- Tue. Jul. 8, 2008
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Like a virus that runs through the nation's capital every couple of decades, healthcare reform is back. Just about everyone assumes that, regardless of who is elected president in November, in 2009 the country will once again engage in the periodic policy upheaval that accompanies efforts to redistribute what is now one-sixth of the nation's economy.
Whether, unlike previous attempts, this one will actually result in a major change to the way health care is organized and financed is anyone's guess.
Early polling suggests -- much like the last effort in the early 1990s -- that the public is eager for health system change. But a closer look suggests that, during the 15 years since the last health reform effort crashed and burned, the public still hasn't learned much about how the healthcare system actually works.
And as the body politic heads into another full-scale debate about major change, it's not insignificant that most people don't know the difference between Medicare and Medicaid, or between coinsurance and deductibles.
Such basic health system illiteracy leaves voters as wide open to demagoguery now as they were last time, and raises the chances that even proposals that might otherwise command majority support could be torpedoed by a minority's misinformation.
One of the biggest misunderstandings, according to health policy researchers Ezekiel Emanuel and Victor Fuchs, is that employers actually share in the financial burden of paying for health insurance.
"Employers do not share fiscal responsibility and employers do not pay for health care -- they pass it on in the form of lower wages or higher prices," Emanuel and Fuchs wrote in the Journal of the American Medical Association last month.
Indeed, they point out, the run-up in health insurance premiums over the past three decades is in large part responsible for relatively flat wages over that same time period. Whether they realized it or not -- and most non-union workers probably didn't -- workers have been trading off raises for health insurance coverage.
The same thing is true for government, which gets its money, after all, from taxpayers. The more government -- federal, state, and local -- spends on health care, the less is left for other priorities, like education and infrastructure.
Indeed, rising Medicaid costs have prompted many states to have to increase college tuition, putting additional stress on families that are increasingly financially strapped by rising healthcare costs. How ironic is that?
Emanuel and Fuchs say that the "myth of shared responsibility" has an important detrimental impact on efforts to reshape the healthcare system. "It is essential for Americans to understand that while it looks like they can have a free lunch -- having someone else pay for their health insurance -- they cannot. The money comes from their own pockets."
Until the public realizes that, they say, it won't be as willing to consider alternatives.
Then there's the matter of confronting the public's differing beliefs about the healthcare system. And, according to a series of polls being done by the Harvard School of Public Health and Harris Interactive, "Debating Health: Election 2008," Americans' beliefs about the healthcare system do differ.
In a telephone survey of 1,026 adults conducted March 5-8, 45 percent of those surveyed said the United States has "the best health care in the world," 39 percent said other countries had better systems, and 15 percent did not know or refused to respond. Broken down by party affiliation, Republicans were far more likely to say the U.S. healthcare system was the best than Democrats and independents.
When asked whether they "would be more likely or less likely to support a presidential candidate who said the United States health care system should be more like the" health system in countries like Canada, the United Kingdom, or France, 37 percent they would be more likely to support a candidate, 21 percent said they would be less likely and 29 percent said it did not matter.
Broken down by party affiliation, Democrats and independents were far more likely to respond that they were more likely to support a candidate who said U.S. health care should be more like those other countries. The poll has a 3-point error margin.
In a release accompanying the poll, Robert J. Blendon, a professor of health policy and political analysis at the Harvard School of Public Health, said: "The health care debate in this election involves starkly different views of the U.S. health care system. One party sees it as lagging other countries across a broad range of problem areas while the other party sees the system as the best in the world with a more limited range of problems."
There is much the public needs to learn before it can make informed decisions about how best to reshape the nation's healthcare system. And most of that learning will have to take place amid the overheated rhetoric of a presidential campaign. Maybe that helps explain why health reform is a goal that never seems to get accomplished.
CongressDailyAM
