Vol. 216 July 1, 2019 Public Opinion About High Health Care Costs

‘TIS THE SEASON FOR POLS AND POLLS

 

As the presidential election summer season heats up with Democrat’s TV food fights and President Trump’s relentless echoes of 2016 campaign rhetoric, the frequency of public opinion polls on political issues and candidates is increasing. What do polls show about what people think about health care costs? The New England Journal of Medicine just published an analysis by three authors of 14 public opinion polls on health care costs done in 2018-2019 (1)

Two-thirds of the U.S. public thinks that reducing health care costs is a top priority for both President Trump and Congress in 2019 (second only to “strengthening the economy” at 70%).

About 90 % of respondents picked the following priorities as “extremely important”:
Reduce prescription drug prices
Reduce the overall cost of healthcare
Do not cut Medicare insurance benefits
Maintain insurance coverage for pre-existing conditions.

Half of respondents reported that health care costs had “actually affected their household a lot”.
40% were “not satisfied” with how much they had to pay for health care.

Why did respondents think that health care costs were so high?
drug companies charge too much …………. 78%
hospitals charge too much ……………………. 71%
Insurance companies charge too much ….. 71%
new drugs, treatments, and technology…….62%

The expert opinion consensus is that the over $500 Billion (yes, that’s a “B”) cost of “unnecessary services”, “inefficient delivery” , and “excessive administrative cost” is a significant cause of the high cost of our health care, but only 23% of public poll respondents thought so.

“At this level, unnecessary health care costs and waste exceed the 2009 budget for the Department of Defense by more than $100 billion (OMB, 2010). Health care waste also amounts to more than 1.5 times the nation’s total infrastructure investment in 2004, including roads, railroads, aviation, drinking water, telecommunications, and other structures. To put these estimates in the context of health care expenditures, the estimated redirected funds could provide health insurance coverage for more than 150 million workers (including both employer and employee contributions), which exceeds the 2009 civilian labor force. And the total projected amounts could pay the salaries of all of the nation’s first response personnel, including firefighters, police officers, and emergency medical technicians, for more than 12 years.” (2)

How did people think we could reduce healthcare cost?
Nearly 90% want the federal government to negotiate drug prices for Medicare
65% want the government to limit charges by hospitals and health professionals
65% want to allow 50-64 year olds to buy into Medicare
52% support “Medicare For All” with little or no private insurance.

Which government?
State 50%  (favored by 60% of Republicans)
Federal 50%  (favored by 70% of democrats)

By what mechanism?
Private insurance competition  (60% of Republicans)
Government insurance program (65% of Democrats)

A majority agreed on two unacceptable ways to reduce costs?

  1. Restrict access to treatments and prescription drugs via “expert opinion” of cost/benefit ratios.
  2. Tax incentives to individuals to buy high-deductible insurance plans.

Only 25% of the public polled were concerned that Medicare would run out of money in 10 years, i.e. little concern about the aggregate cost of health care. Most considered the cost problem as one of high prices rather than of over utilization.
Also, the public is highly skeptical that ANY approach will greatly reduce healthcare prices.

So, despite the consensus that reducing health care costs should be a high priority for President Trump and Congress, there is an obvious partisan divide about how to do it; a partisan divide that continues to make us (the U.S.) unique as the only developed nation lacking universal health care insurance for its people.

References
1. NEJM 380;26 June 27, 2019
2. Best Care At Lower Cost, National Academy of Medicine, Institute of Medicine, 2013

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