Robert Murry

Introduction
In recent months there has been a large debate over universal healthcare and a healthcare
plan passed by the president and congress. Many people remain uninformed over this issue and
it is almost impossible to look into the future to foresee the benefits and/or drawbacks of an
American universal healthcare system. I hypothesize that people of lower incomes will have
much more support for the idea of a universal healthcare system in the US and that people of
higher incomes will be less supportive of a universal healthcare system.
Literature Review:
The first article reviewed is Is American Health Care Uniquely Inefficient?(Garber and
Skinner 2008). This article covers the inefficiency of our current system and states in its
conclusion that an egalitarian welfare system would help but it would not reduce our high
expenditures overall unless we work to reduce our high costs and how much we pay our doctors,
hospitals, and administrators. It also illustrates how our country spends a lot more of its GDP on
healthcare than our peer countries. Another article, An Assessment of Health-Care
Expenditures Within and Across Racial and Ethnic Groups(Rasell and Bernstein, 1995).This
article discusses the inequalities in our system in which certain racial/ethnic groups and social
classes do not receive the same care or funding as others. In many cases minorities have to pay
higher premium costs for health insurance. This article offers subsidies as a solution to this
problem with our current system and financing using income tax would be even more successful
and progressive. This article suggested that a mandatory universal system might raise costs for
lower income families. This article also stated that other financing mechanisms to provide
universal coverage would raise revenue through income or payroll taxes.

Robert Murry
A third article reviewed The Misalignment of Institutional "Pillars": Consequences for
the U.S. Health Care Field(Caronna 2004). This article approached the issue of dissatisfaction
of our system using an institutional approach. This article suggests that we improve our system
by making it more productive and efficient and one of its last suggestions was that we provide
care to as many Americans(insured and uninsured) as possible. This would increase public
satisfaction and health.
A fourth article used was, The Imminent Healthcare and Emergency Care Crisis in
Japan(Suzuki 2008). This article, along with a few others, is very useful to compare the
Japanese system vs. our system and how it effects their lower class. This article illustrated a
comparison of PPP GDP spent on healthcare and the United states is at the very top and Japan is
below the average healthcare spending line. Not only do the Japanese spend less on healthcare
but they take it more seriously and have a much higher life expectancy and standard of living in
terms of health. Another article on the Japanese system, Influence of Income on Health Status
and Healthcare Utilization in Working Adults: an Illustration of Health among the Working Poor
in Japan(Tokuda 2009). This article listed certain advantages and disadvantages to the system
in Japan. Income level had little to no effect on the level of healthcare received. A universal
system can actually be universal.

---------------------------------------------Component II------------------------------------The data set being used is the 2008 National Election Survey. The variables from this
survey being used are Income and Universal Healthcare. My theory was that Income levels
would have an effect on the favorability of a universal healthcare system. To test this theory, a
significant effect between income and support for universal healthcare must be found.

Robert Murry
Methods used to find support for my theory were the comparison of the data between the
Income and Support for Universal Healthcare variables. A cross-tabulation was the first thing
used to look for a positive relationship. The next procedure is to test the data using regression to
test for the impact of income on support for healthcare with control variables.
Dependent Variable:
The Universal healthcare variable was the variable chosen to be the dependent variable. It
is the variable that my theory hypothesizes is effected by income. The Healthcare variable was
split into 5 choices on the initial survey, each representing the scale of amount of support for
UHC(1:favorable to 5:unfavorable). This variable was the most appropriate variable that could
be chosen from the given data set that would directly represent public support for universal
healthcare. To be able to see a relationship, the 5 categories in the variable had to be recoded
backwards(from 1-5 to 5-1, so from 1:unfavorable to 5:favorable.).
The income variable measures family income and it was divided into 6 categories of
income brackets(1:>$15k, 2:$15k-$30k, 3:$30k-$45k, 4:$45k-$75k, 5:$75k-$110k, 6: >$110k).
It is coded so that as income increases it is expected to have a negative effect on support for
UHC. For control variables these independent variables are also included in the regression:
Education (5 bracketed variable of increasing education levels), Ideology (ideology is coded
from 1:very liberal to 7:very conservative), Party ID (7 categories 1=Strong Democrat,
2=Moderate Democrat, 3=weak Democrat, 4=Independent, 5= weak Republican, 6=moderate
Republican, 7=strong Republican) each of those divided into strong, moderate and weak), and
age (which is coded into 6 categories 1:18-24 2:25-34 3:35-44 4:45-54 5:55-64 6:65 and over).
Criteria that must be met to support my theory is proof of a significant relationship
between the variables in my study/analysis. A linear regression will be done on the data to check

Robert Murry
for significance and to compare coefficients. A simple crosstab will also be made by splitting the
Universal Healthcare variable into two categories (support and not support) and it will be
compared with income.

-------------------------------------------------Component III------------------------------------------------

The linear regression results indicated that all of the independent variables have negative
effects on support for UHC. These results can be observed in Table 1 below. The results indicate
that as income increases, support for UHC decreases (and as income levels decrease support
increases for UHC). Party ID has a coefficient of .25 that suggests that the more Republican one
is the less likely they are to support UHC. In addition, age and ideology variables also have
significant negative effects. Education did not have a significant effect. The R square of this
model is 0.22.
Second, a cross-tabulation is done on the variables and a clear relationship is visible
between the UHC and Income variables. It showed that as income increases, support for UHC
goes down and as income decreases it goes up. According to the crosstab, support for UHC
almost triples in the lowest three income brackets and the more than $110 annually bracket is
the only bracket to show a majority of disfavor towards Universal Healthcare. If the relationship
was not clear enough in the first two figures a graph(Graph 1) is provided on the following page.
This graphs shows that the amount of participants that strongly support UHC decreases
significantly as income levels increase.

Robert Murry

Tables
Table 1: Regression Table for Recoded Universal Healthcare Variable vs. Independent
Variables(Income, Education, Age, Ideology, Party ID)

Table 1
Variable

Coefficient B

(Constant)

5.48

Income

-.12**

Education

-.06

Ideology

-.10*

Age

-.11**

Party ID

-.25**

Adjusted R Square

.22

Participant Count

860

One asterisk(*) = .05 significance

Two Asterisk(**)= .01significance

Table 2: Universal Healthcare Recode and Income Variable Cross-tabulation

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Graph1:

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---------------------------------Component 4----------------------------------The initial hypothesis was supported by the data found in the study. The data in the study
showed a significant relationship between income and universal healthcare support. As income

Robert Murry
increases, support for universal healthcare decreases. The same relationship was found with age
and education as well. The older a person is the less likely they are to support universal
healthcare. What was most surprising in the findings of the study was the effect party Id had on
universal healthcare support. Party Id had twice the effect on universal healthcare support than
income did. This was surprising because the initial theory was based on the assumption that
income would be the best determining factor on universal healthcare support. It turns out that
party Id is twice as influential as income and all of the others. Logically peoples basis for their
support of healthcare should be income (their ability to afford healthcare) but surprisingly people
go to their party to make decisions on what is best for them. This matters because this could be
used in a study to show how a polarized political environment can affect the way societies make
decisions regardless of what might actually be best for them.
To study universal healthcare support further a larger survey would need to be done or a
more recent survey (2012) could also help further research. Back in 2008, universal healthcare
was a new issue for many people and perhaps their opinions about it will have changed by 2012
for the next NES survey. To do further research it would also be good to focus on the strange
relationship with party ID. The fact that people will so boldly stand with their party on issues
that directly affect them shows that parties have some power in determining social issues and
some power over their followers. Testing Party Id with many other controversial issue variables
may turn up similar results. What is interesting to me is that some lower income people oppose
universal healthcare when it could highly benefit their family and others.

References

Robert Murry
1: Caronna, Carol A. (2004)The Misalignment of Institutional "Pillars": Consequences
for the U.S. Health Care Field Journal of Health and Social Behavior Vol. 45, Extra Issue:
Health and Health Care in the United States: Origins and Dynamics (2004), pp. 45-58

2: Garber, Alan M., and Skinner, Jonathan. 2008. "Is American Health Care Uniquely
Inefficient?" Journal of Economic Perspectives, 22(4): 2750.
DOI:10.1257/jep.22.4.27

3: Rasell, Edith and Bernstein, Jared (1995) An Assessment of Health-Care

Expenditures Within and Across Racial and Ethnic Groups The American Economic Review
Vol. 85, No. 2, Papers and Proceedings of the Hundredth and Seventh Annual Meeting of the
American Economic Association Washington, DC, January 6-8, 1995 (May, 1995), pp. 127-131

4: Suzuki et al. 2008.The Imminent Healthcare and Emergency Care Crisis in Japan
West J Emerg Med. 2008 May; 9(2): 9196.

5: Tokuda et al. 2009.Influence of Income on Health Status and Healthcare Utilization in

Working Adults: an Illustration of Health among the Working Poor in Japan.Japanese Journal
of Political Science (2009), 10: 79-92