- To cover all children
- To protect against financial ruin due to a major illness or accident
- To obtain coverage regardless of a pre-existing condition
- To have health coverage continue even when losing a job, changing jobs, or starting up a business
- To have “affordable” health costs (premiums, deductibles, and out-of-pocket) relative to their income
- To keep current insurance if they want.
But how to get there? CR found absolutely no consensus among the people. There’s a third that likes a mixed public-private solution, a third that prefers a single-payer system, and a mix of people who believe that tax incentives are best. But there is no clear winner.
CR spoke to Jacob Hacker who wrote the Great Book, The Great Risk Shift, about this survey result. He said, “The Achilles’ heel of reform is that most Americans do have some source of insurance most of the time. The easiest way to kill reform is to say that this change will destroy what you have and will make you pay more for less.”
Hacker’s recommendation? Issue a “clear, simple, and unthreatening vision of reform that meets public concerns head-on.”
Health Populi’s Hot Points: Consumers blame high and growing health care costs on pharmaceutical companies, insurers, lawyers, and politicians…but not their health providers, neither doctors nor hospitals. That’s because consumers are blaming the costs they viscerally feel and see. These would be the bills they pay at the point-of-purchase for drugs, their health insurance premiums, the clinic requiring the out-of-pocket payment at admission. But the greatest costs in the system are generated by hospitals and in doctors’ practices, both of which often generate too much care that doesn’t work (see my previous posts on the merits of value- and evidence-based health care, the brilliant work of John Wennberg et. al., and Shannon Brownlee’s book, Overtreated). In addition to these costs, consumers need to spend some time figuring out how to live healthier lives, which would have a direct impact on their personal health spending.
PS–See this week’s JAMA on “From Waste to Value in Health Care” by Dr. Thomas Boat and colleagues on how to implement concerted, local efforts to reduce waste in health care.