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Taking the pulse of health reform

A new Health Care Consumer Confidence Index designed by University of Minnesota researchers is just one of many developments in the ongoing national debate on health reform in the United States.

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, can be reached at cselix[at]minnpost[dot]com.