Matthew Holt

Don’t think anything is certain on the reform front

And in more from the “is it really bad enough out there to guarantee health reform?” front…

Pew Research is out with a poll showing that the numbers in favor of a major health care system reform are growing abut nowhere near as large as they were in 1993.


For those of you who are real survey geeks it’s (almost) worth noticing that Harris, which asks a similar three questions about appetite for reform never got above 40% for its “rebuilding” category back in 1993. I’m not sure why these are different numbers, but the last one I saw from Harris in favor of “complete rebuilding” was at 33%.

But the answer is that support from the public is no more a dead cert than it was in 1993–4.

5 replies »

  1. Not to beat around the bush: I had thought that those of us who do health care policy (for a living or for fun) agreed by now that only a fool would believe that deep health system reform was a certainty in 2009.
    I have yet to see any indication that the stage is set for reforms that can improve the value of care in a material way. For the thousandth time: the public doesn’t get it. And when the public doesn’t get it, it won’t get behind you when your reform plan runs into industry opposition. And any plan that substantially improves the value of care by forcing (through regulations or the payment system) industry players to get more efficient, rewarding quality rather than quantity, etc., will face fierce industry opposition. When doctors, hospitals, pharma, etc., put up their multi-million dollar ad campaigns condemning the cruel, bureaucratic government intrusions that (in their framing) prevent them from saving lives, the reform plans will collapse.
    Those of you who are still optimistic, take a look at what happened and is happening in New York and weep. NY has the highest Medicaid costs in the nation, and among the highest hospital costs, both of which are straining state budgets. When Spitzer was at the height of his power and approval after he was elected, he tried to reform the system and was crushed by an alliance of SEIU (1199) and the New York Hospital Association. It was a beautiful display of cynical self-interest overwhelming the public interest. And it is repeating itself now with the Paterson administration, now that Paterson has proposed his own reforms along the same lines. The latest I hear is that the anti-reform forces feel they are winning again and it is only a matter of time before Paterson surrenders on the material reforms.
    I’m a broken record on this: the stage is set for universal health care with minor system reforms this year IF the administration wants it. Survey show much higher support for that than for “system reforms.” The public wants universal health care. It does not understand the need for system reforms beyond insurance, nor does it have any idea what reforms would work to lower costs or improve quality. If you want system reform, you need to spend the next several years educating the public on the real cost drivers, where the money in healthcare goes, and where the system falls far short of quality benchmarks that could be attained using current knowledge.

  2. My guess is the 20% who only want minor changes have never experienced a major heath care setback.
    If you believe that everyone in a car accident has the right to be taken to the hospital and treated then you believe in some form of socialized medicine. Now let’s move past the buzz words and try to solve the problem in a way everyone can afford. We are all in this together.

  3. MD, if there is no excuse for deficit spending is there an excuse then for deficit investment in healthcare, infastructure, global warming and energy conservation/conversion/financial oversight?
    Frankly we would NOT be in a deficit situation now if we/our fathers/grandfathers had stepped up and made timely investments for our/our kids/grandkids future instead of spending/borrowing what we/they had on ourselves/themselves.

  4. There is absolutly no excuse for deficit spending for healthcare. While time travel is proving possible by bringing future dollars from the future to the present, there is no way to know just how far into the future we can loot. Eventually some young politician elected President will discover there is no more money to borrow.
    One hundred years from now we are all dead, no matter what kind of healthcare we have. Borrowing for our selfish selves is not going to sit well with our grandchildren. They will simply default. With that eventuality, work backwards with our lenders’ considerations: are they dumb enough to loan us the money for healthcare?
    You answer it.

  5. Hillary started her hearings in September 1993 and HillaryCare was declared dead in September 1994 by Sen. Mitchell. We are still a long way from September 2009. However, I suspect that “reform” will fail for two reasons. First, it will be mired down in negotiations, as the recent White House Health Care Forum demonstrated. Second, the Dems have 15 years of pent-up demand from their interest groups for taxpayers’ dollars that, despite stimulus and omnibus, are a long way from being sated. To take a risk on health reform before feeding everyone at the table, and lose to a Republican resurgence, is unlikely.