The ACP Advocate Blog
by Bob Doherty
Tuesday, March 9, 2010
What does the American public really want?
As part of their closing argument against health reform, Republicans argue that Democrats who vote for the bill will be ignoring the will of the American people, at their own political peril. Senate Minority Leader Mitch McConnell accuses Democrats of wanting "to plow ahead on a partisan bill Americans don't want..."
McConnell is correct that just about every recent poll shows that majorities of Americans dislike the current legislation.
Supporters of the legislation counter that it really has more public support than a simple "for or against it?" poll would yield. The Kaiser Family Foundation tracking poll finds that the country is evenly divided on the legislation, but large majorities support many of the major provisions in the bill. And, when asked about the next steps for health reform, a plurality of 32% said that Congress should, "Move soon to pass the comprehensive legislation that has already been approved by the House and Senate" compared to 22% who want to "Put health care on hold, so Congress can work on other priorities and try to deal with it later in the year," 20% want to "Pull out a few key provisions where there is broad agreement and pass those, even though this won't be comprehensive reform," and 19% want them to "stop working on health care" this year.
Economist Uwe Reinhardt has another interpretation of what the public wants, not from polls, but his own keen observations. He blogs in Health Affairs that "as the policy-making elite stews in its stalemate, the American plebs dreams of a political Messiah willing to build for them a health system that:
1. Lets only patients and their own physicians determine how to respond clinically to a given medical condition, never an insurance clerk or, even worse, government bureaucrats.
2. Limits their families' out-of-pocket payments for health care to make it "affordable."
3. Keeps insurance premiums and taxes for health care low.
4. Does not ever ration health care, because that is un-American and practiced only by un-American alien nations with inferior health systems.
5. Does not allow public or private insurers to let "costs" or "cost-effectiveness" ever enter coverage decisions, because that would implicitly put a price on human life which, in America, unlike elsewhere in the world, is priceless.
6. Does not mandate individuals to purchase health insurance, if they do not wish to do so, if for no other reason than that this would be unconstitutional and, therefore, un-American.
7. On the other hand, grants every American the moral right - backed up by a government mandate called EMTALA - to receive critically needed and possibly high cost health care from hospitals and their affiliated doctors, even if they are uninsured and could not possibly pay for that expensive care with their own resources.
8. Controls Medicare spending, which is widely thought to be completely out of control, as long as it does not reduce payments to hospitals or to doctors or to producers of medical technology, or to any other provider of health care.
9. Provides universal health insurance coverage to all Americans, provided it does not mean raising taxes or cutting Medicare spending or raising premiums on healthy Americans.
10. Keeps government out of health care but somehow makes sure that insurance companies do not exploit patients through incomprehensible fine print, no one engages in price gouging - e.g., charge $10 for an aspirin - and no one in health care earns excessive profits (or any at all).
One must wonder why America's policy-making elite has found it so hard to satisfy these simple wishes of the American plebs. And as the American people anxiously wait for that Messiah, I wish them luck. In the meantime, we shall muddle through as usual."
I think Reinhardt is onto something. We tend to blame the politicians for the muddle in Washington, but I wonder if they are just reflecting the muddled views of people they represent. This could be why polls can simultaneously show that the public is against the health reform legislation - except when they say they are for its key elements.
Today's question: Do you think Uwe Reinhardt is correct in how he characterizes the muddled views of the American people?
About the Author
Bob Doherty is Senior Vice President, American College of Physicians Government Affairs and Public Policy; Author of the ACP Advocate Blog
Email Bob Doherty: TheACPAdvocateblog@acponline.org.Follow @BobDohertyACP
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