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US: We'll pay for health insurance. World: Not us

There's a world of difference between Americans and the rest of the planet on the question of the government paying for health insurance—but the gap is even bigger within the U.S. between Democrats and Republicans.

A marketplace guide works on the Healthcare.gov federal enrollment website as he helps a resident sign up for a health insurance plan under the Affordable Care Act, at an enrollment event in Milford, Del.
Andrew Harrer | Bloomberg | Getty Images
A marketplace guide works on the Healthcare.gov federal enrollment website as he helps a resident sign up for a health insurance plan under the Affordable Care Act, at an enrollment event in Milford, Del.

Americans, to a striking degree, are less inclined than citizens of other countries to say that the "government" should be responsible for providing health-care coverage, according to data compiled for CNBC and Burson-Marsteller by market research firm Penn Schoen Berland.

When asked, just 37 percent of people in the United States said that's the government's job.

While that was the top single answer, a total of 50 percent said that insurance is either the responsibility of "individuals" or of "corporations."

In contrast, an average of 65 percent of people in other developed countries said health insurance should be provided by their governments.

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And an even stronger majority gave that answer in countries with emerging economies—an average of 72 percent.

The disparity in the results didn't surprise health-care experts, who said that they underscore both cultural differences and the difference between the health-coverage system of the U.S. and most of the rest of the world.

"I think it reflects the fact that they have a national health-care system," said Kaiser Family Foundation president Drew Altman, referring to the other countries whose residents overwhelmingly believe it's the responsibility of governments to provide their coverage. In contrast, the U.S. does not have a national health-care system.

"It also reflects a societal decision—the societal decision to provide health care for everyone," Altman said of the other countries.

He said Americans' response to the question specifically about health care is reflective of their overall views about government.

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"We've always had, as a country, a love-hate relationship with government," Altman said. "We want the services it delivers, but we want a smaller government. There's a tension in this country between the sense of communal obligation and a fierce sense of personal responsibility."

"And where do you see that tension expressed more strongly than in health care?" asked Altman.

Altman said he believes that the passage and the adoption in recent years of the Affordable Care Act, known as Obamacare, has accentuated the split between Americans who favor a larger role for government overall and those who oppose that idea. He also said public opinion on the ACA is often not based on actual details of the law, which often poll well individually, but reflect how people view President Obama and government generally.

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"The debate about Obamacare isn't a debate about Obamacare," he said. "The health law has become a proxy for a larger debate about, yes, the president, but also about the role of government."

The Penn Schoen Berland poll, which did not ask about Obamacare by name, found a distinct split between Democrats and Republicans on the question of who should provide health insurance. Just 17 percent of self-identified Republicans in the survey said they believed government should provide such coverage. But 57 percent of Democrats gave that answer.

Conversely, only 17 percent of Democrats said individuals should be responsible for their health insurance. But 42 percent of Republicans gave that answer.

"One of the things that is fundamentally true about public opinion is that the American people are capable of all sorts of conflicting beliefs." -Drew Altman, Kaiser Family Foundation president

The poll found that young adults, those 18 to 34 years old, were much more likely to believe government should pay for health insurance, with 47 percent of those younger people giving that answer.

However, adults 65 years or older were essentially no more likely to believe it was the government's responsibility to provide health insurance than adults between the ages of 35 and 64. A total of 34 percent of those senior citizens named government when asked the question, compared to around 33 percent for other adults older than age 34.

That result stands out because U.S. adults who hit age 65 are automatically eligible for Medicare—the federal government health insurance program for the elderly.

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David Squires, a researcher for the Commonwealth Fund, said he's not surprised that seniors are not necessarily more likely to support government-sponsored health insurance for everyone, because they likely view Medicare differently than something like Obamacare.

"I think a lot of people recognize Medicare as just being a fundamental part of the landscape, whereas the idea of providing health insurance to everyone is much less familiar and not something they necessarily endorse," Squires said.

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"I would imagine that when they're responding to that question, they could be thinking about a new program and new proposed programs, instead of something that's been around since the '60s," Squires said.

The view of seniors on that question may also reflect a sense that they have, over the years, paid into the Medicare system and thus are entitled to receive the benefits from it after hitting the qualifying age.

But it may also be another example of the difference between what Americans believe about health insurance and the reality of where they get it.

The survey found that just 21 percent of people said "corporations" when asked who should be responsible for providing health insurance for people. That was the lowest result of any answer to that question, other than "don't know."

However, as the U.S. Census Bureau noted last week, "The largest single type of health insurance in 2013 was employment-based health insurance, which covered 53.9 percent of the population." Many of those people work at corporations, which in turn pay the lion's share of the premiums for those peoples' insurance.

And nearly 30 percent of the Americans questioned by the survey said "individuals" when asked who should provide insurance. That was the second leading answer in the survey. But people who buy their own insurance on the individual plan market—as opposed to group, employment-based plans—are the smallest category of those with health coverage in the U.S.

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Just 10.3 percent of the population—32.2 million Americans—was covered by individual plans in 2013.

While that number has grown in 2014 as a result of Obamacare, around 86 percent of people who bought Obamacare exchange-sold individual insurance plans have had their premiums subsidized by federal tax credits. In other words, the government will foot some, and in many cases most, of the insurance bills for those people.

Altman, the head of the Kaiser Family Foundation, said, "One of the things that is fundamentally true about public opinion is that the American people are capable of all sorts of conflicting beliefs."