By LEE BOWMAN
Scripps Howard News Service
May 17, 2009
It's a no-brainer in a stickup situation. But when discussing health-care reform, the answers get a little trickier.
Most people would say they want both access to good medical care when they need it and for that care to be affordable.
When people are sick, they're more likely to worry about getting care. But most Americans -- including many uninsured -- worry more about affordability than access or quality of care. That's particularly true when the economy is in a downturn, with mounting evidence that people are postponing or skipping health care to save money.
A new survey released this week by the Stanford Center on Longevity reflects some typical attitudes about the health-care system and reform. While 62 percent of the more than 2,000 voters surveyed nationwide said the health-care system works well for them, 68 percent said it does not work well for most Americans.
Only 16 percent said they were "very" or "fairly" satisfied with the cost and affordability of health care, but only 20 percent said they were "not at all" or "not very" satisfied with the quality.
Yet when the survey got into specific ideas about how to hold down costs or expand coverage, none attracted overwhelming support -- nor were they rejected overwhelmingly, either. "We were a little disappointed that there was not something that everybody loves, but it shows people are paying attention and have legitimate concerns about what the changes might mean for costs and access,'' said Dr. Laura Carstensen, director of the center.
"People realize that there is no magic wand to reduce health-care costs," said Geoff Garin, president of Peter Hart Research, the polling firm that did the survey. "Most people, as they think through the options, are keeping an open mind. They see this as not a matter of black-and-white, but in shades of gray that cut across party lines."
President Obama has made it clear that holding down health-care costs is critical both to reduce their drag on personal and national finances and to make it possible to expand and subsidize coverage for nearly 50 million Americans who don't have health insurance.
And it's no accident that congressional committees on finance and ways and means have just as much of a role in producing health-reform legislation as those overseeing health care. Those committees are moving quickly from outlines of broad principles to policy options and will soon start negotiating and drafting language that might actually become law.
Health-care lobbyists are, naturally enough, swarming this process like bees to a syrup-truck spill, determined to ensure that collective sacrifices don't come too much from their clients' pockets.
Reform is hard because the $2.5 trillion-plus we're spending on health care is somebody's livelihood as well as somebody's burden. Making health care more affordable means cutting back payments to some providers, perhaps raising them for others, or limiting services to patients in some fashion. It means, sometimes, saying no.
Most of the reform proposals for holding down costs involve putting more responsibility for managing costs and delivering quality on doctors and hospitals -- and on patients.
For instance, Medicare has already laid out a list of common preventable hospital mistakes -- so-called "should never happen" events -- and declared that it won't pay hospitals for any additional care that's required to correct or follow up one of those mistakes.
Lawmakers of all political stripes say they want to set up a system that pays for the most effective care, for good results, rather than simply more for more care.
At the same time, health-insurance plans and employers are pressing patients to be more cost-conscious through higher co-pays and deductibles, restrictions on drugs and emergency-room visits.
Yet one of the hardest things in health care -- for either doctor or patient -- remains being able to find out up front what a particular test or procedure is likely to cost. It's not clear if any of the changes being proposed in the reform debates would be able to make expenses fully transparent.
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