Friday, March 13, 2009

Who do voters trust on health reform? (Doctors!)

There is brand new research that finds very strong and deep public support for health care reform, including from Republican voters.

In a survey taken in the first week of February, Celinda Lake and Associates found that voter support for reform (after hearing a series of arguments for and against) is strong across partisan lines, with the strongest support among Democrats (67% favor, 21% oppose) and Independents (59% favor, 27% oppose), and with over half of Republican voters on board (52% favor, 42% oppose).

This is important, because the major "con" argument tested by the pollsters - that health care reform will allow bureaucrats to make decisions best left to doctors and patients - is the strongest card critics have to play. That it doesn't resonate with voters - including a majority of Republican voters - bodes well for health care reform.

There were some surprises.

"By very wide margins (+56 points) voters support instituting comparative effectiveness reforms to supplement doctors' clinical knowledge, but voters need to be reassured that scientific and cost effectiveness data do not replace their doctor's judgment. Seventy three percent of voters (45% strongly) support creating an independent organization that supports health providers by giving them information about best treatments to rely on in addition to their own judgment."

The surprise is that Republican voters are more likely than Democrats and Independents to support comparative effectiveness research if it explicitly mentions cost instead of just clinical effectiveness. Why is this surprising? Because its was conservative critics, like the Wall Street Journal's editorial writers, who argued that CER would result in the government denying care found to be too costly.

Voters see it differently: "Messages that focus on providing doctors with scientific and cost effectiveness evidence, modernizing the health care system with health information technology, and controlling overuse of the health care system are seen by voters as both supporting doctors and improving care for patients." (emphasis added). This may be because, "Voters have a great deal of confidence in their doctors ... They trust their doctors and consistently support changes to help their doctors do their jobs."

One thing this tells me is that doctors - and by virtue of this, physician organizations like ACP - have enormous credibility in the health reform debate. If we say that programs like comparative effectiveness will help our doctors do their jobs well, we are more likely to be believed than, say, some non-physician editorial writer ranting about bureaucrats telling doctors what to do.

Another interesting finding is that although the public like and trust their doctors, they don't mind getting care from someone else. "By an overwhelming margin (+57 points), voters support allowing health professionals other than doctors to provide more care to free up doctors and help control costs."

Voter opinion can still change, of course, and hundreds of millions of dollars will be spent trying to shape it. But the advocates for health reform start out with a decided advantage. The critics will have to come up with something more persuasive than trying to scare voters about rationing, especially if their doctors tell them otherwise.

Today's question: How do you feel physicians - and physician membership organizations - should take advantage of the high degree of trust and confidence that patients have in doctors to influence health care reform?


Jay Larson MD said...

"We are here to add what we can to life, not to get what we can from life.” Sir William Osler

This should hold true as health care reform progresses. The worst thing that could happen from health care reform is forgetting the patient and the ethics of being a physician. Trust is delicate and should be handled with care.

Dr.T said...

You think that it is a "con" that bureaucrats (and worse) may wind up making decisions for you?

And you believe that if effectiveness data demonstrate an expensive technology to be more useful than a cheap one, decisions won't be skewed (and skewered?). I strongly believe you are wrong.

The government always muscles out those who participate in its bureaucracy and those who feed at its trough. And they bend the facts and change the rules midstream on you once you join their game. So it will go with this so-called "health care" reform (why do we lump medicine and surgery in the same laundry basket as insurance, cost and distribution?).

I know for a fact what happens when the government takes over, and I have the proof.

To date, the only part of medicine that is controlled by the federal government is mammography. When they took it over in 1993 it was a burgeoning field with facilities being built everywhere, new technology ready to burst on the scene and a new residency program (women's imaging) ready to supply the doctors needed.

16 years later, mammography is a barren field. Technology has slowed to a crawl; Women's centers close at the rate of 20 per month; 75% of residency spots aren't even applied for, let alone filled. No one wants to read mammograms, so the system is clogged with the 30 million studies done every year.

What happened? Reams of paperwork; red tape and bureaucracy that keep you up at night; expenses through the roof just trying to keep up with all the foofaraw they mandate at mammography...and price controls that set the reimbursement too low to pay for any of this.

Oh, and effectiveness data? How about the fact that in a woman with dense breasts a mammogram is a coin toss but an MRI has a real chance of finding a malignancy if there is one; but just try to order a screening MRI. One physician who opened a screening MRI breast magnet in California was arrested and his imaging center shut down by the State for "false advertising."

I've been blogging about this at if you want to read more; but, if not, just think hard about these "reformers" whose purpose is not to protect patient health but to achieve social and political goals that in no standard way correlate with good medicine and patient care.

It's no con, believe me.

Evan Falchuk said...

Doctors must be at the forefront of these issues, and not just because they are so trusted by voters. It's because they know better than anyone the practical realities of what it means to take care of patients, and how the well-intentioned efforts to manage our health care system have interfered with that over the years.

It is worth pointing out that while there is a great deal of support for the concept of "reform," there is not a consensus on what that term really means.

For example, while there is public support for a scientific body to evaluate medical treatments, that support seems shallow.

The Kaiser Family Foundation and the Harvard School of Public Health asked supporters of the idea if they would still support the creation of such a body if it might mean that treatments recommended by a doctor might not be covered by insurance. Support nearly evaporated: from more than 60% in favor to just over 30%.

Reform is going to be a long and winding road. Doctors will be our best guides and must take a leading role.

Evan Falchuk