Thought Leadership

In-Depth Look: How Americans Perceive the U.S. Healthcare System

By Revive
posted Mar 15, 2024

This blog is a recap from a session in Revive’s Summit series, where we bring together the best and the brightest managed care executives, legal experts, and renowned thought leaders to discuss the state of our healthcare industry and how we can chart a successful path through its challenges. In this session, Revive sat down with Jarrett Lewis, a Partner at Public Opinion Strategies, a national political and public affairs research firm, whose clients include leading political figures, Fortune 500 companies, and major associations.

Jarrett has extensive experience conducting public policy and corporate survey research in the areas of economic development, education, energy, financial services, healthcare, and technology. He also has experience conducting business-to-consumer and business-to-business research. Much of his work has centered around public awareness and communications campaigns, message development, advertising testing, corporate image and branding, and public policy campaigns.

This Summit session involved a deep examination of American attitudes on the healthcare industry. Jarrett discussed how Americans view the U.S. healthcare system, particularly focused on health systems and hospitals, and how these shifting attitudes in public opinion can lead to policy changes. Jarrett also spoke about the current political environment and key trends leading into the 2024 election that will impact the healthcare industry. Here are a few key takeaways from our conversation with Jarrett.

A Matter of Public Opinion: The State of Our Nation’s Healthcare System

Health systems encounter challenges such as policy scrutiny, widespread American pessimism about healthcare, and declining trust. Addressing these issues requires proactive measures, including enhancing patient experiences and assertively negotiating contracts with payors.

Key Takeaway #1: Americans are deeply pessimistic about the state of the U.S. healthcare system.

Over the last several years, there has been a growing sense of frustration with the U.S. healthcare system. COVID-19 temporarily boosted public sentiment, as Americans appreciated all that hospitals and healthcare workers did to keep them safe. But following the pandemic, sentiment has decreased to pre-COVID levels and, in many cases, has worsened.

One exception is with local facilities: Patients feel differently about care close to home. Polls show patients trust their local facilities more than the “system” of healthcare.

Key Takeaway #2: Cost is the #1 reason for declining trust in the American healthcare system.

Americans are deeply concerned about healthcare costs. In a Pew National Survey conducted in June 2023 of 5,115 adults, 65 percent of Americans thought that the affordability of healthcare was a problem in the country, second only to inflation.


More and more people are talking about costs, much more than they have in the past. A large number of Americans continue to put off medical treatment due to cost: A Public Opinion Strategies survey shows that 41 percent of Americans are extremely concerned that illness or a medical issue will force them into bankruptcy.

Many Americans continue to put off medical treatment due to cost. About 40 percent of Americans have put off medical treatment, for themselves or their family members, because of the cost they would have to pay, according to a January 2024 Public Opinion Strategies National Survey of 1,008 adults.


Key Takeaway #3: Lack of access to care and declining care quality are emerging concerns for Americans.

Access to healthcare is a growing problem in the nation. Two-thirds of Americans believe that access to medical care is a problem where they live. 29 percent of those surveyed said that it is a major problem. Where it used to take weeks, now it takes months to get in to see a doctor.

Americans recognize the limitations of health systems: 46 percent of those surveyed state they have heard “a lot” about patients experiencing long delays for medical care at hospitals due to staff shortages, according to a Gallup poll.

But it’s not just delays in medical care due to providers: 34 percent of Americans say they have put off medical treatment because of delays or the hassle in obtaining approval from a health insurance plan in the last 12 months. Prior authorizations can help patients combat this.

We are seeing an erosion in the quality of our healthcare system. 48 percent of Americans rate the quality of U.S. healthcare as “excellent” or “good.” This is the first time in 20 years that that number has dropped below 50 percent. (10 years ago, the number was in the mid-60s.)

When it comes to consumerism in healthcare, 67 percent of those surveyed agree that the U.S. healthcare system “does not treat me like a valued customer.” Health systems need to get better at consumerism, at enhancing the patient experience.


Key Takeaway #4: Despite the frustrations with the U.S. healthcare systems, voters are not looking to overhaul it.

Attitudes on how we finance the healthcare system have changed very little over the last five years. The majority of Americans (53 percent) say they prefer a private healthcare system, versus 43 percent who want a government-run system, according to Gallup. Americans are not ready to move into a one payor system just yet.

Americans do, however, expect the government to act as a backstop, which is a reason for an increasing number of voters wanting the expansion of Medicaid. A majority believe it is the responsibility of the federal government to make sure all Americans have healthcare coverage.

Key Takeaway #5: Health systems have plenty of policy and political risks.

There is an increased policymaker scrutiny on not-for-profit hospitals:

  • Tax exemption
  • Community benefit
  • Surprise medical billing
  • Price transparency
  • 340B
  • Certificate of Need

There is a significant erosion in institutional trust — healthcare, government, police, media, and big business. This erosion of trust has been largely driven through social media. Because of this, this has led to support for more government oversight and regulation.

Key Takeaway #6: A healthy majority of Americans continue to hold a favorable view toward hospitals. But we are seeing erosion in trust.

Nurses and doctors are viewed very favorably by Americans, with hospitals also receiving high ratings. Payers and Rx are viewed less favorably.

There has been an erosion of trust. Nurses still top the most trusted professions list — but doctors have slipped. 56 percent of Americans have a high view of doctors, a drop from 77 percent.


Key Takeaway #7: There has been a lot of pressure from others against health systems over the last few years.

There are a number of groups trying to deflect blame to health systems. From consolidation to price transparency, hospitals are being attacked. Health systems must win the public opinion battle with both voters and policymakers.

Key Takeaway #8: There are a few headwinds facing health systems.

The following are headwinds facing health systems:

  • Price transparency
  • Community benefit
  • Size and scale

Price Transparency

In terms of public opinion, a plurality of Americans believe that hospitals are doing well financially. 47 percent of Americans believe hospitals have good times financially. The perception of a lot of Americans is that hospitals are doing well right now. When Americans think hospitals are doing well, yet costs are high, there are more inclinations to blame hospitals for those high costs.

When it comes to price transparency, 17 percent of Americans say they know how much their healthcare products or services will cost before they receive them. Meanwhile, 95 percent believe that healthcare organizations should be required to tell patients how much a product or service will cost before they receive it.

Americans don’t pay attention to price transparency. People aren’t shopping for healthcare the same way they shop for other services and goods. But price transparency is not a public opinion issue — it is a policymaker issue.

Community Benefit

Few Americans have seen stories about not-for-profit hospitals failing to provide enough charity care in exchange for tax breaks. However, nearly two-thirds are inclined to believe the allegations that hospitals are taking tax breaks while not providing enough free care.

This is an opportunity for health systems to do a better job at telling their story. 45 percent of Americans don’t know if their preferred hospital is a good community partner. There is a huge opportunity to combat the cynical view of tax exemption and community benefit status.


Size and Scale

Whether or not you’re a “major corporation,” even not-for-profit hospitals are lumped together with “big business.” This is one outcome of consolidation in healthcare. Many people aren’t aware of hospitals’ tax-exempt status, so in many cases, hospitals are viewed as big corporations. And the “very dissatisfied” rating for the size and influence of major corporations is at an all-time high.

Key Takeaway #9: Health systems can push back on this narrative.

The industry must go on the offense. Payors have been aggressive through surprise medical billing and the No Surprises Act. Providers have to do something similar and be more assertive on pushing back.

There’s opportunity for providers to lead the way in:

  • Push for more government funding to alleviate staffing shortages.
  • Advocate on behalf of those experiencing a mental health crisis.
  • Embrace AI in health systems.

Providers can remind Americans what they love about health systems and reignite trust in the system of healthcare.

Like what you read? Don’t miss the rest of the Summit Series, where we bring together top managed care executives, legal experts, and renowned thought leaders to discuss the state of our industry and how we can chart a successful path through its challenges. Register for the next session in our series here.