Published in the Cincinnati Enquirer November 27, 2008
As Americans reflect on their blessings this Thanksgiving, will they count the U.S. health care system among them?
Politicians, the media and probably most people would say no. But if we alter the question, directing it toward the individual and away from the system, the answer changes drastically.
A startling majority of Americans – 77 percent – said the quality of their own health care was "excellent" or "good" in a recent study.
The Council for Excellence in Government, in coordination with the Institute of Medicine, Accenture and Gallup, conducted the study to find out what real Americans think about health care. "The American Public on Health Care: The Missing Perspective" was released in October.
The "missing perspective," indeed.
Though we hear of nothing but a "broken" system in need of an overhaul, a lot of people seem to favor that overhaul for the benefit of others.
Another survey, in March 2008 by the Harvard School of Public Health and the Robert Wood Johnson Foundation, revealed a combined 82 percent rating their own medical care "excellent" or "good," for those who had received care in the past year.
What politician can claim approval ratings in the high 70s to lower 80s?
That doesn't mean the vast majority of people love the structure of the U.S. system. But it does highlight something missing in our dialogue: Americans are saying they're receiving good health care. Elected officials focused on reform should find out why. The aspects of care that people like are the ones we should keep if we're going to have an overhaul.
Unfortunately, "The Missing Perspective" didn't report why people felt positively about their care. It could have been people's doctors, nurses, access to care, recovery from disease – we don't know. That data point was overshadowed by an emphasis on survey respondents' concerns and desires for the future, as expected for an election-focused release.
So let's take a look at what the people want.
They favor portable health insurance policies. A full 78 percent said they want to be able to take their coverage with them from job to job. With one in four Americans changing jobs every year, this is necessary to modernize insurance and health care delivery.
Americans want price transparency and competition in the health sector. They said they wanted to see performance ratings for doctors and hospitals as well as openly published prices for health services – both tools that would allow the patient to compare and choose. We have these for other service industries, including hotels and restaurants. The Internet makes it quick and easy for people to report and rate their experiences, or to compare costs before selecting a provider.
A majority – 71 percent – also said they want competition in the insurance market. Specifically, they want to be able to buy coverage across state lines. Ballooning numbers of coverage mandates have driven up the cost of care and trapped consumers, who are required to buy policies in their own states. The latest statistics from eHealth Inc., which operates eHealthInsurance.com, show average monthly premiums in 2007 for individual insurance plans ranging from $83 in North Dakota to $388 in New York. That's a difference of $3,660 per year.
As one might guess, the study showed most Americans are enthusiastic about covering the uninsured, and many agree with getting the government involved in that process. But that enthusiasm vanished when higher taxes were mentioned.
A resounding 57 percent said no, they would not be "willing to pay more in taxes to cover the uninsured." That finding jibed with a September survey by the Kaiser Family Foundation and the Harvard School of Public Health, where a total of 57 percent said it was "most important" or "very important" that a new "health care proposal not raise taxes."
The Council for Excellence in Government took note of a bias against government control.
"It's noteworthy that one proposal for expanding coverage for the uninsured – allowing anyone to buy Medicare coverage at group rates, regardless of age – gets significantly less strong agreement than any other policy prescription surveyed," the CEG study said. "This is consistent with Gallup poll results over many years which show that the public has a preference for maintaining a system based on private insurance rather than a government-run health care system."
The American people are demanding competition and patient control of their health care. They want private insurance options, and they don't want tax hikes. The new Congress must listen. And before embarking on a massive overhaul, elected officials also must learn what people like about their care, instead of insisting that everything is broken.
Amy Menefee is director of communications for the Galen Institute, a nonprofit research organization that focuses on health-care reform.