The healthcare disconnect
– Darrell West is vice president and director of governance studies at the Brookings Institution and the author of Digital Medicine: Health Care in the Internet Era. The views expressed are his own. —
It is not the first time Washington has been disconnected from the general public, but recent discussions over healthcare reform reveal a D.C. establishment fixated on arguments not central to the general public.
The air waves are filled with clashing claims over the so-called public option whereby Medicare would be expanded to include more Americans. Proponents claim this is the best way to cover most Americans currently without coverage and drive down costs by creating competition for private insurance companies.
Opponents complain about a “government-run” health system and bureaucrats coming between physicians and patients.
According to pollster Geoffrey Garin, though, voters do not have a big problem with the public option, or employer or individual mandates requiring coverage. A recent New York Times/CBS News survey found that 72 percent of Americans support a “government administered health insurance plan” similar to Medicare and 59 percent believe the government would do a better job than private insurance companies in holding down health care costs.
The problem, from the voter standpoint, is how to pay for reform. With costs estimated to top $1 trillion and federal budget deficits already having sky-rocketed, people want to know who pays and how changes will affect their personal medical care. It matters to them whether the bill for coverage expansion comes in the form of higher taxes on sodas, alcohol, tobacco, or employer benefits or reduced spending on physicians, hospitals, and other health providers. With personal finances under great strain due to the recession, the public is not in a particularly generous mood.
The greatest fear people have, according to public opinion experts, is that their current care will suffer. Seventy-seven percent of Americans are satisfied with the medical coverage they currently receive. While they are interested in expanding coverage, they don’t want to do so if it is really expensive or endangers their own treatment.
The best thing President Barack Obama can do is remind people that if they like their current care, they get to keep it. No one will be forced into a public plan. People can keep physicians they like. If they worry about government-run health care, they can stick with private insurance.
The biggest change from 15 years ago, when the Clinton administration attempted health care reform, is that now people worry as much about mistreatment from private insurance companies as government-sponsored health plans. The bureaucrat they fear is not just a government employee making policy decisions affecting health care, but the commercial insurer that denies claims, demands extensive paperwork and removes people from coverage due to pre-existing conditions. From the voter’s perspective, the playing field between the public and private sectors is more level than in earlier reform efforts.
New technologies furthermore give consumers greater control over medical information and treatment. Regardless of what policy decisions Washington makes, America is moving towards “consumer-directed” health care that will transform the practice of medicine. The monopoly over medical treatment held by physicians and hospitals is eroding. In the future, people will use remote sensors to monitor glucose levels and blood pressure; electronic medical records will be utilized for storing information. Information technology will produce the real long-term revolution in health care.