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The Healthcare Agenda For The New President And Congress?

The Kaiser Family Foundation and Harvard School of Public Health teamed up to survey Americans about their healthcare reform priorities (Kaiser has been doing this every year since 1992). A random sample of 1,628 adults participated in the telephone survey between December 4-14th, 2008. The results were presented at a press conference that I attended on January 15th.

Although you might want to view a presentation of the entire webcast here, I’ll summarize the points that I found the most interesting:

Dr. Robert Blendon (Professor of Health Policy at the Harvard School of Public Health) offered some fascinating commentary on the survey results:

1. Americans Are Fickle About Healthcare Reform Issues. Most public opinion polls do not take into account the degree of conviction with which people describe their health reform priorities. In reality, the public is generally quite ambivalent regarding the specifics of how to achieve reforms like improved access to care, and decreased healthcare costs. The Kaiser survey clearly demonstrated the public’s tendency to agree with specific reform ideas, but then change their minds when the potential downsides of such initiatives were described. So for example, most survey respondents liked the idea of an employer insurance mandate (requiring employers to subsidize employee health insurance costs), but when asked if they would favor it if it might cause some employers to lay off workers, then they no longer supported the mandate.

2. Public And Government Priorities Differ. While the public is primarily focused on relief from skyrocketing healthcare costs, the government is focused on healthcare delivery reform.

3. Americans Don’t Want Change To Affect Them. An underlying theme in the survey was that the average respondent didn’t want to pay more for healthcare, and they also did not want to be forced to change their current care and coverage arrangements.

4. It’s All About Money. America is in a near economic depression, and therefore the healthcare reform climate is very different from that of 1992 (when the Clinton reform plan stalled). Middle income Americans in an economic downturn are not willing to pay more taxes. The only way forward in our current economy is to find a revenue stream for reform that does not increase taxes on the average American. Blendon summarizes:

“It isn’t enough that all the groups agree on how to spend money on healthcare. ‘Who is going to pay?’ is the critical issue.”

At this point in time, it looks as if the American public is most supportive of the healthcare reforms listed below (but their opinion is certainly subject to change, depending on how the political discussions unfold, and how the media influences the debate). Blendon also cautions: “This doesn’t mean that this is a sensible health reform plan, it’s just what has public support at the moment.”

Healthcare Reform Initiatives Currently Favored By Americans

Expanding Coverage

1. Health insurance mandate for children

2. Fill the Medicare doughnut hole

3. Tax credits to employers to help them offer coverage to more employees

4. Health insurance for the unemployed

5. Eliminate medical underwriting (“pre-existing condition” carve outs and such)

6. Expand Medicare to cover people ages 55-64 who are without health insurance

7. Require employers to offer health insurance to their workers or pay money into a government fund that will pay to cover those without insurance

8. Increased spending on medical care for veterans

9. Increased spending on SCHIP

Controlling Costs

1. Negotiate for lower drug costs under Medicare

2. Allow Americans to buy prescription drugs imported from Canada

3. More government regulation of healthcare costs

4. More government regulation of prescription drug costs

5. Regulate insurance companies’ administrative spending and profits

Raising Revenue

1. Increase the cigarette tax

2. Increase income taxes for people from families making more than $250,000 a year

***

As you can see, the public supports reform that would result in substantial increases in healthcare spending without a clear idea of how to pay for those initiatives. Our government, in partnership with healthcare’s key stakeholders, is going to need to come up with a reform plan that identifies new revenue streams to cover the costs associated with expanding coverage. I find it hard to believe that increasing taxes on cigarettes (and a few very wealthy Americans) is going to be sufficient. If ever there were a time to nurture our American entrepreneurial spirit, it’s now.

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