October 16, 2006
Health Care Attitudes
Kaiser, ABC, and USA Today just released a pretty expansive poll documenting the country's opinions on health care. The nickel version is that your countrymen are mostly liberal, deeply confused, and more likely to loathe the status quo than clearly conceptualize potential alternatives. Respondents said it was the third most important issue in the country, behind Iraq and the economy, but before immigration, gas prices, or terrorism. That's probably because opinions towards the system are so overwhelmingly negative: 80 percent are dissatisfied with the cost of health care in the country, and 54 percent are dissatisfied with the quality. So the system starts out with few friends.
From there, things get more complicated. Nearly 90 percent are satisfied with the quality of care they received. Nearly 60 percent are satisfied with their costs. In other words, Americans believe everyone else's health care system costs too much and delivers too little. Their own system rocks. Meanwhile, a full 25 percent reported that they or someone in their household had problems paying for medical bill in the last 12 months, and 28 percent put off medical treatment due to cost. Of that 28 percent, 70 percent admitted that the delayed treatment was "serious." And remember, this is all in the last year.
Individual fears become more acute when asked about the future. 60 percent worry about affording insurance "over the next few years" and 56 percent fear losing their coverage if they lose their job. As for what's driving all these high costs, the reported culprits, in descending order, are excess profits of drug and insurance companies, medical malpractice lawsuits, fraud and waste, overpaid doctors, administrative costs, unnecessary treatments, unhealthy lifestyles, expensive new treatments, the aging population, and better medical care. That's depressing. In order to get an accurate view of what's driving health costs, you'd need to basically invert that list. To say the American people have it backwards is to be unusually precise.
How to fix it? Letting individuals shop around for the best prices they can get garners wide support, with 80 percent judging it some level of effective. Suggest far higher deductibles and low risk insulation, however, and watch that drop. 56 percent would prefer "a universal coverage program...like Medicare that is government run and financed by taxpayers" to the current system, but that number plummets if you ask about higher taxes, limited choice, or rationing. 70 percent support an employer mandate while a mere plurality support tax breaks for low-income workers (despite the fact that high income workers currently enjoy a massive tax break through employer deductions).
So, in sum: The health care system sucks, but nearly every American's health care is great. That would suggest the opportunities for reform are minor, unless directed at the loathed elements (like insurance or Pharma). Folks don't like the high costs and fear they'll soon be overtaken by bills, but they blame all manner of minor and moderate contributors for the problem, not their own health choices, overtreatment, or new technologies. Universal care is heavily desired, but only if it doesn't cost anything or demand any sacrifices. In other words, the appetite for reform outpaces the realism of would-be reformers. The tradeoffs of the current system seem poorly understood, and attitudes towards its desirability are contradictory. Not a whole lot of hope in here for anyone.
"That would suggest the opportunities for reform are minor ... Not a whole lot of hope in here for anyone."
Meh. The numbers don't seem that bad to me.
Just because the public is clueless doesn't mean this isn't possible. The appetite is there, and all the rest is just a matter of clever policy and politics.
Folks need to be reassured on doctor choice and cost. Folks need to be reassured that a UHC will be better for them, not just for the uninsured.
Once they've been reassured, UHC can be rather easily sold as something offering greater security than what is currently enjoyed.
Posted by: Petey | Oct 16, 2006 11:07:20 AM
I don't think that many people really feel that 'their system rocks'. The early discussion is phrased similar to the old saw about people hating Congress except their guy. But I think it is more nuanced than that.
The poll numbers indicate to me that many people know the costs are high & quality is lacking in general, but individually they are okay. However, when they think about the future, they know that they might not be okay. So I see it as worry about the overall climate, being okay or guarded about their own case while worried about the future on an individual level.
Posted by: Seanly | Oct 16, 2006 11:50:09 AM
The healthcare system is tremendously intimidating to many people, which is why they are hesitant to criticize their own doctors. If you suspect your doctor is incompetant, there's often no way to prove it if you aren't a doctor yourself or have done a tremendous amount of research. Plus, most people don't spend a large amount of time in hospitals--they get treated for an illness and then don't go back till the next illness.
People who work inside healthcare, however, will tell you stories of patient abuse and mismanagement that would curl your hair. And those who don't have insurance could tell you even more.
But most people don't want to think about such fearful things, so they don't examine their own care too closely.
I think if you want to make UHC appeal, you phrase it in simple terms; Americans pay more and get less than they could under UHC. Show them how much a bargain it could be, and stress how broken the system is now (not hard to find those stories, after all).
Posted by: emjaybee | Oct 16, 2006 12:20:28 PM
I'm not sure that the 90% thing is so strong. Take me as an example. I'm fairly young and healthy. (Upper 20s). My interaction with the health care system is the occasional check up. It's been fine.
However, my grandfather died shortly after heart surgery. His health care sucked. So I'm pretty motivated to see some reform even though I, personally, won't need to benefit from it for years (I hope). I wonder how many of those 90% are in a similar situation where they personally are ok because they don't use the system often, while they have older relatives that they know are in trouble.
Posted by: Dan | Oct 16, 2006 12:20:35 PM
I'd jokingly suggest that respondents might be worried that expressing a negative opinion of their care might lead to claims being declined or being struck from doctors' rolls, but I'm not sure if it would be just a joke.
I'm in the 'just fucking do it already' camp. Nye Bevan spoke of stuffing the consultants' mouths with gold in creating the NHS, and that might be necessary. It's a little like the situation that the clinically depressed find themselves in: until they receive therapy or medication, they're impossible to see how shitty things were before.
Posted by: pseudonymous in nc | Oct 16, 2006 1:49:06 PM
I always thought the US health care system was a huge racket, but it didn't touch me much, and since I come from healthy stock, it probably won't for another few decades.
However, watching my wife (with "good" insurance) engage with it on a few matters and watching my mother (with "better" insurance) engage with it on serious matters has turned me from an indifferent critic into a passionate one. My family is from Austria, so I have heard no shortage of criticism of its system, but nothing I've heard there compares.
I am firmly of the opinion that a liberal these days is a Republican who needed health care. Give it another decade or so for more people to have these secondhand experiences and it should be a we-lower-taxes defining issue for the guys with (D) after their names.
This isn't even to start on billing. Holy hannah, the billing.
Posted by: wcw | Oct 16, 2006 3:41:54 PM
The notion that price transparency and allowing people to shop around for their medical services will drive down costs seems inherently flawed to me. I am at the national meeting for ER docs, and today the Sec HHS gave a nice, well-received talk in which he highlighted the administration's conviction that the market could just fix this by making health care a commodity and allowing the invisible hand ro smooth all the inefficiencies out of the system.
While I have no per se problem with price transparency, and I am an advocate of making the billing structure more understandable to the lay public, the notion that health care will ever be viewed as a commodity by the public is optimistic at the least. If you were pregnant, would you pick your OB based on price? No! You choose someone with a good reputation who you like and trust. If you are equidistant from two ERs, are you going to choose the one you go to based on cost? Not likely if there is a perceived difference in quality and environment. Even less likely if the consumer is not bearing much of the direct cost.
I don't have a solution. I am warm to the quality movement, though a little skeptical. My 0.02
Posted by: shadowfax | Oct 16, 2006 7:41:47 PM
In other words, Americans believe everyone else's health care system costs too much and delivers too little. Their own system rocks.
Somewhere, some social scientist has written a superb paper on the automatic "their-thing-sucks/my-thing-rocks" bias in survey responses. If only we could find and read that paper, we would know by what factor to discount replies such as this one. Unfortunately I am far too lazy to search for that paper.
Posted by: brooksfoe | Oct 18, 2006 11:41:32 AM
Americans have been insulated from the true cost of health care and are not being held accountable for poor lifestyle choices. Yes, the system is not the greatest . . . but I would take it over UHS any day.
When is the last time you went to the DMV? Has the government ever done anything cheaper and more efficiently? If you remove capitalism from healthcare you will remove what drives research and development.
Posted by: Kim Oliver | Oct 20, 2006 2:46:13 PM
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