By
Humphrey Taylor is Chairman of The Harris Poll. Prior to joining Harris, Taylor worked in Britain where he conducted all of the private political polling for the Conservative Party and was a close adviser to Prime Minister Edward Heath in the 1970 campaign and subsequently to Margaret Thatcher.
What do people really think about health care reform? When political issues are difficult and complicated, published polls sometimes confuse rather than enlighten the debate. And health care reform is fiendishly complicated, with many different issues and many different proposals for addressing them. No wonder that the debate is generating more heat than light. This is surely one of the times when political leaders should lead rather than follow public opinion. As Winston Churchill once said, “The problem with politicians who keep their ear too close to the ground is that it is difficult to look up to them in that ungainly posture.”
While policy makers have to address the details of the proposed policies, most people do not. They know what they want, or don’t want, but have only a very limited understanding of which policies will actually achieve their aims. They are often strongly influenced by political rhetoric that varies from the accurate to the simplistic to the completely false. Many different words and phrases are used to describe different policies. It is unreasonable to expect the public to understand the details of the proposed reforms or how they work in practice.
However, if you study all the polls, as opposed to cherry picking them as many politicians do, a clear picture of public opinion emerges:
- Most people are unhappy with the current health care system and favor reform. They want to have a system that gives them affordable access to quality care for the rest of their lives. International surveys show that Americans are more dissatisfied with the U.S. health care system than are people in all, or almost all, other developed countries.
- Most people think that some kind of government intervention is needed to fix the system, to expand coverage, and to contain costs. However, support for government intervention does not, in most case, translate into support for a “government-run” system. (Though what people understand by that phrase is far from clear.)
- While most people believe that fundamental changes are needed in our health care system, only a minority wants to completely rebuild it. Most people favor building on the present system and the bits of it that seem to work well.
- There is substantial support for health care reform not only among the public but from large majorities of almost all major interest groups. Only small minorities of doctors, employers or insurers think that the system works pretty well now. However, they also have different interests and tend to see very different problems and support or oppose different proposals.
- Most people are at least reasonably satisfied with their own health insurance (if they have it) and with the quality of care that they receive. However, that does not mean that they like the system. Most people believe that the costs are too high and that everyone should be covered.
- More people think that both the total cost and the out-of-pocket costs of care are too high, but their perceptions of why this is so are different from those of most health economists. They often blame greedy insurers and pharmaceutical companies and think there is a lot of fraud and abuse. But they are less likely to focus on over-utilization, the impact of fee-for-service incentives and the relatively (compared to other countries) high price of medical services.
- Few people seem to worry much about the unfunded liability for Medicare that economists tell us is a huge problem.
- Proposals that people believe will take away the health insurance they have now, or force them to change doctors, that “ration” care, or prevent them from getting the treatments they think they need are deeply unpopular.
- There is no consensus on the appropriate roles of the government, employers and individuals. Half of the population thinks that health insurance and health care should be “an entitlement paid for by taxes,” while a third believes that it should be like other products and services, where you get what you can pay for.
- Republicans and Democrats are highly polarized on many aspects of reform. Most Democrats think that this is a very important issue and focus on expanding coverage and limiting out-of-pocket costs. They tend to favor an expanded role for government. Most Republicans focus on cost containment and oppose a bigger role for government. Democrats are much more likely than Republicans to think that health care is a “right.”
- There are many things that many people do not want. They do not want to pay much higher taxes and out-of-pocket costs. They don’t want to damage the economy or increase unemployment. They dislike the idea of rationing and oppose anything that they think might reduce the quality of their care or limit their choices.
- Most people do not think or talk about the issues that are the focus of much debate among policy wonks, think-tanks, and legislators. They rarely mention health information technology, comparative effectiveness reviews, a health information exchange, reimbursement reform, pay-for-performance, quality measures, or outcomes research. When asked about these issues, the public’s replies vary dramatically, depending on whether the language used is that of the proponents or opponents of proposals. For example, a new agency to provide information on which treatments work better or worse sounds pretty good – but not if it is used to deny care that a doctor or patient wants.
- Most people do not seem to see a conflict between giving patients every test and treatment they and their doctors want, however expensive, and containing costs.
As a pollster, I believe that it is unreasonable to expect the public to understand health care reform policies because the issues are so tough and so complicated. As H.L. Menken wrote, “For every complex and difficult issue, there is a simple solution – and it is wrong.” The enormous complexity of the issues and the emotional public response to misleading political rhetoric, make one think fondly of Bismarck’s famous maxim that the public should not be allowed to watch the making or sausages or laws. We should also remember that almost all health care systems in all countries seem to be almost permanently “in crisis” and that no matter what reforms are implemented, the demand for more reform – like death and taxes – will always be with us. Democracy may be better than all alternatives but it sure is messy.
Humphrey Taylor is Chairman of The Harris Poll, Harris Interactive. Prior to working at Harris Interactive, Taylor worked in Britain where he conducted all of the private political polling for the Conservative Party and was a close adviser to Prime Minister Edward Heath in the 1970 campaign and subsequently to Margaret Thatcher. In 1970, Taylor’s firm was acquired by Louis Harris and Associates, and Taylor took responsibility for building the Harris organization’s international business. In 1976, he moved to New York. He was appointed president of Harris in 1981, chief executive officer in 1992 and chairman in 1994.
Taylor has testified to congressional committees and subcommittees on Social Security, health care cost containment, Medicare, aging, policies affecting the disabled, drug exports, taxation of employee benefits and privacy. He has presented on these subjects in the White House and on Capitol Hill. He has published many articles and papers on survey research and public policy, he has also written editorial page articles for the New York Times, Wall Street Journal and the London Times. Taylor has been a guest lecturer at the University of California at San Francisco, the Kennedy School and the School of Public Health at Harvard, Oxford, New York University. He writes a weekly column that is syndicated in over 100 newspapers, and he broadcasts frequently on radio and television. He is the author of chapters on opinion polls in two leading textbooks on marketing research in both the United States and Europe (published by AMA and ESOMAR).
A few Harris polls on health care (PDFs):
- Is the U.S. Health Care System the ‘Envy of the World’?
- The More People Think They Know About Obama’s Health Care Reform Proposals…
- 5-3 Majority Supports Idea of Government Health Plan
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All members of Congress have a conflict of interest in the health care debate- They all have fantastic health care. They should all recuse themselves or give up their government sponsored, tax payer funded health care. Let them get it on the open market. The premiums have become too expensive for the taxpayers.
Wouldn’t it be great if at least a few of OUR representatives and senators decided ‘to hell with re-election’, I’m going to vote for what is REALLY best for the American people and what THEY want to see happen?
I’m afraid the news media would have a field day – but then they’d probably like it because it would be BIG news. If it was my senator or representative, I would certainly re-elect them. But then I’m not one of those ‘American people’ who get counted in polls or by politicians.
It seems that no matter what, people expect the government OR some large corporation to solve the problem or pick up the pieces when we are all broken, but it really falls into our own laps every time, STAY HEALTHY BECAUSE ITS IN YOUR HANDS NOT OBAMA AND NOT THE HEALTH COMPANIES. http://www.vitaminalmanac.com
CF Mother. Thank you for telling your story. Millions can relate. What really got me was how you mentioned that what kept you up at night was not the disease, but the thought of losing insurance.
I’m a 20 something year old with Reumatoid Arthritis. I worked for a national theme park company the past 5 years and was laid off in December. Even with Cobra, my medication costs me $400 a month (there is no generic brand). I was also was forced to discontinue my physical therapy because of the co-pays.
I say this not so people will feel bad for me, but because it is the story of so many. Arthritis is the leading cause of disability and cost’s the U.S. economy nearly $128 billion per year in medical care and indirect expenses, including lost wages and productivity. 50% of people diagnosed with RA will nolonger be able to work after 10 years. Indivicuals who can’t afford proper medication, doctors, or therapy, are likely to end up not only disfigured, but also living off the government and YOUR tax dollar’s. I don’t have the answer’s. Yet I do know that we deserve a change. Not only for those going through medical challanges, but also for the rest of you who will have to help “pay the price” in the long run.
I believe that the Federal government is the only entitiy trying to help the people of the United States.
If the insurance companies want to help they would have already done so. I dont understand why people dont get it that that the health care system is broke. I have some examples;
11 years ago I went to the hospital emergency room and withing 1/2 hour I was out cold due to loss of blood.
I dont need to tell the whole story, but this was a very tramatic experience for my body and it took a long time to recouperate. 2 days after I got home from the hospital the someone from the insurance company called me and said they may not cover this because I did not call them to tel them I was in the emergency room! I went bazerk and asked them if there were trying to kill me, I told them that for some strang reason when I went to the emergency room I was not thinking about them. They are cold and calculating and have no compassion at all for what I just went through. I almost died and they probabily would have preferred that i did.
Another time I was denied a proceedure because they said it was experimental. A Dr had recommended this proceedure as an attempt to prevent cancer. (So where is the rationing, rite here with the insurance companies). Next time I had a problem was when I moved and tried to get individual insurance and was denied due to pre-existing condition. Same thing happened for my wife. Has everyone heard about the girl that died because she was denied a kdney transplant and due to public outrage the insurance finally agreed and then the girl died before she could get the transplant. I am sure the CEO of that insurance company was happy that they didnt have to pay for that transplant. Also the people at the insuance companies that talk to you when you call are arogant and disrespectfull. They may not seem that way on the surface, but try to get a real answer sometime! Insurance companies are only out to make a profit and for healthcare insurance this must change. They will never change without being forced to.
What happened to preventive care? They dont care, what they want is for every one to give them money and they never want to pay out for the reason we give them the money. One insurance company said they were going broke and needed to have a large increase and then gave a bonis. Somehow I dont see how a bonis can be given when they are going broke? I understand that there are people out there that have good health care and dont care if anyone else ever has the same and also wish the older people would just die off. But I wonder how they would think if things changed for them!! And they will also be old some day. So lets get real people and get behind the govt and get this health care bill passed.
reforms need to change health care as important for a better quality of life of people in countries with low economic resources, according findrxonline this reform should be based on obtaining prices and lower costs, improve medical centers and keep people better served, because these are basic concepts for a better performance in the health system.
Questions for those who do not support health care reform:
Twenty years ago our cheery toddler was diagnosed with cystic fibrosis. Afraid, we dug into the medical research to understand the disease that threatened his future. We healed through optimism, roused by the news eight days after his diagnosis that the gene that causes CF had been found, opening the door toward a cure. We knew that our heroes, the researchers and his doctors, would continue to find ways to protect his future. We were no longer afraid of CF.
The fear that woke me in the night was of losing our health insurance because our son was on every insurer’s no-fly list. While my husband’s profession was periodically roiled by layoffs, he decided against the security of opening his own firm because the cost of carrying coverage for our eldest son was too high, the thread on which his health care dangled too slight.
With luck, we made it through our son’s childhood without a gap in coverage. Now 22, he’s kept his health thanks to his medical care and his own glorious determination not to allow CF to cramp his style. He earned his black belt, went to college, joined a fraternity, and drives a 1961 Buick LeSabre. He spent a year in China, learned Mandarin, and discovered that even the drug that enables CF patients to digest food couldn’t help him digest raw sea cucumber. He backpacked through Thailand, had his wallet and passport stolen, but managed to hang on to his meds. This spring he will graduate with a degree in chemical engineering with a concentration in biochemistry. His resume includes summers researching the transmembrane conductance regulator, the protein channel in our cells that, when malformed, causes cystic fibrosis.
We can’t wait to see what this kid is going to do next. Next, however, has filled me with that old middle-of-the night fear. Our son will age off our family policy in April. He must shape his future not according to his dreams and ability, but in ways that will ensure that he keeps his health insurance. He must find an employer with health benefits that will hire a new college graduate in a poor economy. Or he must extend his full-time student status until he’s 25, putting off career plans and his desire to support himself. Despite his wanderlust and world-wide opportunities, he must remain a resident of Massachusetts, an isolated island where CF patients are not pariahs to health insurance companies.
I tell our story not because it is unique. Other families have been harmed, rather than merely threatened, by the ruthlessness of American health insurance. I tell it to ask a question. It is for you, the person reading this who does not wish the current effort to reform health care to succeed, who calls it “Obamacare” and “socialized medicine”. Help me understand your position, because I am mystified.
Are you a parent? Do you know that the bill under debate will prevent insurers from dumping people with pre-existing conditions, like my son or, perhaps, someone in your family? Do you believe that anyone who needs health care can get it somehow, or that illness happens only to other families?
Are you a fiscal conservative concerned about cost? Do you realize that the current system discourages small business development and blocks young adults’ opportunities to succeed, the foundations of a growing economy? Do you believe access to health care is not as essential as access to education in preparing our next generation of skilled workers?
Are you are an insurance executive? Do you devise new ways to make it difficult for my son to obtain prescriptions and services as cost-saving measures? Would you prefer to cover the cost of his lung transplant, because he has not been able to get the treatments he needs to stay healthy? Or have you decided that the ultimate cost-saving measure is to let CF patients and other chronic burdens to your bottom line die young?
Help me understand why, rather than reforming the American health insurance system, we should turn our backs on my son and the promise he and other young Americans like him offer all of us.
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This is the solution to our health care crisis. We all ultimately turn to God during times of crisis. This will create a propagating, everlasting, taxable income stream that will create jobs, pay for socialized health care and rebuild social security.
I do not understand how the government is giving free health care to people who are ilegal in this country. If someone is ilegal, that means they have broken laws and entered this country. Now, to reward them we will offer free health care? Something does not sound right!! I am an American citizen and can not really afford health care. How can I get free health care. Do I have to break a certain law. Maybe the answer would be having double citizenship, will that help to get free medical coverage. Illegal aliens get free food stamps, medicaid, and the American citizens get “shafted”. As my little girl says, “AWW, COME-ON”
• Page 29: Admission: your health care will be rationed!
• Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)
• Page 42: The “Health Choices Commissioner” will decide health benefits for you. You will have no choice. none
• Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.
• Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.
• Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens
• Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter.
• Page 124: No company can sue the government for price-fixing. No “judicial review” is permitted against the government monopoly. Put simply, private insurers will be crushed.
• Page 127: The AMA sold doctors out: the government will set wages.
If this stays intact would it be better to be an illegal alien. If they recieve all the benefits for entering this country illegally, what motivation do they have for following the laws. Hey, did’nt President Obama say that the health care plan “Would not benefit Illegal aliens”, I remember someone screaming “YOU LIE”
hhhhmmmmm…..AAAWWWWW COME-ON
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What I look forward to having real choice and real Competition free from the strings of employer Grounded insurance. Our Lopside, Corrupt governmental agencies have created a partnership with corporate America that is detrimental to the publics good.
As much as I hear the distain for socialism. It is Facism that has prevented Health Insurance from being reformed. The Corporate profit Makers dictate the terms of this circus performance that some call Congress. Americans are not stupid as some repeatedly mention. They know that this push for additional members come with a price. While the partners of fascist ideaolgy have decided on eliminating the cracks in the floor of Pre-Exsisting:the Sky has no limits in out of pocket and Premium control.
If Health Insurance was actually part of this Free Market Society and was held accountable by the Members. We would see the Changes that some dread and older people look forward too.
Expecting anything from Congress is like expecting a bum to get a job.However, Social Security and Medicare have keep your parents off the Streets in their twilight years. Profiting off the misery of others is so priceless that the term Fascist is synomious with profits first and foremost.
Dear Friends and Relations,
I hope I won’t offend any of you by writing to express my anger about reports we read in UK papers about the distortions and downright lies concerning the British National Health Service (NHS), propagated by the enemies of your President. I hope you will feel able to copy this e-mail to any friends who are against Obama’s proposals for health reform.
It is particularly galling to hear that the utterances of an idiot UK Member of the European Parliament are being quoted as gospel. The man concerned (whose name I can’t recall and of whom we had never heard until this episode) is clearly far to the right wing of the Conservative party and his views have been disowned by the leader of that party.
No health service is perfect because it depends on people to run it, and to err is human. When it runs well, it is not “news”, but the occasional failures and problems hit the headlines in the right-wing press.
There are also issues about how to handle leading edge and expensive technology. New technology has to tried and tested, but when it is both new and expensive, choices have to be made about the initial use of it in designated centres of research. This always gets into the papers because patients who just might possibly have their lives prolonged by a new treatment, understandably want it NOW. I know this would be my own gut reaction. But if logic suggests that the money (which is not infinite in any system) could be more cost-effectively used for other more proven treatments for many more people, then I have to agree that it would not be sensible to for me to get the experimental treatment. I used to draw the comparison between kidney and heart transplants. It is probably cheaper now, but a few years ago one could save the lives of many people in kidney failure for the cost of one heart transplant. The experimental technology eventually becomes cheaper and routine, a fact that I am heartily glad about.
It seems that the anti-brigade have latched onto this concept to say that the NHS rations care and dictates who shall live and who shall die. That is a crude nonsensical interpretation of the facts and must be contrasted with cases in the US where people don’t take the drugs that would save them, because they cannot afford them.
May I also point out that the USA spends twice as much as the UK per head of population on health care, and yet you have a worse life expectancy and perinatal mortality rate than us. I read recently that your perinatal mortality rate was far worse than the much-vilified Cuba. How ironic that the bete-noir of the US right wing should actually give its infants a better life chance, in spite of years of economic isolation. In fact, Cuba trains so many doctors and para-medics that many work in other third-world countries.
How much of the money spent on health care in the US goes into the profits of the insurance companies and the profits of the private health facilities? And yet I read that 50 million Americans are without health insurance and rely on a dodgy and inadequate back-up system. How many more have insurance limited because they have a pre-existing health problem? How many more have health insurance through their job and so dare not change jobs?
What would my recent experience of the NHS have cost in the USA?
For those who don’t know, one day back in March this year, I fainted at our Local History “club”. The emergency number was dialled and our local stand-by para-medic in a fast car was there within minutes, shortly followed by an ambulance which took me to the local hospital. No questions about insurance, because we are all looked after by the NHS. All sorts of tests and scan were done and the doctors discussed the findings with doctors at the main teaching hospital in Leeds. It was decided that I should be transferred to Leeds, about 10 miles away.
The transfer to Leeds under flashing lights and siren was about the only thing about the following two weeks that I can still remember. I think the ambulance men were anxious that I didn’t die on them, hence the flashing lights etc.!
At the Leeds General Infirmary, they did more tests, and told Helen that they were reluctant to operate because it was potentially so difficult and hazardous. I am told that I was quite chatty that weekend, but on the Monday I collapsed again and they decided that surgery was urgently necessary. Helen was visiting and talked with the surgeon before he started 13 hours work on me. They replace my aortic valve and a section of the ascending aorta. I was then unconscious for 5 days in Intensive Care before gradually being brought round. There was a setback 4 days later, when they had to take me back to theatre to remove some clotting round the heart; but that went well and three days later I was moved to the ordinary ward from where I went home 10 days later.
I like to joke that, if the new parts last half as long as the originals, I will live to 105!
A few days after I got home, the cardiac rehabilitation nurse came to visit me (all part of the service), and I was advised to take graduated gentle exercise and invited to attend the Tai Chi classes at the local hospital. I am about to graduate to a more strenuous exercise class at the hospital (all available free), but as some of you know I can already do modest 2 or 3 mile walks.
I am on Warfarin (I call it rat poison) to prevent clotting, and my blood has to be tested regularly to get the dosage right. It now seems to have stabilised so that is now being done at 4 week intervals whereas earlier it was weekly. I am also on two blood pressure reducing drugs, making 7 pills a day, all free of course. I would have to pay something for medication if I was aged under 60 and over 18 and had an income.
Contrary to what is being put about by President Obama’s enemies, the treatment I had was exemplary. Every single member of staff at the hospitals was superb. Even the orderlies who dished out the food did their best to cheer me up and get me eating. Something, either the anaesthetic or being on the by-pass machine, had spoilt my sense of taste, so most food either didn’t taste of anything or was slightly revolting. Fortunately that has passed and food is nearly back to normal. But the whole atmosphere on the wards was cheerful and encouraged one to push oneself to get better. So it annoys me intensely when people opposed to your proposed health care reform claim that the NHS is failing. It is a lie.
The NHS is superb. I hope you get something like it soon.
In the UK, we are not forbidden from take out supplementary health insurance. We ourselves actually have it, mainly so that we can get privacy when we need it for minor procedures, and so that Helen as an ex doctor is not in the embarrassing position of potentially being treated by staff she worked with. But it is really rather a waste of cash, because, when the chips are down in a serious emergency, the NHS gives us everything we need.
As a smoker, I am SO for a tax on soda. I hope you holier-than-thou assholes get a taste of what we’ve had to deal with for years now. While they’re at it, I hope they tax the fuck out of all sugary and fatty foods. And then, instead of using that money to help people with junk-food addictions, they just lump all that money in with the rest of their tax revenue. Maybe then the rest of you would realize what a bunch of snooty shits you’ve been to us smokers.
Several Congressional committees controlled by the Democratic Party recently passed bills representing their vision for healthcare reform before the August recess. Their goal was to achieve President Obama’s ambition to reform the American healthcare system and to insure all Americans. During the recess, many Congressional representatives encountered strong opposition from their constituents when they went back to their home districts. Many people, with some encouraged by right wing Republicans, were very vocal and confrontational during the town hall meetings. After August recession, a senate committee unveiled another bill which made some compromise and reduced some cost, but still a very ambitious plan.
This display of angry shouting is certainly not constructive if we are to have a serious discussion of such an important social policy. Many of the arguments by the opposition are based on misinformation. One such argument against the Democratic reform bills, which has been blown out of proportion by the media, is that they would create so-called “death panels”. I, in fact, think this is a good idea. It lets patients, especially elderly patients, receive consultation from doctors about possible end of life treatment. They can then decide in advance whether in certain circumstances they would choose to either continue or end life support, so that their family would not be burdened with the decision. This would avoid what happened a few years ago to Terri Schiavo. In her case, her husband and her parents could not agree whether to keep her in a vegetative state or to end life support, and thus they went to court, resulting in a long and costly litigation process. Using the term “death panels” to describe this reasonable proposal is outright ridiculous.
Likewise, pretending to be on the moral high ground by using “politically correct” language, such as “it is everyone’s right to have the same quality of healthcare as a Congressman” does not help solve the problem either. Blaming the rapid increasing of healthcare costs mainly only on the health insurance companies is also baseless.
Undoubtedly, healthcare in the US has a lot of problems. Healthcare spending in the US is much higher than in other developed nations. In fact, the cost of healthcare is increasing faster than inflation. There are also several millions Americans without health insurance. However, there is still a silver lining. Our high quality health professionals and new advanced medical treatments attract patients from all around the world. The emergency care system in the US is well established and top rated and hospitals accept patients for treatment regardless of their ability to pay. The US is the leader in developing new drugs and new medical advances. More than half of the Nobel Prize winners in medicine are from the US. Recent statistics also show that life expectancy is now almost at 78 years and the death rate from most diseases is decreasing.
No one thinks that reform is unnecessary. The question is how.
My two main concerns and doubts on the reform bills presented by the Congressional committees are as follows.
First, in order to provide health insurance for everyone including those with low incomes, the government needs to spend a lot of money. No matter how it is paid, it is taxpayers’ money. Do tax payers want to pay for it? If the government forces those employers who do not provide health insurance for their employees pay a penalty tax, eventually either the employees will be paid less or it will be passed on to the consumers. If the government forces the wealthy to pay more in taxes, it means to raise the percentage of the tax paid by rich people. If most people think it is reasonable, this money can be used in other areas, for example, to reduce the huge deficit or to let those with lower and middle-class incomes pay less in taxes. If it is paid by increasing the deficit, not only will our children need to eventually pay it off, it will also adversely affect the economy and everyone will suffer.
These bills contain very little cost cutting measures. The amount they claim to save from Medicare by cutting waster may not be very much and waster can and should be cut already without a huge program. Watering money is government’s crime. The final cost of all governments run programs is almost always far higher than originally projected, whether it is a huge program, such as Social Security or Medicare and Medicaid, or a small program, such as Cash for Clunkers. For the latter case, our recent memory will hopefully still remind us that Congress later injected two times the amount of money than originally projected for the Cash for Clunkers program. Current plans in the bills largely use the Massachusetts health plan as a model. The Massachusetts health plan has been around for three years and it has already impacted its state budget. We must also remind ourselves that Massachusetts is the third richest state in the US. Its per capita income is 30% higher than the per capita income for the entire country. If the same standard is used, a much higher percentage of the population in the nation will need government subsidized insurance then that in Massachusetts.
Secondly, both President Obama and his supporters promise that there will be no single-payer system. Those who are satisfied with their current insurance and doctors can keep what they have and nothing will change. However, if there exists a government subsidized insurance plan, some private insurance companies may disappear and many employers may drop their health care benefits. It will be cheaper for them to pay the penalty tax than to provide health care benefits for all of their employees. Eventually the government plan will become the only plan.
President Obama recent address on healthcare reform tried to attract more people to support his ambitious goal. To count the opposition, one thing he said that I found very striking but also encouraging is that he will not sign a bill which will add a dime to the federal deficit now or in the future. Additionally, he mentioned that spending and benefit will be cut if the promised savings are not realized. I will be very appreciative if he really means what he said and if there will be a concrete measures to do so. None of the current bills has such an automatic cut mechanism.
If you’re someone who currently has no interest in highly involvement by the government in healthcare, does not like a Canadian or European style healthcare system, but at the same time wish to give some help to those who cannot afford health insurance and reduce the speed at which healthcare costs are increasing, then what I propose next may be something worthwhile to consider. Of course, there is no free lunch, but what I propose is to spend much less than what President Obama proposes, and to walk in small steps instead of huge ones.
Design a very basic health insurance plan. The government helps those with low incomes buy such a plan or other similar plans. It provides free basic health checkups every two years instead of every year, as most current plans provide. It has a higher co-pay for other medical services than most of current plans. It does not cover certain drugs such as Viagra nor organ transplants. In essence, it does not cover health services which do not mainly cure a disease or which are very expensive. It covers only generic drugs with a co-pay. Brand name drugs will only be covered if they are life-saving or if there are no similar generic drugs which can be substituted. Ambulances are only covered only for life-saving cases and physical therapy is covered only for severe cases. I am personally acquainted with a Medicaid patient who often used an ambulance to take him to a hospital which was four blocks away from his home when he could definitely have used a taxi. Hospitals should provide economy rooms, where each room would accommodate four patients without the use of a TV and where the patients would pay for their own meals. If there are similar medical tests, choose cheaper ones. For example, the cost of a Pap smear with or without using computer assistance is about two to one, but the difference in the effectiveness of detecting cervical cancer is minimal.
Such a plan still requires additional taxpayers’ money, but it is much less than what is currently proposed by Congress. In the future, as the economy grows, the deficit is down, and voters want to provide more assistance to low income persons, coverage can be expanded. Compare this to President Obama’s plan. He wants to start off with a huge plan and cut out parts of it if it ends up costing too much. I would rather start with a small plan and expand it when we are willing to spend more.
Every worker is given a tax-free healthcare expenditure account, and a minimum of three to five percent of their income would go to this account. Like a 401k retirement account, one can contribute more pre-taxed income to it if one wishes. The money in this account can only be used to pay medical expenses. When the person reaches 65, it will be converted into a retirement account, if there is any money left. If the person dies, his or her spouse and children can inherit. Do not require everyone to buy a health insurance, but if you do not, you need contribute five (or more?) percents more of your income into your health account.
The government should not set a price cap for any drug or medical treatment, but any healthcare provider, hospital, drug company, and pharmacy must charge the same price for the same treatment or the same drug. Currently a bill sent to an uninsured patient by a hospital is much larger than what would be received by an insurance company. A drug store now charges much more to a person who buys a drug without insurance than it would receive from an insurance company. Pharmaceutical companies sell the same drug to many foreign countries cheaper than to the US. This means that Americans are subsidizing foreigners.
Likewise, health insurance companies shall sell the same plan at the same price. Currently they give large companies big discounts. A heath insurance company cannot reject any child because of a precondition. It also cannot reject anyone who had insurance but discontinued it due to situations, such as being laid off, switching jobs, or bankruptcy of an insurance company to buy a similar plan. For those adults who do not have health insurance and want to buy an insurance because of a pre-existing illness, an insurance company can not reject, but can charge an extra fee, for example 5 or more years insurance premium. Insurance companies may give a discount for those who do not smoke nor are not overweight, and may charge extra for those caught using illegal drugs.
Encourage patients to check their bills. Previously, I’ve discovered that my insurance company once paid a hospital twice, that a hospital charged it did not perform, and that a doctor charged for a procedure different from the one that was performed. Insurance companies, including Medicare, and Medicaid should give some reward patients who find such errors.
Set a cap for medical malpractice judgments, but increase the deduction. It can not only reduce the insurance premiums doctors buy and hence reduce the cost of healthcare, but more importantly it can reduce the waste of unnecessary procedures when doctors order a test mainly for preventing future law suit. High premiums only increase the healthcare cost, while high deduction will help decrease malpractice due to carelessness.
Since there is a shortage of donated organs for transplantation, the law needs to be changed so that if one does not opt out, the person will automatically be an organ donor. Also it is reasonable that, with all other considerations being equal, an organ donor should come before a non-donor when determining who shall receive the transplantation.
Some of the good ideas in the current bills, such as the requirement of digitizing medical records, can be implemented independently, without attaching it to a huge reform plan.
Personally, I am not against using tax payers’ money to cover legal abortions. Since this is a very emotional issue and many are strongly against it, it is wise not to cover it. Let private organizations raise money to help pay for abortions.
When Medicare and Medicaid is facing bankruptcy because it is taking in less money than it is paying out, the federal deficit is increasing by leaps and bounds, and the economic recession is yet to recover, it is not wise for the government to start a huge costly program. We should reform Medicare and Medicaid first to make them solvent. Doing so will also allow us to gain experience for future healthcare reform. If we still want to do something, then the above suggestions can be considered a compromise, even though some of them may be politically incorrect. I hope more people will raise concrete suggestions instead of shouting and saying big words.
It has been interesting listening to the news, US congress, and public outrage about a government run health plan. Knowing most people have known a family member who has been out of work for an extended period of time, denied a needed surgery’s , or just needed comfort care to finish living their last day’s only to be denied. Medical plans help people who have them, and they are not perfect, what is even worse is hearing how people who don’t have medical shouldn’t be covered; everyone could go into a story of how someone they know can’t get treatment. It is also public knowledge on how much Emergency rooms are costing the average tax payer in America because they are being used as doctor’s offices due to the fact they are not allowed to turn anyone away. Yet healthcare is become such a political issue, it is almost as if everyone is scared they are not going to get credit for coming up with the solution; however, they also don’t want to take credit for backing one that isn’t 100% perfect. If congressmen and women would stop putting out false claims on what could happen and trying to scare people into thinking how evil this plan is, a solution could be reached.
It is despicable that anyone on Capitol Hill was voted for; hearing that a public option would ruin private health care was almost laughable if it wasn’t such a dangerous claim. Workers have been told that if there is a public option companies would not get the same discounts and healthcare would go up for both the company and the workers. Here’s a fact if a public option was available and it was so good that the majority a company’s employees switched over, it could save major companies millions, offering a higher net income and possibly higher wages to its employees. Now look at the fact of all the people that get an injury that with proper medical treatment they could go back to work, instead they spend month’s applying for disability, they appealing the initial denial, before finally losing almost everything they own running up countless emergency room visits, and living on welfare before finally getting the treatment they needed to return to work. Of course that doesn’t hurt other American’s right, or is that even more costly than if someone was off work for 6mths got the medical coverage they needed and then became a productive member agian. This also has to make you wonder would it also help social security if so many young Americans did not need to be on disability because they were able to get the medical help, or if people would not need to lose or quit their jobs because they were able to take the time off for medical coverage.
The next point all the fear messages that are being sent out by the media, first the companies are not going to lose money if insurance rates have to go down to compete. Less people will be on disability if they have the medical coverage that will get them treated before they qualify, remember under the current rules you have to be off work for one year before you can even qualify of disability. Also the dreaded public option again if it is cheaper than what you are paying now or the coverage is better, would that really be a bad idea. Many people have lost their own retirement funding because of the 80/20 plans. People would abuse the system, yes in the beginning many people would probably go to the doctor frequently to take care of several issues they have neglected for years, due to not having any coverage. The same is happening at companies that are offering insurance to its employees, those that have had it for a long time don’t need it as often and tend to be healthier because they have used when they needed to, although the ones who have not had it run to the doctors several times a month for the first couple years taking care of everything while it last. That is an all too common factor for people who care about medical, if you have it and it is good coverage eventually you don’t think about it and just use it when you have too. If you have not had it and are grateful for having it you may use it in excess for a while, that does calm down, unless you are a hypochondriac. They are going to be exceptions to every rule that does not mean that the exceptions are the rules and that is what Americans are being told, by employers, and others that thrive on people fears.
In conclusion, while a government run anything may not be the best possible solution, having no solution is even worse, at least with a government run health care system it would open the door for private run insurance companies to relieve some of its burdens and come up with some new innovated ways of doing business. It is often when you see something else done that a new idea may come up, and possibly much better solutions. I have found stats both ways supporting universal health care and against universal health care, I guess it just depends on which opinion I want to have that day. What is pathetic is how American’s continue to die or be out of work because people in the Media and Government can’t come together on what needs to be done and that is getting more people healthcare. I will leave you with one thought, I have an Aunt who has worked for the same place for the last 37 years and does not get health coverage, if she ever retires she will lose her home, not to mention she has now developed a lump on her throat, question is it cancerous or isn’t it? Does it even matter she will worry herself to death wondering because of the lack of treatment and if it is cancerous it will spread too far to be treatable by the time she does get coverage. So she will lose her home, and everything she has spent her life working for all because she can’t afford insurance. Who is going to have to pay for all the medical bills she leaves behind and the foreclosed home, you are that’s who. Makes you wonder if getting people in her situation medical coverage should be a concern, of course she will probably one of them that has to get on disability early and take an even bigger chunk from social security and still we argue and put fear into people just because you have the power to do so. The fact is when this next election happens the public will speak again and let everyone know if health care was an important issue, that is unless of course it gets pushed through now and then the tied can be turned onto a different subject, but make no mistake those that listen to the media and didn’t listen to their own states will not be there for the next health care debate.
Thanks for the information. This whole thing is very frustrating. I am a single mother of 5 and struggling to make ends meet. I do have a full time job. The state does not help me in any way, ( I would rather do it myself anyway). Any other info on this new reform they trying to pass would be helpful.
Please take my health care survey for my AP Government class. Here is the link.
http://www.surveymonkey.com/s.aspx?sm=C0cJjk_2fBoRkfZUp1UrGRSQ_3d_3d
Thank You
We are wanting to reform health care because of the ever rising cost and massive inflation.
There are a couple of things that congress could do that would help.
TORT reform. Stop the insane lawsuits.
Fix the government run health care entitlement programs we have now in Medicare, Medicade, and VA.
I think it’s time to quit “playing politics” and get down to business. If this country is serious about healthcare reform then it needs to happen. I think an excellent starting point is to nationalize healthcare and get EVERYONE on the SAME plan. Once the playing field is leveled we’re going to see a far more honest approach and a lot less political posing. It serves no purpose to have some of the people on the “elite” plan and the rest of the country on a “basic” plan. As for mandatory health insurance, get real. People on minimum wage haven’t got money for monthly premiums. If they are forced to pay for those, then they’ll need to decide which is most important. Health care or a roof over their heads. A lot of people are going to fall into brackets where they might be able to afford a monthly premium but won’t be able to use the plan because the copays and deductables are too high. Everytime I read new information, the total earnings for a family of four keeps dropping. Right now it’s sitting at 22K. With a few school loans, a mortgage and a family, how in the heck do you afford mandatory healthcare? Go figure…
I think we need for our government officials to get down to some real planning and quit with the posing.
To everyone who wants the government to control their healthcare:
I was hit by a drunk driver. I recieved a severe brain injury and a broken neck, while he broke a few ribs and hurt his shoulder. He was out of the hospital in about 2 weeks. I was in a coma, in the hospital for two months and I have lots of brain injury related issues. He got SS Disability quickly while I have been turned down 2 times and am on my 3rd and final try. I cannot work! By the way, he had disability while in jail. How does that make sense. One of the times I was turned down, I was examined at a chiropractic office by a SS doc. I DONT HAVE BODY DISIBILTY, I HAVE A BRAIN INJURY. They didn’t test me for what was wrong. Instead they tested me for something totally different. The government will choose who and what they will cover and they will get it wrong the majority of the time. I dont trust them with healthcare. I speak from experience.
What’s really in Obama’s health care reform bill? Almost no one knows, and here’s why: It’s 1,017 pages long and written in an alien form of bureaucratic English that can barely be decoded by earthlings.
I want to suggest a key component that I think is missing in the debate: a Health Credit. This is how it would work.
If I have good health (as quantified by not spending as much on healthcare), I get a health credit. This works very well within a public option system. Say each person in the program pays (say) $1000 per year to buy a public option that covers $2000 of healthcare bills for basic/preventive care including dental, vision, and generic (but not branded) drugs. The person and the government would split the cost 50/50. If that person has a balance of any portion of their $1000 at the end of the year, they roll it over to the next year or can withdraw it tax free. This should incentivize people to not spend, and the best way not to spend is to keep yourself healthy. If they want to save up for say Lasic – then they can earn earn it by staying healthy over several years.
Like all other plans, the public option would be negotiating price discounts for mass purchase power.
Of course in this system, people are free to buy more advanced health insurance or fee for service products. Thus the for profit insurance companies will still make plenty of money. Analogous to riding the subway for $1.25 or taking your private car for $20 on a federally funded interstate – people should have choice based on what they can afford. If you want better plan – then you need to go get a better job so improve yourself and think long term. The government shouldn’t subsidize anything above the minimum required to keep the overall health of the population high enough to be competitive in a globally connected economy. Remember our constitution says “life, liberty, and the persuit of happiness” – but not free healthcare – are rights. This must be balanced against the long term sustainability of our economy which means we as a people have a vested interest in keeping the population healthy.
To go along with this, we need a large government funded training program to train physicians and other healthcare workers who promise to spend the first 5 (or so) years of their practice within the public option system (likely at a lower salary level but good benefits) in exchange for free or lowered tuition. This way even if there are more patients who enroll, they can be covered by the physicians or residents in training in these public option programs. The programs could be hosted by existing hospitals & clinics – who will be happy since they won’t have to pay as much and get more low cost labor. As part of this plan, the government would block or severely curtail medical malpractice claims in the public option.
Then once physicians are done with their service, they could decide to go into private practice or not based on the best choice for them, but you’d have a significant percentage of physicians over time who belong to this fraternity and in the future would know how to reduce overall healthcare cost and provide higher value in ways we do not today.
I also would make all healthcare records conform to basic healthcare IT data model so that as a consumer or any other person in the healthcare economy I could pay for a third party review that could spot ineffciencies and allow for clawbacks or fines on overcharges. A whole new industry analogous to the credit card credit score monitoring services would open up. Development of this data model should be facilitated by the government (just like the internet was).
Everyone wins:
1. People have choice and can get a good low cost plan, or any other plan they can afford.
2. Insurance companies are free to compete for more profitable patients and win through innovative products and keeping their overhead low.
3. Doctors don’t graduate with crushing debt that forces them to make career choices based on profitability.
4. Hospitals get sufficient labor and more efficient business processes because of standardized IT
5. Government saves money, builds infrastruture for long term returns, and creates jobs.
6. New industries are created
7. The workforce is competitive globally because we’re healthier
Why doesn’t the USA step out of their bubble and look at other countries’ Health Care Systems.
Australia – Medicare tax of 1.5% of gross income, no upper limit (if you earn a million you pay $15,000 per year) – lower income earners, pensioners etc do not pay. The average full time worker earns $60,000 per year and pays just $900 per year for medicare! Nobody complains about the medicare tax, the middle man (insurance companies) are cut out of the picture. Insurance companies now offer extras cover for elective surgery, dental cover, prescription lenses, chiropracty or naturopaths, or to have your own doctor in a private hospital (eg for childbirth you get your own gyno)
Medical services such as hospitalisation are essentially FREE for ALL. NOBODY is ever refused hospital treatment. Yes the system is not perfect, you may have to wait a few months for non urgent surgery such as cataract removal, but let’s face it we are a much healthier nation, as there is a strong emphasis on PREVENTATIVE medicine (free mammograms, pap smears, eye tests, hearing tests etc) which saves everyone money in the long run.
A friend of mine from USA told me she had such a sore knee which clicked because she fell down the steps a couple of months ago, but could not afford to go to the doctor… I could not believe her, she could have a chipped patella or anything and she is walking around in pain!
My daughter got sick at the age of 12, at that time I had left my husband and was struggling trying to set up a new business, diagnosis (Stills Disease) and hospital treatment was free, and because of the excellent treatment she got she is now a healthy 18 year old, with no treatment she could have easily suffered irreversible damage and pain throughout her life… how many US children have to live in pain because their parents can’t afford insurance or treatment?
Obama… take a good look at the systems in Australia & England. I would say the USA health system is beyond repair…scrap it and start afresh!
On Tuesday, 9/29/09 at Noon P.D.T. we are asking all Americans who support a Public Option as the only remaining viable choice for health reform, to shout out “Strong Public Option” wherever they are. It would be preferable if this were done outside or in a group. Let’s put voices behind all of those emails, in the manner shown in the film “Network”. Pass it on…