Playing Fair

Fairness Beliefs and Health Policy Preferences in the United States

This report of original research explored what factors shape public opinion about U.S. health policy, particularly the importance of self-interest and fairness considerations.

Researchers used a nationally representative Internet-based survey to evaluate how Americans perceive fairness of inequalities in health and health care and whether it influences their opinion about government health insurance expansion.

Survey respondents were asked about their self-interest, political affiliation, humanitarian values and other demographics that influence people’s opinions. They were asked to read vignettes that showed inequalities in health outcomes, health access and quality of care received and rate them on a fairness scale. They were also asked whether they supported a government insurance plan to cover all medical and hospital expenses for everyone.

A majority (70%) of respondents find inequalities in access to health care or health care quality fundamentally unfair. Far fewer Americans (31%), however, perceive inequalities in life expectancy as unfair. Even after taking into account self-interest considerations, those who perceive inequalities in health care unfair were supportive of government providing health insurance.

“Americans’ predisposing attitudes about fairness, and not just their self-interest or group identifications, could be harnessed in a political effort to mobilize support for expanding government health insurance provision,” the researchers conclude.