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Health Care Reform: What Americans Want
WASHINGTON WATCH
MICHAEL J. PENTECOST, MD
Health Care Reform: What Americans Want Not since 1993 has the noise surrounding health care reform been so loud in Washington. The press, members of the Senate and House, physicians, and hospital, insurance, pharmaceutical, and device industry representatives crisscross Capitol Hill elbow to elbow. Lines awaiting entrance to congressional committee meetings rival those at rock concerts. Television crews hang on very word of the pundits and politicians driving these debates. Mandates, public options, community rating, tax exemptions, and other heretofore obscure policy topics have become front-page news. All around Washington, cable news, blogs, tweets, newspapers, magazines, and presidential speeches have focused enormous attention on the great debate about health care reform. How about outside the Beltway? On Main Street, what are the issues? What do ordinary Americans think about health care reform, and what outcomes do they desire? Or fear? Three issues shape Americans’ opinions concerning health care: the existing problems affecting the country as a whole, the state of their current lives and health situations, and the concerns about their individual futures [1]. Regarding health care on a national scale, Americans are dissatisfied with the status quo, with a majority seeking major change. Expectations include better access for the uninsured, the control of spiraling costs, and improved quality. Means to these ends are an expanded role for government, health insurance reform, and some form
of mandates, either individual or employer. Not unexpectedly, there are fewer worries about less concrete and more long-range issues, such as the viability of the Medicare trust fund, the percentage of the gross domestic product dedicated to health care, and the future of government entitlements. How about the current status of their lives and health? That’s a different story. More than half of those polled are content with their health insurance, like their doctors, believe they are receiving quality care, and value their local hospitals. A few economic demographics are inescapable and help explain the contentment of most citizens. Five percent of the population account for 50% of health care spending; 70% consume less than 10%; 20% spend nothing annually on health care [2]. Furthermore, more than 80% have medical coverage, most through externally supported means such as Medicaid, Medicare, or tax-advantaged, employer-based plans. These two groups—the healthier 70% and the fortunate 80%— constitute a lot of the satisfied poll respondents (and a lot of voters). With Americans concerned as a nation but more content from an individual perspective, the tiebreaker for their support of political reform may rest in their personal views of the future. And in that crystal ball, most questioned in polls see little change in quality, worsening personal care, greater individual costs, and, by a huge margin, higher taxes (79%) [1]. Of course, predicting the future of one’s individual health, much
less national politics or economics, may be a fool’s errand, but it is a great culture medium for political rhetoric. And that is exactly what has happened in 2009. Into the uncertain milieu surrounding health care reform, many political partisans have injected a number of extreme claims: scare tactics, oversimplifications, even mistruths. Advocates for sweeping reform say the future without radical change is bad; opponents say the opposite, that reform will only make things worse. The result has been a sudden and dramatic skepticism about one of the most unsettling ideas of humankind: change [3]. Will Americans’ health and medical care in the future improve or decline? How about access to their personal physicians or local hospitals? If needed, will tertiary and quaternary care be available? Will they remain employed and hence insured? Who will meet the medical needs of their families? What about out-ofpocket costs? When on the precipice of change, the answers to those questions—not unfunded liabilities, health information technology, entitlement reform, and other health policy initiatives—will drive or derail health care reform. REFERENCES 1. Blendon RJ, Benson JM. Understanding how Americans view health care reform. N Engl J Med 2009;361:e13. 2. Halvorson GC. Current MSA theory: wellmeaning but futile. Health Serv Res 2004;39: 1119-22. 3. Kinsley M. Change we’d rather do without. The Washington Post. August 28, 2009:A25.
Michael J. Pentecost, MD, Magellan Health, 6950 Columbia Gateway Drive, Columbia, MD 21046; e-mail: pentecost. [email protected]. © 2009 American College of Radiology 0091-2182/09/$36.00 ● DOI 10.1016/j.jacr.2009.09.010
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MICHAEL J. PENTECOST, MD
Health Care Reform: What Americans Want Not since 1993 has the noise surrounding health care reform been so loud in Washington. The press, members of the Senate and House, physicians, and hospital, insurance, pharmaceutical, and device industry representatives crisscross Capitol Hill elbow to elbow. Lines awaiting entrance to congressional committee meetings rival those at rock concerts. Television crews hang on very word of the pundits and politicians driving these debates. Mandates, public options, community rating, tax exemptions, and other heretofore obscure policy topics have become front-page news. All around Washington, cable news, blogs, tweets, newspapers, magazines, and presidential speeches have focused enormous attention on the great debate about health care reform. How about outside the Beltway? On Main Street, what are the issues? What do ordinary Americans think about health care reform, and what outcomes do they desire? Or fear? Three issues shape Americans’ opinions concerning health care: the existing problems affecting the country as a whole, the state of their current lives and health situations, and the concerns about their individual futures [1]. Regarding health care on a national scale, Americans are dissatisfied with the status quo, with a majority seeking major change. Expectations include better access for the uninsured, the control of spiraling costs, and improved quality. Means to these ends are an expanded role for government, health insurance reform, and some form
of mandates, either individual or employer. Not unexpectedly, there are fewer worries about less concrete and more long-range issues, such as the viability of the Medicare trust fund, the percentage of the gross domestic product dedicated to health care, and the future of government entitlements. How about the current status of their lives and health? That’s a different story. More than half of those polled are content with their health insurance, like their doctors, believe they are receiving quality care, and value their local hospitals. A few economic demographics are inescapable and help explain the contentment of most citizens. Five percent of the population account for 50% of health care spending; 70% consume less than 10%; 20% spend nothing annually on health care [2]. Furthermore, more than 80% have medical coverage, most through externally supported means such as Medicaid, Medicare, or tax-advantaged, employer-based plans. These two groups—the healthier 70% and the fortunate 80%— constitute a lot of the satisfied poll respondents (and a lot of voters). With Americans concerned as a nation but more content from an individual perspective, the tiebreaker for their support of political reform may rest in their personal views of the future. And in that crystal ball, most questioned in polls see little change in quality, worsening personal care, greater individual costs, and, by a huge margin, higher taxes (79%) [1]. Of course, predicting the future of one’s individual health, much
less national politics or economics, may be a fool’s errand, but it is a great culture medium for political rhetoric. And that is exactly what has happened in 2009. Into the uncertain milieu surrounding health care reform, many political partisans have injected a number of extreme claims: scare tactics, oversimplifications, even mistruths. Advocates for sweeping reform say the future without radical change is bad; opponents say the opposite, that reform will only make things worse. The result has been a sudden and dramatic skepticism about one of the most unsettling ideas of humankind: change [3]. Will Americans’ health and medical care in the future improve or decline? How about access to their personal physicians or local hospitals? If needed, will tertiary and quaternary care be available? Will they remain employed and hence insured? Who will meet the medical needs of their families? What about out-ofpocket costs? When on the precipice of change, the answers to those questions—not unfunded liabilities, health information technology, entitlement reform, and other health policy initiatives—will drive or derail health care reform. REFERENCES 1. Blendon RJ, Benson JM. Understanding how Americans view health care reform. N Engl J Med 2009;361:e13. 2. Halvorson GC. Current MSA theory: wellmeaning but futile. Health Serv Res 2004;39: 1119-22. 3. Kinsley M. Change we’d rather do without. The Washington Post. August 28, 2009:A25.
Michael J. Pentecost, MD, Magellan Health, 6950 Columbia Gateway Drive, Columbia, MD 21046; e-mail: pentecost. [email protected]. © 2009 American College of Radiology 0091-2182/09/$36.00 ● DOI 10.1016/j.jacr.2009.09.010
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