Thursday, September 23, 2010

The Muddle-Minded Middle

Today, on the sixth month anniversary of health care reform becoming law, a new Associated Press poll shows that much of the public still doesn't understand it:

"Many who wanted the health care system to be overhauled don't realize that some provisions they cared about actually did make it in. And about a quarter of supporters don't understand that something hardly anyone wanted didn't make it: They mistakenly say the law will set up panels of bureaucrats to make decisions about people's care - what critics labeled 'death panels.'"

More than half of voters believe that the Affordable Care Act will result in most people paying higher taxes this year - when, in fact, only people who use tanning salons will see a tax increase in 2010, a tax championed by the American Academy of Dermatology. (The fact is some 17 million employees of small businesses could benefit from a health premium tax credit, according to a new analysis by economists at the Commonwealth Fund. The credit will offset as much as 35% of premium expenses from 2010 to 2013 and as much as half the cost in 2014 incurred by some small businesses - resulting in a $40 billion tax cut to eligible firms with fewer than 50 employees.)

On 19 "True or False" questions asked by the pollsters, sizable minorities got the answers wrong, according to AP, and two-thirds were not confident in their answers on eight out of nine core provisions. When presented with more and correct information, most Republican voters remain strongly opposed. But the level of support increases among independents and Democrats as they get more accurate information.

The Obama administration is intensifying its efforts to explain the law and tout its benefits, many of which go into effect today. Still, the AP says that the public's continued lack of knowledge is a "dismal verdict for the Obama administration's campaign to win over public opinion."

I am under no illusion that people with strong philosophical, ideological, or partisan objections to the law will be persuaded by more or better information. As I have said many times before, there is a principled argument to be made against the ACA - many people sincerely believe that it costs too much, and gives the government too big a role - which I respect, even though I see things differently. But it bugs me when people make judgments based on misinformation that is demonstrably false - and when such falsehoods (like the death panels) are intentionally spread by some critics.

To help improve public understanding, the American College of Physicians has partnered with AARP to produce a patient/consumer friendly brochure that explains, in simple language, why and how changes were made by the law and the date the changes go into effect. ACP encourages its members to consider making copies of the brochure for their patients, but it is also available for direct download by the public.

ACP has also updated "An Internist's Practical Guide to Health System Reform", which provides a comprehensive, understandable description of the key provisions of the law - by topic area and date of implementation - in an easily searchable form. Readers can scan the table of contents, pick a topic of interest to them, and use their computer's cursor to read a concise, stand-alone description.

Neither the AARP/ACP consumer brochure nor the guide for internists are intended as advocacy pieces - they do not call on readers to take any action in the political arena. They don't reference the ACP's views. They just provide the facts, as simply as possible.

And even though much of the public seems locked into their views, I suspect that there is a muddled middle that would welcome accurate information about what the law will and will not do. More and better information could also lead to a more informed public debate. Wouldn't it be nice if the argument was over the respective roles of the government and private sector in providing affordable health care, instead of being over imaginary death panels and 2010 tax increases and other figments that don't square with the facts?

Today's questions: What is your reaction to the AP poll's finding that large numbers of Americans give the wrong answers on basic facts about the Affordable Care Act? Will you be using the new resources from ACP (the practical guide for internists and the ACP/AARP brochure for patients/consumers)?


Jay Larson MD said...

The AP poll results are not surprising. Yes, the population is dazed and confused about health care reform. With the age of information technology, incorrect information can be disseminated rapidly to large masses of people. Yes, the concept of “death panels” still pops up during patient visits. When it does, I extend the discussion by bantering with the patient about who should be on a death panel. I argue that since the younger generation will be stuck with the bill, they should be the one deciding “thumbs up” or “thumbs down”. When the patient stops and thinks about a PlayStation junky with an I-pod in their ear and a Smart phone at their face deciding the fate of human beings, they realize the ridiculousness of the whole notion of a “death panel”.

The ACP/AARP brochure explaining ACA does a nice job and I have some in the exam rooms for the interested patients.

Arvind said...

First of all, the definition if "anniversary" is "yearly observance", so there is no such thing as a 6-month anniversary.

The complexity of the law is the reason people are confused. The second reason is that the peoples' representatives made no effort to explain their back-room deals to their constituents.

I don't plan to use the ACP's materials because I believe they paint a far too rosy and unbalanced picture of the law.