Published in The Hill, July 8, 2009
With President Obama’s encouragement, congressional leaders are charging ahead to reshape America’s health sector. In seeking support, they often cite isolated answers to opinion polls that purport to show widespread support for their proposals.
But public opinion polling is a messy business. More comprehensive analyses reveal serious concerns about the president’s platform. In fact, most Americans are wary of reforms that could result in the government tampering with their coverage, digging into their wallets, or increasing the public debt.
Make no mistake: Most Americans think reform is urgently needed. A recent Diageo/Hotline poll found that 62 percent of respondents favor “enacting a major overhaul of the healthcare system.” An April poll from the Kaiser Foundation discovered a similar number — 59 percent — think “it is more important than ever to take on healthcare reform now.”
But when it comes to priorities for legislative action, Kaiser found that Americans rank overall health reform fourth, following improving the economy, assuring the financial stability of Medicare and Social Security, and reducing the federal deficit.
A recent Wall Street Journal/NBC news poll found serious concerns about the government’s fiscal irresponsibility. A quarter of respondents put the deficit as the most important economic challenge facing the country. Just 11 percent put healthcare first.
Reformers need to keep these results in mind because huge new government programs could put the country even further into the red.
Americans are also wary of the government disrupting their current coverage or raising taxes to finance reform. A recent New York Times poll found that more than three-fourths of respondents were satisfied with the quality of their own medical care. And only about four in 10 were willing to pay $500 or more in taxes annually to finance an overhaul of the health system.
Similarly, a Washington Post-ABC News poll from late June found that most people are “very concerned” that legislation could cause “higher costs, lower quality, fewer choices, a bigger deficit, diminished insurance coverage and more government bureaucracy.”
The poll also should serve as a warning against sweeping reform: More than 80 percent of those surveyed reported being satisfied with their quality of care.
In other words, Americans want reform — but they don’t want it to jeopardize their existing coverage, require additional deficit spending, or result in new or higher taxes.
That applies as well to the efforts to restructure the Medicare Part D prescription drug benefit. Currently, beneficiaries can choose from among a variety of private insurance plans, and participating insurers must compete for customers by offering the best benefits at attractive premium prices.
Some lawmakers want to scrap this market-based system, which well over 80 percent of seniors say they like, and instead have the government dictate drug prices. But this would lead to exactly the kind of coverage disruption Americans don’t want. Some companies wouldn’t be able to afford to sell at government-dictated prices and would pull out of the program, meaning their drugs no longer would be available to beneficiaries.
It’s the same story for efforts to have the government determine what medical treatments are good or bad. Congress already has allocated $1.1 billion to create a new government “comparative effectiveness research” program charged with assessing how different medical treatments stack up against one another.
This information could be used to deny patients on public insurance access to advanced — but expensive — treatments. That’s just the kind of bureaucratic tampering the American people are worried about.
Indeed, an April poll jointly conducted by Kaiser, National Public Radio, and the Harvard School of Public Health found that while 55 percent of respondents support an independent body of scientific experts recommending which medical treatments should be insured, significantly fewer (41 percent) approve of that body if its members are “appointed by the federal government.”
Health reform is crucial. But most Americans like the care they have and don’t want the government intruding. And they don’t support higher taxes or a bigger deficit.
To garner support for health reform, lawmakers should scrap their plans to inject more government into the health marketplace and instead encourage more competition and innovation. To expand access, policymakers can target subsidies to the uninsured, provide incentives for more affordable health insurance, and provide a better safety net for those who have trouble buying coverage. Lawmakers can also make health insurance portable and allow people more options to keep their insurance if they move or change jobs.
These are the sorts of reforms that patients — and maybe even politicians — could support because they don’t threaten to turn the one-sixth of our economy that is our health sector over to the government.