, Morning Consult, YouGov, AP/NORC, Quinnipiac, Zogby, et al include health system related questions in their surveys. Collectively, there’s consensus among these on three major findings:
- A growing majority of American adults think the health system is fundamentally flawed an in need of major improvement. Price transparency, affordability (household costs) and accessibility are major sources of discontent.
- A growing majority think the system is controlled by business interests. They blame hospitals, insurers and drug companies—all three– for unnecessarily high costs believing corporatization and consolidation responsible.
- A shrinking majority think the quality of care provided in the U.S. health system is better than other systems of the world. Polls show the majority think the prescription drugs they use are safe but more expensive than in other countries. They think health insurance is necessary to financial security but expensive and designed to limit access when needed. And they think hospitals are important but see little distinction between “not-for-profit” and investor-ownership.
Generally, polls show these views held strongest in lower income, non-Caucasian and younger age groups and among those who self- identify as Democratic or Independent voters. But within cohorts, attitudes range widely, especially when attitudes on specific health topics are queried. i.e. abortion rights, costs, universal coverage, drug prices, affordability, Medicaid expansion, et al.
Measuring the public’s opinions on healthcare issues and ideas in the U.S. via polling is tricky.
- Most U.S. adults do not have informed views about the entire health system nor a basis for comparing it to systems in other countries. Their attitudes are based on personal experiences–some good and many bad–and the individual values derived from family, faith or critical experiences. Formal education about how the health system operates is not a required part of public/private education curricula at any level in the US though healthcare is 18% of the GDP and the nation’s biggest employer. Thus, polling about the health system requires probing often rarely structured in quantitative polling methodologies. In its place, focus groups serve an important adjunctive purpose in understanding views. Note: the lack of an informed view of the system is a noticeable deficit in the healthcare workforce and among the trustees who oversee its performance.
- Most think healthcare is complicated and needs government oversight. The majority believes access to healthcare is a fundamental right without regard to an individual’s ability to pay. And the majority have reservations about the role of government in the its oversight, preferring private options to government ownership.
- Most believe the health system is unnecessarily expensive, wasteful and fraudulent. They believe most operators care more about profits than patient care. They do not understand how system costs are accounted, how payments across the system are set and flow, nor how prices are set. Most believe an unexpected healthcare event can ruin their finances for life. And most think executives in healthcare are overpaid.
These are core beliefs. They are predictive of how voters/consumers respond to polling questions on specific issues, policies and choices. In perspective, their views are not surprising. Healthcare’s complicated and the public’s not equipped to make informed judgements about its performance or future. Ditto other industries with one caveat: healthcare operates around a presumption that consumers are incapable of making rational choices about their healthcare, preferring dependence on physicians/caregivers for their directives. Nonetheless, the “medical system” joins every other major U.S. institution’s precipitous erosion of trust and confidence over the last two decades:
Gallup: % Great deal/quite a lot of trust and confidence 2025 vs. 1996:
| Institutions | 2025 | 1996 | Change | Peak |
| Medical system | 32 | 42 | -10 | 44/’05 |
| Higher education | 42 | 57* | -15 | 75/’20 |
| Organized religion | 36 | 57 | -21 | 60/’01 |
| Large Tech companies | 24 | 32 | -8 | 32/’20 |
| Congress | 10 | 20 | -10 | 30/’04 |
Social researchers, think tanks and industry experts associate the decline with a myriad of root causes– changing demographics, social media influence, big business dominance, household finances, domestic politics and more. All matter. But healthcare’s decline is troubling because the majority believe the industry takes advantage of them.
The Trump 45 and Biden administrations saw it: price transparency executive orders (’21, ’22) that continue to stand today are a repudiation of the industry’s failure to respond to consumer needs and views.
My take
In 1968, social psychologist Milton Rokeach authored “Beliefs, Attitudes and Values: A Theory of Organization and Change”. It defined beliefs as ‘the ways we see the world and make predictions’ noting beliefs predict how people think, act and vote.
Given that consumer sentiment is at an all-time low (University of Michigan Survey of Consumers May 2026), it’s logical to assume that hospitals, insurers and drug companies will address affordability concerns directly and clearly. To date, that’s not the case. Instead, blame and shame crossfire among the trio seems the response for now. It’s contributed to consumer beliefs the system’s broken.
The public’s belief in the health system needs immediate attention not to justify yesterday’s business practices but its commitment to a transformed system tomorrow. Public opinion about the U.S. health system is concerning.
Paul
PS In 1868, John A. Logan, Commander-in-Chief of the GAR (Grand Army of the Republic) issued General Order No. 11, which called for all posts and departments to set aside May 30th “for the purpose of strewing with flowers or otherwise decorating the graves of comrades who died in defense of their country during the late rebellion, and whose bodies now lie in almost every city, village, and hamlet church-yard in the land.” Initially called Decoration Day, it became Memorial Day in 1887 and expanded to include all soldiers who died in service of the country in all wars.
When I was in high school, our weekly assembly began with recognition of former classmates missing in action, wounded or killed in Vietnam the prior week. I remember Jack Keefe’s call-out among the dead. The Vietnam War became real to me that day hearing Jack was gone. My first day in DC when I began my work there in 1995, I visited the Vietnam Memorial and every year since. Vietnam had a profound impact on my generation.
Then, as now, the public’s views on issues reflect generational divide. Then, as now, how public opinion forms, changes and impacts daily life is under-studied. It’s impact on health policies is no exception.
I dedicate this Memorial Day edition of The Keckley Report to Jack.
Quotables
Pope Leo XIV on AI: “Disarming AI means freeing it from the mentality of ‘armed’ competition, which today is not limited simply to the military context, but is also an economic and cognitive phenomenon. Disarming does not mean renouncing technology, but preventing it from dominating humanity,”
Pope Leo XIV’s May 25, 2026 during the release of his first encyclical, “Magnifica Humanitas” (Magnificent Humanity) pope Leo address today – Search
AMA President on dismissal of USPSTF co-chairs: “The AMA is extremely concerned by today’s HHS decision to remove the vice-chairs of the U.S. Preventive Services Task Force. The task force serves an essential, non-partisan role in making evidence-based recommendations on clinical preventive services and screenings that physicians rely on to prevent disease. Today’s changes were foreshadowed by the earlier dismantling of the Advisory Committee on Immunization Practices. We strongly urge HHS to restore the USPSTF’s long-standing, transparent process for selecting members, specifically clinicians with expertise in the fields of preventive medicine and primary care. We also implore HHS to commit to once again holding regular Task Force meetings to ensure its important work can continue without further delay. Our patients’ lives depend on it.”
RFK Jr. fires USPSTF vice chairs, drawing sharp rebuke from AMA | Medical Economics
Archelle Georgiou, MD on Prior Authorization: “Prior authorization, when used correctly, curbs misuse and abuse of high-cost services.
The real problem is that prior authorization has expanded far beyond its original purpose. Every unnecessary PA review consumes clinician time, delays care and increases administrative costs. PA only generates value when it detects and prevents care that is not appropriate…
The negative correlation with care coordination cuts to the core of how plans rationalize their PA programs. Plans operating high-volume PA programs may be dedicating their resources to administrative gatekeeping rather than addressing fragmentation and enabling better care… Prior authorization isn’t the problem. Undisciplined, unmeasured prior authorization is the problem. We have the data to tell the difference. We should start using it”
ArcHealth https://www.archellemd.com/
Murphy on cultural decay: “In America, little remains of what used to be called the public commons—the essential parts of life organized for mutual benefit rather than profit extraction. Hospitals, nursing homes, and insurance companies were once mostly nonprofit, run by local boards. No more. Education, from preschool to college, is being colonized by for-profit owners. Even utilities such as electricity and water, once treated as public goods, are being taken over by profit-obsessed investment firms.
Virtually everything in America has become a commodity—even middle-school hockey. Every minute of our life is fodder for profit maximization. And when everything exists primarily for someone else’s gain—even your child’s Saturday-afternoon game—it breeds emptiness and resentment…”
Money Is Ruining Youth Sports – The Atlantic
Health Affairs on autism therapy market: “The rapid expansion of autism therapy for children has been driven by increased need, generous taxpayer-funded Medicaid payments, and PE penetration. Some companies have capitalized on the opportunity, at times outpacing regulatory oversight. Not only do instances of fraud and excessive utilization drain finite health care resources, but they divert support from children and families who need it most. As a result, children with ASD may experience reduced access to critical support, and taxpayers are left footing the bill.”
Economy
HHS Launches Crackdown Using AI to Detect Medicaid Fraud and Waste
CMS proposes rule aimed at limiting Medicaid state-directed payments
NYT on tech market layoffs: “Since 2022, large tech companies have collectively laid off more than 150,000 workers, unraveling what many tech workers once perceived as a guarantee of affluence and employability. The threat of being replaced by artificial intelligence has loomed over those who remain. This year alone, Amazon has indicated that it is laying off more than 15,000 workers, Block 4,000, Meta 8,000 and Oracle an estimated 30,000.
The shift in Big Tech has reshaped its culture, according to interviews with more than a dozen workers at several companies: Cooperation and collegiality are on the wane; chumminess between employees and managers has cooled as mutual suspicion pervades their relationships; and a throbbing economic anxiety infects almost every conversation.”
On Blind, Anxious Tech Workers Get the Lowdown on Layoffs – The New York Times
NYT on education decline: “Something troubling is happening in U.S. education.
Almost everywhere in America, students are performing worse than their peers were 10 years ago, according to new, district-level test score data released Wednesday by the Educational Opportunity Project at Stanford.
Compared with a decade earlier, reading scores were down last year in 83% of school districts where data was available. Math scores were down in 70%. The declines have affected both rich and poor districts, and crossed racial and geographic divides.
From 2017 to 2019, students lost as much ground in reading as they did during the pandemic, and reading scores continued to fall at a similar rate through 2024.
In one in three school districts in the United States, students are reading a full grade level lower than they were in 2015.”
Why U.S. Test Scores Are in a ‘Generation-Long Decline’ – The New York Times
Hospitals
Modern Healthcare on hospital criticism: “Hospitals are under attack in Washington, and not just by their longtime foes in the insurance and drug industries.
Those political powerhouses have indeed stepped-up campaigns targeting hospitals, and all sides have ramped up spending on lobbyists. But increasingly others, including employers and conservative groups, have weighed in. Lawmakers in GOP-run Washington appear to be listening…The sudden negative attention on the hospital sector is the result of several political trends coming to a head simultaneously, including the rise of populist rhetoric on the right, attempts by insurers to push back on policies increasingly targeting them, and the all-consuming debate over affordability between the governing Republican Party and the Democrats hoping to seize control of Congress on Election Day.
“It’s no surprise that drug companies and large commercial insurers are trying to shift attention away from their own abysmal record,” American Hospital Association President and CEO Rick Pollack said in a statement. “Hospitals can’t solve the affordability issue alone. It will require everyone — drug companies, commercial insurers, suppliers, government, patients and others — to fix our outdated system.”
Hospital pricing under fire from GOP, insurers and employers – Modern Healthcare
BLS Report May 2026: Hospital workforce: “Mean annual wages for hospital workers range from $37,080 for maids and housekeeping cleaners to $454,940 for cardiologists…
Registered nurses — the nation’s largest healthcare occupation — earned a mean annual wage of $101,420 nationwide… Hospitals account for about 1.9 million registered nurse jobs nationwide, representing roughly 56% of RN employment.
Healthcare practitioners and technical occupations employed about 9.8 million workers nationwide and had a mean annual wage of $108,700.”
Occupational Employment and Wages Summary https://www.bls.gov/news.release/ocwage.nr0.htm
Quorum announces NFP transition (May 21, 2026): “Quorum Health, a leading provider of hospital and outpatient services across rural and mid-sized communities, today announced it has entered into a definitive agreement with QKA Health Corporation, d/b/a Healthside Partners that will enable the organization to transition from a for-profit, private equity-backed model to a nonprofit health system…
The move also allows the system to reinvest more deeply in its (11) hospitals across nine states—approximately 75% of Quorum’s hospitals serve as sole providers or critical access hospitals…The new system will retain Quorum Health’s workforce, continuing employment for more than 3,000 health care professionals, including nearly 200 employed physicians and advanced practice providers…and more than $300 million in planned capital investments through 2029, including outpatient expansions, facility upgrades, and new technology.”
The transition also positions Quorum Health’s hospitals to benefit from nonprofit-specific advantages, including 340B Drug Pricing Program eligibility, projected to generate more than $11 million in annual value, tax exemptions on property, sales, and use taxes, estimated at approximately $13 million annually and access to philanthropic funding…”
Insurers
KFF: ACA Insurance Premiums: The average ACA deductible has jumped 37%, an increase of more than $1,000 per person, from 2025 to 2026, according to a KFF analysis published May 19. Enhanced tax credits expired at the beginning of the year, shaking up premiums and shaping enrollment trends. This is the steepest increase in deductibles ever seen in this market and largely reflects the shift from silver plans with reduced deductibles for lower-income enrollees to bronze plans with very high deductibles. The average deductible reached a record high of $3,786 in 2026.” Other highlights:
- Average monthly effectuated ACA enrollment could drop to roughly 17.5 million people in 2026, perhaps going as low as 16.5 million. This would be down from 22.3 million in 2025. In March, CMS reportedthat ACA enrollment was at 23.1 million in 2026, a 5% decrease from 2025. The Wall Street Journal found about 14% of ACA enrollees in 2026 did not pay their first monthly bill for January coverage.
- The share of those getting premium tax credits was 87% in 2026 versus 92% in 2025. This was the first drop in subsidy uptake in six years.
- The average bronze deductible in 2026 was $7,476.
- The percentage of all ACA consumers opting for a silver cost-sharing reduction plan — available to consumers between 100% and 250% of the federal poverty level — fell to 37%, the smallest share on record. More than half of consumers selected these plans last year.
The Washington Post: Millions May Lose Their ACA Coverage as Costs and Premiums Spike, Report Finds
Physicians
Study: PE in primary care: “Primary care is essential to advancing population health, yet it has faced underinvestment and workforce shortages in the US. Private equity (PE) investments could expand access by facilitating participation in value-based contracts and enhancing information technology capacity. However, PE’s emphasis on short-term profitability may impose productivity pressures on physicians, with uncertain implications for patient care. Using a stacked difference-in-differences design and national Medicare claims data, we examined 225 PE acquisitions of primary care practices during the period 2016–22. PE acquisition increased the number of services billed and patients seen by primary care physicians by 30% and 11%, respectively. Patients in PE-acquired practices received 12.9% more additional services, driven by laboratory testing and the Medicare annual wellness visit. PE acquisitions also increased the total number of primary care physicians and advanced practice providers, with the latter growing at a faster rate. Taken together, our results suggest that PE investments have the potential to increase the use of primary care services, in part through greater reliance on advanced practice providers….
Polling
New York Times/Siena poll: Among 784 Democratic voters likely Democratic surveyed May 11 to 15, 2026.
In order to win the next presidential election, do you think the Democratic candidate needs to move the party to the left, move the party to the center, or not move it in either direction?
- In general: Move left 25% No Change 18% Move to the Center 52%
- On economic issues: Move left 36% No Change 20% Move to the Center 42%
- On healthcare: 45 26 27 Move left 45% No Change 26% Move to the Center 27%
Which comes closer to your view, even if neither is exactly right?
- The economic system in this country is generally fair to most Americans 11% vs. unfair 88%
The political and economic system in America needs to be torn down completely 20%, major changes 63%, minor change 15%, or no change 1%
Poll Suggests a Possible Path Forward for Democrats – The New York Times
Democrats’ Midterm Strength Masks Fierce Divides and Frustration, Poll Shows – The New York Times May 18, 2026
Pew: Public opinion on issues: Per the Pew Research Center survey of 5,103 U.S. adults conducted April 20-26, 2026:
“Economic issues continue to dominate Americans’ ranking of the top problems facing the country. And over the course of the last year, the shares who view issues like health care affordability and the budget deficit as very big problems have risen.” Highlights:
- 73% of adults now say the affordability of health care is a very big problem for the country, up 6 percentage points from February of last year.
- 64% view the federal budget deficit as a very big problem, up 7 points from last February.
- 66% say inflation is a very big problem, up from 63% last year. And while a far smaller share sees unemployment as a very big problem in the country today (36%), this is also up (by 11 points) from early 2025.
Americans See Health Care Costs, Inflation as Big Problems Facing the Nation | Pew Research Center
U of MI Consumer Sentiment: Final Results for May 2026: “Sentiment is now just below the previous historical trough seen in June 2022. The cost of living continues to be a first-order concern, with 57% of consumers spontaneously mentioning that high prices were eroding their personal finances, up from 50% last month. Lower-income consumers and those without college degrees posted particularly strong sentiment declines; these groups are more sensitive to increases in the cost of gas and other essentials. Independents and Republicans saw decreases in sentiment, with both groups reaching their lowest readings of the current presidential administration. Meanwhile, sentiment of Democrats was little changed from last month. Critically, consumers appear worried that inflation will increase and proliferate beyond fuel prices, even in the long run.
Year-ahead inflation expectations inched up from 4.7% last month to 4.8% this month. The current reading substantially exceeds the 3.4% reading seen in February 2026 prior to the start of the Iran conflict, along with all 2024 readings. Long-run inflation expectations climbed from 3.5% in April to 3.9% in May, notably higher than the 2.8% to 3.2% range seen in 2024. This month’s increase in long-run expectations reflects sizable jumps among independents and Republicans. For the latter group, long-run inflation expectations are currently more than double their February 2025 reading on a monthly basis.”
Prescription Drugs
AHA on 340B drug policy: “Your editorial (WSJ May 7) praises a judicial opinion that misunderstands the 340B program. Far from a grift, 340B is one of the rare government programs that has made drugs more affordable for average Americans. Hospitals use 340B discounts to provide free or low-cost drugs to patients most in need. The law also requires drug companies to pay a steeper 340B discount when they raise the price of their drugs faster than inflation. This isn’t ‘sweet arbitrage’; it is a smart policy designed to deter drug companies from raising drug prices at exorbitant rates.
By establishing contract pharmacy relations, 340B hospitals ensure their patients get access to drugs closer to where they live, improving their medication adherence and ultimately their health. For many Americans, especially those who live in rural communities, these arrangements are the difference between driving hours to a 340B hospital or picking up a prescription at a local pharmacy.
Legislators across America — in both red and blue states — have enacted laws protecting these contract pharmacy relations. With healthcare affordability on everyone’s mind, policymakers should recognize 340B for what it is: a program that makes healthcare cheaper and more accessible for patients at no cost to the federal government.”
Mitchell on direct contracting for prescription drugs: “I think that is welcome. I think it is needed, and both employers and providers want to find a way to partner directly. What is less clear is if this approach is scalable. Right now, it’s in Texas, and it provides some baseline terms, which are great, but … it’s got to be more broadly available. Also, our members are really focused on quality, access and outcomes, and I think we need to address those in any contract arrangement.”
Will Mark Cuban’s Cost-Plus Wellness Appeal to Employers? – MedCity News
Study: Retail pharmacy access: “Our results highlight that both spatial proximity and social similarity are critical determinants in modeling people’s access behaviors. Particularly, social similarity indicates that people are more likely to access pharmacies located in communities with sociodemographic characteristics similar to their own. Our mobility model also achieves higher predictive accuracy than the random forest model. Overall, this paper offers insights to support decision-making in healthcare access planning, emphasizing that services should be both geographically proximate and socially accessible to the communities they serve.”
