With the vote on the healthcare reform legislation behind us, it’s nice to believe that we can now move to the stage where people begin looking at what the legislation will and will not do — not based on speculation or the political rhetoric, but what is actually in the legislation itself.
I realize that this is unlikely, since we all tend to engage in cognitive dissonance when confronted with information that does not square with our own pre-conceived notions, political leanings, and philosophical bent. I know I do it (as much as I try not to) and I’m sure this is true of just about all of us. Still, there are trusted and highly-credible sources of information that I hope will be of value to anyone who is open to learning more about the new healthcare legislation and its potential impact. Read more »
Why aren’t Americans in the streets, demanding reform of a health care system that is providing inadequate care for millions, wildly inefficient, and gradually bankrupting our country? A major reason: proponents of reform have lost control over the message because people think it’s too complicated to understand. Confused about important details of the proposals, the public is susceptible to misrepresentations by opponents. Read more »
Doubled over in pain, you stagger into the emergency room and are diagnosed with acute appendicitis. A surgeon leans over your stretcher:
Surgeon: You need an appendectomy.
You: What are my options?
Surgeon: Either I take out your appendix or you die.
Now that’s a conversation people can understand. But what if, instead of whisking you up to the operating room, the surgeon kept talking and invited a few other people into the discussion?
Surgeon: Do you think I should take it out by an open operation or laparoscopically?
You: Huh?
Laparoscopy equipment salesman: You know, cutting you open the old-fashioned way and leaving a big scar or having a tiny incision. Laparoscopy is much better than the open procedure.
Guy who sells scar-removal cream: Wait a minute. Better for whom? Laparoscopy takes fourteen minutes longer.
Hospital administrator: But hospital stay is reduced by 0.7 days on average, patients have less pain, and you can return to work sooner.
Surgeon: Laparoscopy costs more than an open operation while you’re hospitalized but less once you’re home. What’s your co-pay?
You: Doc, my belly’s hurting a lot more now.
Guy who owns shares in a drug company: What if we just treat him with antibiotics?
Surgeon: Don’t be silly. His appendix could burst.
Funeral director: What about doing nothing?
Very smart people are zoning out of the health care reform debate because they think it’s just too complicated.
The latest poll out today from the Kaiser Family Foundation, a nonpartisan health-care-policy research organization unaffiliated with Kaiser Permanente, says only 27 percent of the public has been following the health reform debate closely. Despite this, more than half (56 percent) of Americans think health reform is more important than ever.
Simply put, there are four main goals of the legislation:
Coverage expansion and subsidies. This is where most of the estimated trillion dollar price tag over ten years would go – to expanding Medicaid for uninsured and lower income people and to help people who can’t afford it pay on a sliding scale for insurance through new health insurance exchanges.
Insurance market reforms. This is about fair play in the insurance industry. Advocates want to eliminate practices such as refusing to cover people with pre-existing conditions and jacking up premiums if they’re sick. The most controversial proposal is the establishment of a “public option” – a government insurance plan that would compete against private ones.
Delivery and payment reforms. This is about delivering more effective care at a lower cost.
About 20 percent of the 2.5 trillion dollar annual health care price tag does not contribute to better health.
Prevention. This has been long overlooked in America. Spend a few dollars on foot care for a diabetic and you may prevent a foot amputation and thousands of dollars in expenses.Defining the goals is relatively easy to understand. Implementing them is tough and that’s where people are made to feel stupid – partly by special interest groups who intentionally or unintentionally confuse the debate. Drew Altman, Ph. D., the President and CEO of Kaiser Family Foundation, told me there’s “all kinds of spin, mis-statement of fact and plain old mis-truths being bandied about and the debate is getting nastier and nastier.” He added that people are becoming confused and “it’s beginning to make the public more anxious and antsier.”
Half-truths feed on fear. People are afraid of losing or compromising what coverage they already have. They’re afraid of higher taxes and lower quality of care. Who has the time or patience to read the 1,000-page bill proposed by the House of Representatives? So we rely on summaries and are susceptible to all sorts of misrepresentation. And nobody wants a plan with major faults rammed down their throat in the name of political expediency.
Today’s Kaiser Family Foundation report suggests that the tactics of special interest groups are working. Sixty percent of adults surveyed support a public option. But “(w)hen those who initially support the public plan are told that this could give the government an unfair advantage over private companies, overall support drops to 35 percent. Conversely, when opponents are told that public plans would give people more choice or help drive down costs through competition, overall support jumps to roughly seven in ten.”
It’s in the interest of those who oppose health care reform to make us feel that it’s just too hard to understand. I have certainly felt that way at times over the past year. But the stakes are too high for Americans to bale out on the discussion. Our common sense and sense of fair play are crucial to the national conversation. We should hear out the special interest groups; they often have legitimate concerns and thoughtful analysis. But we need to remember where they are coming from. And we must seek out information from sources that try to be nonpartisan, such as the
Kaiser Family Foundation.
No, you’re not stupid if you’re confused about health care reform. But you may be psyched out. You probably know a lot more than you think – but you may need to do some homework in order to participate in this extraordinarily important national debate. The national debate needs you.
For this week’s CBS Doc Dot Com, I moderate a debate about the public option between Wendell Potter, former head of public relations for Cigna and Rob Schlossberg, Executive Sales Director for BenefitMall. Mr. Schlossberg opposes it and Mr. Potter favors it.
To view the debate on a public option, click here.
To view a brief discussion of for-profit vs. not-for-profit health insurance organizations, click here.
For Janet Adamy’s excellent summary, “Ten Questions on the Health-Care Overhaul,” in the July 21st issue of the The Wall Street Journal, click here.
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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