Taking the pulse of health reform

President Barack Obama
REUTERS/Kevin Lamarque
President Obama at his Tuesday press conference at the White House.

As members of Congress and the health-care industry thumb through hundreds of pages of health-reform legislation and President Obama prepares for questions from a live audience tonight, the pulse of the public should become detectable in a new consumer confidence index developed by University of Minnesota researchers.

The Health Care Consumer Confidence Index (PDF), based on surveys taken in May before the reform debate heated up, found:

• 86 percent think health reform is part of the fix for the ailing economy.

• One in four people (23.6 percent) fears that they will lose their health insurance at some point in the next 12 months.

• About half of all Americans (46 percent) are worried that they won’t be able to pay for future health care needs.

• 22.4 percent say they or a family member put off seeing a doctor (when medically necessary) during the past year because of concerns about cost.

• 22.7 percent said they had trouble paying medical bills during the past year.

While the data are collected as part of the widely quoted Reuters/University of Michigan’s monthly Consumer Sentiment Index, the numbers are analyzed by the State Health Access Data Assistance Center (SHADAC) at the University of Minnesota. June’s index will be released in July. 

“We don’t have a lot of history yet with the index, but it does show that people are very concerned about their health care and face significant barriers,” said Lynn Blewett, director of SHADAC, which developed the index for the Robert Wood Johnson Foundation. “I anticipate that we haven’t hit the bottom yet. It will be very interesting to watch movement in the index over time. If the Congress passes health reform, I would anticipate that citizens will have less worry about the future.”
 
The index declined between April and May, the first two months of data collection. Understandably, the index shows big differences in confidence between insured and uninsured people in access to health care and future worries: 104.1 points for the insured and 57.3 points for the uninsured. The base line is 100. An index below 100 is considered negative territory; an index of 200 would show the highest level of confidence.

Lynn Blewett
Courtesy of U of M
Lynn Blewett

Further analysis by SHADAC reveals a gap in confidence between people 65 and older and young and middle-aged people with low incomes. “If we took them (65-plus) out, the index would be lower,” Blewett said. “Those folks are pretty satisfied” because the federal “Medicare [program for 65-plus] covers everybody and they have universal benefits. There’s some evidence of the ability to provide universal coverage and ease people’s worries.”

The bottom line: paying for universal coverage
How to provide universal coverage, and pay for it, is at the center of the health reform debate.

On Tuesday, President Obama told a press conference that he thought a public plan is an “important tool to discipline insurance companies.” [Here’s a transcript provided by Kaiser Health News.]

Still, the president conceded there are going to be some “legitimate concerns on the part of private insurers that if any public plan is simply being subsidized by taxpayers endlessly, that over time they can’t compete with the government just printing money.”

“But just conceptually, the notion that all these insurance companies who say they’re giving consumers the best possible deal, that they can’t compete against a public plan as one option, with consumers making the decision what’s the best deal — that defies logic, which is why I think you’ve seen in the polling data overwhelming support for a public plan.”

He stopped short of saying that any legislation must include a public plan.

A couple of hours before Obama’s news conference, the heads of the two largest insurance industry groups, America’s Health Insurance Plans (AHIP) and the Blue Cross Blue Shield Association, released a June 19 letter to Sen. Edward Kennedy, warning that a government-run plan “would dismantle employer-based coverage, significantly increase costs for those who remain in private coverage, and add additional liabilities to the federal budget.” Minnetonka-based UnitedHealth Group is a member of AHIP

Among the universal coverage ideas under consideration are mandates requiring individuals to get their own insurance, a “play or pay” plan taxing employers who don’t provide insurance to their employees, a public option designed for individuals and small businesses, a nonprofit consumer-owned cooperative, and Republican Sen. John McCain’s proposal to tax employer benefits, an idea floated during his presidential campaign.

According to a McClatchy news report, private businesses spent nearly $518 billion on health benefits for employees in 2007, and one estimate put lost federal tax revenue at $246 billion that year.

Don’t have time to read the 800-plus pages of a House bill or a 600-page whopper in the Senate? The Kaiser Family Foundation has a 26-page side-by-side comparison (PDF) of the various proposals in the House and Senate as well as the goals of the Obama administration.

Poll shows broad public support for a government plan
Estimates of uninsured people in the United States run from 47 million to 50 million — or about 16 percent of the U.S. population. Paying for the reform prescribed by a Senate Finance Committee bill, for example, could run $1.6 trillion over the next 10 years, according to an estimate (PDF) from the Congressional Budget Office.

Even so, the public appears eager for change that would result in universal coverage in the United States, according to a New York Times-CBS News poll released last weekend.

Seventy-two percent of the respondents said they would support a government-run program like Medicare that would compete with private insurers, and 57 percent said they would be willing to pay higher taxes for health insurance which “they can’t lose no matter what.” Support for a competing government plan crosses party lines: The poll showed 87 percent of Democrats, 50 percent of Republicans and 73 percent of Independents in favor of the plan. (See more poll results here.)

The poll found that a plurality of respondents (48 percent) supported a requirement that “all Americans have health insurance so long as public subsidies were offered to those who could not afford it.”

A Minnesotan was among the respondents quoted in the Times. “In a follow-up interview, Matt Flurkey, 56, a public plan supporter from Plymouth, Minn., said he could accept that the quality of his care might diminish if coverage was universal,” according to the Times. “Even though it might not be quite as good as what we get now,” he said, “I think the government should run health care. Far too many people are being denied now, and costs would be lower.”

Opponents lining up; supporters plan massive rally 
Besides private insurers, the U.S. Chamber of Commerce has come out staunchly opposed to any mandate on employers to provide health insurance to employees. But the Buffalo News reports that an informal survey by New York Small Business United for Health Care found 73 percent of business owners “preferred a proposal with a public, government-run alternative to private insurance, versus 19 percent favoring an expansion of private market options.”

A few stakeholders are boarding the health-reform train, albeit in baby steps. Last weekend, the pharmaceutical industry promised to spend $80 billion over the next 10 years to help close the “doughnut hole” for older Americans on the Medicare prescription-drug program.

Obama’s allies are planning a massive rally Thursday on Capitol Hill to demand a public insurance option, Roll Call reports. Organizers include Health Care for America Now, an organization supported by the AFL-CIO and American Federation of State, County and Municipal Employees, as well as groups like MoveOn and the Campaign for America’s Future.

While some observers worry that health reform might be dead on arrival because of trillion-dollar cost estimates, tax-averse Republicans in Congress and pressure from industry lobbies, budget experts warn that the legislative process is in its infancy.

“It’s a little like getting halfway through a renovation of your home, and you’re saying, ‘Why on earth did I start this?’ ” Stan Collender, a budget expert at Qorvis Communications, tells the Christian Science Monitor. “You’ve got paint and dust everywhere, and you’re eating off a hot-plate in the basement. You’re kind of like that in the legislative process, which is, people are only seeing the cost, they’re not seeing what they’re going to get for it.”

New York Times columnist and economist Paul Krugman also thinks it’s premature to think the health-reform effort is doomed: “I’m not that worried about the issue of costs. Yes, the Congressional Budget Office’s preliminary cost estimates for Senate plans were higher than expected, and caused considerable consternation last week. But the fundamental fact is that we can afford universal health insurance — even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts. Furthermore, Democratic leaders know that they have to pass a health care bill for the sake of their own survival. One way or another, the numbers will be brought in line.”

Tonight at 9 (Central), the public will hear more from Obama on ABC-TV’s “Questions for the President: Prescription for America.” The network teamed up with Digg to solicit questions from the public about health care. Close to 600 have submitted questions and comments, including several wondering why the single-payer option isn’t on the president’s reform agenda.

Casey Selix, a news editor and staff writer for MinnPost.com, can be reached at cselix[at]minnpost[dot]com.

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Comments (13)

  1. Submitted by myles spicer on 06/24/2009 - 12:18 pm.

    These Selix articles have been well done, useful, and timely. A good job by the author and Minnpost.

  2. Submitted by Bernice Vetsch on 06/24/2009 - 12:20 pm.

    The Obama/Daschle/Baucus plan and all the others under consideration in Washington are written to keep in place the for-profit insurance industry that has succeeded in becoming the manager of our entire health care system and to manage it to enhance its own profits.

    Rising premiums due to too many doctors’ visits and lawsuits? Don’t think so. While the top 10 companies zealously sought ever more ways to deny payment to insurees, they raised premium costs by 87 percent between 2000 and 2007 and increased their profits from $2.4 billion to $12.9 billion —428 PERCENT. These are the people single payer would phase out over 10 years while covering care for every single one of us.

    The drug companies, too, are recipients of our largesse. The president’s recent deal for them to spend $80 over 10 years to reduce doughnut hole costs for seniors pales next to the legislation Congress failed to pass that would require (rather than forbid) Medicare to negotiate drug prices.

    That would have saved a minumum of $30 billion per year (Congress’s figure) but perhaps as high as $80 billion per year if seniors’ savings from excess premiums, co-pays, deductibles and doughnut hole purchases were included (Dean Baker, 2006 report, “The Excess Cost of the Medicare Drug Benefit”).

    Our government seems to value these merchants of greed over a clear public preference for single payer, truly universal care that would save about $400 billion per year. What can be the matter with their thinking processes?

  3. Submitted by Glenn Mesaros on 06/24/2009 - 12:27 pm.

    Here is a small piece of the background on the Robert Wood Johson Foundation, money bags for The Dartmouth Institute; with information provided by the anti-euthanasia organization Life Tree, in its report on “Two Decades to an American Culture of Death. Life Tree writes on the culture of euthanasia that “While RWJF provided the lion’s share of funding, Soros’s Project on Death in America funded the leadership.”

    RWJF has concentrated on “seed money” and “demonstration projects” that have now made the following practices and beliefs commonplace:

    *withholding/withdrawing nutrition and hydration, even when the patient is able to assimilate food/fluids (perpetuation of the myth that a death by dehydration is painless);

    *non-reversible sedation, usually through the use of opioids

    *chronic disease is terminal disease;

    *redefining “imminent.” A prognosis of “imminent death” can mean that the patient might die in a day or so; or within a year.

    Don’t kid yourself. Obamacare will cut Medicare and Medicaid by $900 billion, and kill more people than the German T4 Program in the 1930’s.

  4. Submitted by Lou Harvin on 06/24/2009 - 12:35 pm.

    Several Minnesota Corporations Already Ahead of the Curve on Healthcare Discussion:

    Regardless of where you might stand on the discussion of health care reform, one fact remains: No plan will mean anything unless we start to take responsibility for our individual health.
    Call it coincidental or unique timing that here at the American Cancer Society, we now have the help of CEOs representing some of Minnesota’s largest corporations, agreeing to try to figure out ways to encourage a healthier workforce. They will be meeting tomorrow morning as indicated in this press statement we distributed today:
    Mark Eustis, President and CEO, Fairview Health Services, has been named chair of Minnesota’s CEOs Against Cancer, a prestigious leadership group partnering with the American Cancer Society to reduce the impact of cancer and other chronic diseases on the workplace. Eustis is joined by other leading CEOs in Minnesota who have agreed to unite their efforts.
    “Cancer and other diseases deeply impact individuals, families, and communities,” said Eustis, who leads Fairview’s 22,000 employees. “As CEOs, we have the ability and responsibility to create healthier workplaces. My involvement in CEOs Against Cancer reflects Fairview’s commitment to health and to the well-being of our employees.”
    The Minnesota CEOs joining Eustis in this leadership role are George Buckley, Chairman, President and CEO, 3M Company; Russell Huffer, Chairman and CEO, Apogee Enterprises, Inc.; Pat Geraghty, President and CEO, Blue Cross and Blue Shield of Minnesota; and Jon Campbell, CEO, Wells Fargo, Minnesota. The University of Minnesota’s Academic Health Center and Masonic Cancer Center will host the forum at the University’s Campus Club.
    At the organization’s second annual meeting on June 25, Minnesota business leaders will discuss current employer health care issues and better understand the economic impact of cancer. Collectively, the CEOs in this year’s group represent 500,000 employees and 2 million including family members.
    “I’m proud that executives in the Midwest are pioneering this initiative to find new and creative ways to reduce the overwhelming burden of cancer,” said Jari Johnston-Allen, CEO, American Cancer Society, Midwest Division. “These companies represent several of the largest employers in Minnesota. Their partnership with the American Cancer Society and CEOs Against Cancer demonstrates their commitment to discovering solutions that will help their employees make healthy, informed choices that prevent cancer and save lives.”
    CEOs Against Cancer was founded in Illinois in 2003, followed by Minnesota and Wisconsin in 2007. Chapters in at least seven other states are scheduled to be up and running by next spring. For more information on CEOs Against Cancer contact Maribeth Woodford, American Cancer Society Corporate Relations Executive, 651-255-8111.

  5. Submitted by Gail O'Hare on 06/24/2009 - 01:55 pm.

    I appreciate the good information here and am bewildered by some.
    Do some quick googling of the costs of healthcare in this country. We spent $2.4 trillion in 2007 – ONE YEAR. Of course, it will cost money to get this behemoth under control, but the estimated 1.3 trillion over 10 years begins to look like a bargain.
    Further, I’ve been fortunate to have had some kind of insurance coverage all my life. But it’s been steadily worsening over at least 20 years. Anyone who is worried about the diminution of healthcare quality must have some sort of Mercedes(note I didn’t say Cadillac) plan that the vast majority of us don’t even dream of.

  6. Submitted by dan buechler on 06/24/2009 - 02:53 pm.

    When all is said and done Obama may be compared to another FDR or LBJ domestically. This administration has the optics of Reagan’s first term although he may not get much support from crossover republicans. To have an administration where the number of uninsured is cut in half from 50 mil. to 25 mil. during the near depression of 2008-2009 will be truly remarkable.

  7. Submitted by Joe Johnson on 06/24/2009 - 03:05 pm.

    I prefer Audi. Do you think the government is capable of running our healthcare system let alone keep cost down. You have to be insane to think the government is capable of keeping cost in check. Name one instance in recorded history in which government has been cost effective.

  8. Submitted by Ed Stych on 06/24/2009 - 04:44 pm.

    I know Casey and others at MinnKos are desperate for a dramatic change in how we deliver health care, but the particular NYT poll used in this story is not reliable.

    As usual, PowerLine does a nice job of showing the weakness and biases in polling numbers, including this one:

    http://www.powerlineblog.com/archives/2009/06/023860.php

    As the PowerLine boys point out, Rasmussen is polling a different sector of people and coming up with significantly different numbers.

    Boy, I wish journalists would stop cherry-picking the polling numbers that support their bias or theories. There is plenty of polling on this subject, why not list more than just one on one extreme?

  9. Submitted by Dave Francis on 06/24/2009 - 05:08 pm.

    My family has a small business in Indiana and cannot afford to give it’s employees any kind of health care, that’s why we agree with a large portion of Americans on the government single payer system. Born in Europe I paid for our health care with insurance stamps in a little book, so did the employer everybody worked for? Until the mass legal and illegal immigration into my country of birth all citizens had exceptional medical services. It insured us of surgery, eyes and teeth care for all the people. Today Europe is under considerable pressure from the millions of foreign laborers, who poured into my nation and other industrialized countries around us. Why American newspaper always seem to quote that European health care is free–is beyond me? Nothing is free! We paid for it through our employers, but we were–NOT–subsidizing for profit insurance companies?

    Every health insurance company removes their pound of flesh, their co-pays, deductible, premiums and of course pre-existing conditions. THESE NEFARIOUS BUSINESSES ARE CURRENTLY SPENDING MILLIONS OF DOLLARS, SPREADING RHETORIC AND PROPAGANDA ON TV, RADIO AND IN MAGAZINES. They are truly worried that there mammoth profits are in jeopardy, because for once the majority of the American people are not listening to their lies. Yes! In Europe you do wait for surgical procedures, but no more than three months. Years ago, I had been out of the country visiting relatives in Australia. When I returned their was a letter waiting for me, for an appointment with a nose surgeon. THE RATIONING OF HEALTH CARE HAS ONLY COMMENCED, SINCE THE INFLUX OF FOREIGN NATIONALS NOT PAYING THEIR SHARE IN EUROPE.

    We must take into consideration that a American government pool of health care money, far exceeds European standards and would cover every citizen and legal resident–NOT ILLEGAL IMMIGRANTS. Only the well heeled population don’t care for it and the for profit trillion dollar business base have issues, because they have so much to lose? If nothing else we should have the ability to choose for ourselves. Those who think that for-profit insurance companies, should know that this avenue is available to them. Then the larger portion of the population should not have to beg, to be covered, as they should have access to government Universal health care. We should all know our enemies in this health care issue, who are right now undermining President Obama’s plan. Those politicians who are adverse to any new health care agenda, are without doubt stockholders in hospitals, billing services, insurers or other profit entities. They sold you out to the wealthy special interest lobbyists on E-Verify and a near future AMNESTY. Be ready to throw those political puppets out of office, when their time comes around for re-election. Bombard your Senators and Congressman for a single payer Health care for all AMERICANS.

  10. Submitted by Michael Friedman on 06/24/2009 - 05:10 pm.

    It is not surprising that the section of the population with the most satisfaction are those eligible for Medicare. (Medicare is also well proven as a cost effective government program.) That is why any public insurance emerging this year needs to extend upon Medicare’s principles and practices. Reform serves limited purpose if those insured on the “public” plan are at risk for bankruptcy due to medical debt as is increasingly happening to those who are insured privately. A public plan will also be very difficult to fund if it does not (like Medicare) avoid the administrative expenses incurred by private insurers, and prevent the administrative costs imposed on all medical facilities required to handle numerous complicated and recalcitrant billing schemes.

  11. Submitted by Richard Schulze on 06/24/2009 - 10:56 pm.

    @Joe #7
    I’m a big believer in the profit motive in 99 percent of all cases. If the government decided to open a non-profit hamburger stand, I doubt that it would compete successfully against Five Guys. If it tried to open a non-profit airline, I doubt that it could offer the same value as JetBlue. Insert joke about General Motors and/or the Post Office here.

    The point is, I think the profit motive is generally well worth it in terms of the incentives it creates to cut costs, develop new products, improve customer service, and so forth.

    But health insurance is not like those things.

    Insurance exists because of the decreasing marginal utility of income: most people would rather have a 100% chance of paying $300 a month than a 1% chance of paying $30,000 a month. In fact, our hypothetical customer let’s call him Thomas, might very well accept a 100% chance of paying $400 a month rather than take 1% chance of having to pay $30,000, which he might not be able to afford. This is true even though Thomas will lose $100 on this deal in an average month.

    There’s nothing wrong with this arrangement the customer has improved his marginal utility and the insurance company has made $100. It’s a win-win.

    Health insurance benefits, unlike other types of income, aren’t taxed, and so the employee is less cognizant of them if they show up on his paycheck at all. Not only, then, is the free market maxim of perfect information violated, but it’s violated in such a way that creates artificial profits for the insurance industry: the government is effectively subsidizing every dollar that employee’s company is willing to spend on his insurance benefit.

    The profits the insurance industry are making, of course profits artificially boosted by an enormous backdoor tax subsidy don’t seem to be buying the customer much of anything in terms of improved service or cost savings. On the contrary, health care costs are rising by as much as 9-10 percent per year, without any concomitant increase in the level of service. If JetBlue were raising the cost of its fares by 10 percent per year, they’d be out of business.

    The reason the insurers are staying in business, though, is because barriers to entry in the health insurance industry are in practice quite high. Insurers benefit from pooling risk. The larger the pool, the better in terms of the insurer’s ability to hedge its risk and build negotiating leverage with its providers. That makes it very difficult for a Five Guys or a JetBlue type of start-up to compete: they’ll have trouble getting together enough customers to pool their risk adequately, and even if they do, they won’t have as much negotiating leverage as the big guys. Health care providers may demand a better deal or refuse to accept them. As such, they’ll never get off the ground.

    Insurance, in other words, is a volume business, the main requirements for which are that (1) you have a lot of money pooled together and that (2) you’ve been around for awhile.

    CIGNA and Aetna have a lot of money pooled together and they’ve been around for awhile but they don’t have as much money, nor have they been around as long, as the federal government. It’s possible, certainly, that the profit motive in the insurance industry has driven more innovation than we’re giving it credit for.

    But that isn’t my bet. There’s no obvious reason that the government couldn’t provide more for less. And if we are wrong, we would find out soon enough: if the public option can’t deliver more bang for the buck than private insurers, it wouldn’t gain much market share from them.

    What Joe’s position (#7) reflects instead is ideology: who cares that the federal government could build a better mousetrap? They’re the government and that’s bad. His argument is really no more sophisticated than that. If a libertarian conservative wants to make this argument, more power to them, but they absolutely should not be turning around and suggesting that a public option would raise health care costs. They’re saying, rather, that they’re morally opposed to the cost savings that would ensue.

    It’s my belief that private industry is usually able to deliver more efficient outcomes to the consumer than the government could.

    But usually isn’t always. And health insurance, is one of those exceptions.

  12. Submitted by Richard Schulze on 06/25/2009 - 09:11 am.

    @ Joe #7

    What Joe’s position reflects is ideology: who cares that the federal government could build a better mousetrap? They’re the government and that’s bad. His argument is really no more sophisticated than that.

    If a libertarian conservative wants to make this argument, more power to them, but they absolutely should not be turning around and suggesting that a public option would raise health care costs. They’re saying, rather, that they’re morally opposed to the cost savings that would ensue.

    There’s no obvious reason that the government couldn’t provide more for less. And if we are wrong, we would find out soon enough: if the public option can’t deliver more bang for the buck than private insurers, it wouldn’t gain much market share from them, and Joe will have nothing to worry about.

    But health insurance is not like those things.

    It’s my belief that private industry is usually able to deliver more efficient outcomes to the consumer than the government could.

    But usually isn’t always. And health insurance, is one of those exceptions.

  13. Submitted by Casey Selix on 06/25/2009 - 09:11 am.

    Thanks to all of you for writing and continuing the conversation. Clearly, this is a huge topic with many ideas for solutions.

    Ed raises a good point about the variations in polling and offering a variety of results. The NYT/CBS poll just happened to be the latest one available as I was preparing this first roundup of news.

    I have signed up for alerts from Rasmussen and am looking for other polls. Suggestions? Who knows — maybe there’s a story cooking about the different results in reform polls out there…

    As always, I welcome suggestions on other sources and sites for health reform/policy news and discussions.

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