Tag: Public opinion

Reining in drug costs remains public’s top priority
A new Harvard-Politico poll shows that reining in drug costs remains the public’s top priority. More than anything else, Americans want Congress to bring down prescription drug costs.

The public opinion poll found that four in ten Americans believe that Congress needs to take action on drug costs. To be sure, a far larger percentage of Democrats than Republicans supported this priority–more than half v. three in ten. But, Americans are far less sure about how to resolve the issue of high drug prices.

While there has been a lot of public attention on high drug prices, at both the state and federal levels, policymakers and advocates are promoting a wide range of solutions, virtually all of which involve either helping one subpopulation–e.g., people in Maryland, people needing the Hepatitis C vaccine, people with Medicare–or, addressing one piece of the problem–e.g., lack of generic drug competition, Orphan Drug Act.

Until there is agreement that Congress needs to rein in prescription drug prices across the board–a recognition that access to life-improving and life-saving drugs is a basic human right–Pharma will continue to spend tens of millions of dollars raising fear among different populations over how the proposal will jeopardize their access to drugs.

Not surprisingly, almost 90 percent of people support Medicare drug price negotiation in theory. But, fewer than 40 percent support the policy once they hear that it could mean people with Medicare lose access to certain drugs.

Many people also support drug importation as a way to drive competition and bring down prices. More than half of Americans support importation of drugs that the FDA has not yet approved. After all, we import food with very few safety risks. Why not drugs?

If you want Congress to rein in drug prices, please sign this petition.

Here’s more from Just Care:
October 3, 2017
President Obama calls for public option in state health exchanges
During the health care reform debate, President Obama supported a public health insurance option in order to promote competition and bring down costs in the health insurance marketplace. At one point, it appeared that Congress might support a public option. But, after Senator Ted Kennedy’s death, the Democrats did not have the votes, and the Affordable Care Act was passed without a public option. Now, in an article in JAMA, President Obama advocates for a public option . . . in certain circumstances.

President Obama recognizes that we need more health insurance options in the state health insurance exchanges. However, the President takes a step back from suggesting that everyone in a state exchange should have the choice of a public option. He argues only that the public option is needed “to compete alongside private insurers in areas of the country where competition is limited.”

If “competition” means that companies are vying with each other to gain market share by offering the best mix of price, quality, and service, it’s hard to argue that there’s competition in any state health insurance exchange. Prices overall appear high. And, people are hard-pressed to assess quality differences among plans. Commercial insurers do not seem to be driving value in the marketplace. Rather, for the most part, they are offering access to a narrow network of doctors and hospitals at ever higher costs.

If UnitedHealth opts to exit all the state health insurance exchanges in 2017, which it says it may, the Kaiser Family Foundation projects that 1.4 million people will be left with only one health plan option through their state health exchanges–11 percent of state exchange enrollees. That said, even people with several health plan options often do not have the meaningful choices of doctors and hospitals that Medicare offers. People in the state exchanges tend to have limited if any coverage for doctors and hospitals outside of their area and too often don’t have coverage at the best hospitals in their area.

To drive down costs and promote value in the health insurance marketplaces, Medicare or another Medicare-like public health plan should be competing with the commercial insurers. In 2013, the Congressional Budget Office projected that a public plan would save $158 billion through 2023–with 2 million people enrolling in it–while giving people the choice of a health plan with premiums seven to eight percent lower than the private health plans. Moreover, only a public option like Medicare is likely to provide us the data to understand what’s working in the marketplace and enable us to drive system change.

Secretary Clinton has vowed to support a public option in every state health exchange, if elected President. She also supports giving people 55 to 64 a Medicare option.

Here’s more from Just Care:
July 21, 2016
What price patient satisfaction?

Several years ago, Richard Angelo, a nurse, was convicted of killing several of his patients. He was so well liked that he was able to poison at least 35 of them over several years before hospital administrators realized he was the murderer. Unfortunately, you cannot judge your health care providers by their bedside manners. Indeed, a recent JAMA study reveals that higher patient satisfaction is linked to greater drug and medical spending and higher death rates.

This study suggests that new Medicare payment incentive systems that reward doctors and nurses for high patient satisfaction ratings might end up hurting patients. These incentives may lead providers to behave against their patients’ interests. They might, for example, fail to discuss all health care options with patients thinking that it will make them happier. Or, they might overtreat their patients, providing them with unnecessary procedures they request.

A new study from the Hastings Center finds that a focus on patient satisfaction could hurt efforts to improve quality of patient care. The report notes that there are three ways to define patient satisfaction: 1. The patient received the care that he or she requested regardless of whether it was needed; 2. The patient felt that the doctors communicated effectively and looked after the patient’s comfort; and 3. The patient received needed care that improved the patient’s health outcomes. The first two definitions have no relation to whether the care provided improved the patient’s health.

Of course, patient-centered care that is evidence-based can also lead to patient satisfaction. But, at this time, the satisfaction data does not distinguish between this care and care that is not patient-centered that leads to patient satisfaction.

In sum, you may not want to give great weight to patient satisfaction data in choosing a hospital or a doctor or a nursing home. For sure, be aware that there is no clear link between patient satisfaction and good health outcomes.

August 19, 2015
On its 80th birthday, Social Security is beloved by young and old, Democrats and Republicans

Americans may have diverging views on endless numbers of policy issues but, when it comes to Social Security, we are overwhelmingly united. A new AARP poll reveals that Social Security is popular among people young and old, Republicans and Democrats. Indeed eight out of ten people surveyed said that they plan to rely on Social Security in retirement either somewhat or in a substantial way. And even more of them, 82 percent, felt it is important to contribute to Social Security “for the common good.”

Indeed two out of three people surveyed said that Social Security is one of the most important federal programs. Of particular note, nine out of ten young adults under 30 said that Social Security is an important government program.

Today, millions of Americans face challenges saving for retirement. Of those polled, 69 percent said that current financial needs make it difficult for them to save. Almost half of those polled, 47 percent, said that they had no money left over after paying their bills. And 39 percent said that medical bills prevented them from saving.

Almost seven in ten of those polled, 69 percent, worry that they won’t have enough savings in retirement. And 68 percent worry that health care costs will wipe out their savings. It’s not surprising that a vast majority of adults say they want to expand Social Security or keep it as strong as it is.

For this poll, 1200 adults were surveyed, 483 of whom were retired.

Robert Reich explains in this video that we can afford to expand Social Security. Find out here what your Social Security benefits will be when you retire.

August 14, 2015
Vast majority of Americans want to expand Medicare and Social Security or keep spending as is

A new Kaiser Family Foundation survey of Americans reveals that the public views Medicare and Social Security as the two most important federal programs, slightly more important than federal aid to public schools and the military. Eighty-three percent of the public see Social Security as very important, and 77 percent see Medicare as very important.

In fact, 41 percent of people want to increase funding for Medicare (48 percent would keep spending where it is) and 50 percent of people want to increase spending for Social Security (43 percent would keep spending where it is). Check out this video to watch Robert Reich make the case for expanding Medicare.

Overall, seven of ten Republicans and independents and nine of ten Democrats see Medicare as very important. People over 65 value Medicare especially highly, regardless of party affiliation—85 percent of Republicans, 89 percent if independents and 92 percent of Democrats see Medicare as very important. Not surprisingly, people over 65 are more satisfied with their Medicare health insurance than people under 65 with their commercial insurance.

Support for Medicaid, a program for people with low incomes, differs more significantly based on party affiliation. Fewer than half of Republicans (47 percent) see Medicaid as very important, while 62 percent of independents and 78 percent of Democrats feel Medicaid is very important.

Read more here about Medicare coverage and the key differences between traditional Medicare and a private Medicare Advantage plan.

August 7, 2015
The Affordable Care Act: What happens between now and the November 2016 elections?

The Supreme Court’s decision last month affirming, yet again, the legality and structure of Obamacare (the Affordable Care Act) could signal an end to the 5-year slog of bitter political divisiveness over the law. Or not.

As I see it, one of two divergent scenarios could play out between now and November, 2016:

(1) The number of people benefiting from the law grows briskly, premium increases remain modest, and Americans finally accept the law as permanent and worth it; that leads Republicans (and their presidential candidates) who have vigorously opposed the law to back off, realizing they’re fighting a losing battle that could cost them control of Congress and their bid for the White House in 2016.

(2) The number of people benefiting from the law plateaus, premiums in the state-based exchanges increase 15% a year in 2015 and 2016, deductibles and co-pays increase, concern about restricted provider networks grows, and the public remains deeply divided over the wisdom and impact of the law. Skating off that and sensing blood in the water, Republicans double-down on their opposition to the law and make the election a referendum on it.

These scenarios are oversimplified, of course.   Other events and factors could come into play, such as a foreign crisis that diverts attention from health care.

But there’s little doubt we are now (sorry for the tired metaphor) at a crossroads.   The Supreme Court’s ruling pretty much means that the only route to dismembering the law is political.

As a reminder, the Republican-controlled House of Representatives has voted along party lines over 50 times to repeal parts or all of the law.   In the Senate, also controlled by Republicans since the 2014 elections, efforts by members of that party to repeal the law have been bogged down by rules that require 60 votes to get major legislation to a full Senate vote. The Republicans hold 54 seats in the Senate, to the Democrats’ 44, plus 2 independents. Obama has also pledged to veto any bill that undermines the law.

So the 2016 elections could well decide Obamacare’s fate. If Republicans win the White House and maintain their majorities in Congress, the only way Democrats could block repeal of the law—assuming Republicans pursue that—is through the 60-vote rule in the Senate to break a legislative filibuster.   That assumes Republicans don’t top 60 seats in the Senate in the 2016 elections, a pretty safe bet.

Your role in all this?   Polls by the Kaiser Family Foundation, (“KFF”), since 2011 show Americans have been persistently sharply divided on the merits of the law, and that opinion is strongly party-affiliated. That is, a large majority of Republicans oppose the law while a large majority of Democrats support it.   This has always signaled to me and many other observers that the bulk of opinion on the law as a whole is driven by a combination of party and ideological loyalty, with a generous dollop of sentiment about the role of government in our lives.

Results from deeper-dive KFF surveys bear that out: a majority of Americans irrespective of political party affiliation support several major components of the ACA, such as requiring insurers to cover people with pre-existing medical conditions, without making them pay more.

I might be whistling into the wind, tilting at a big windmill or pushing the proverbial Sisyphian bolder up a steep hill, but I believe this crossroads is a time for opponents of the law (and those on the fence, about 10-15% of the population) to take a step back from the partisan political divide we all say we hate and reassess the ACA on the merits of what it has done to date, its actual provisions, and the concrete arguments pro and con. There’s no dearth of intelligent and easy-to-understand information on the internet, from both sides.

In short, make up your own mind and don’t be led by your political nose.   This is an issue that should transcend lock-step politics.

If premiums and costs rise, there’ll likely be more than a few registered Democrats who’ll need to shore up their support of Obamacare, too.

In very practical terms, take 2 to 3 hours some evening or weekend and learn how the law is actually constructed. Talk to trusted friends on the opposite side of the debate. Read behind the headlines and ignore the political rhetoric—from both sides. Be engaged.

Every so often, big social changes are needed. Health reform was such a moment (well, it actually took 20 years). Keep in mind that Republicans agree that the old system was broken and unsustainable. The ACA is not a perfect law.   Indeed, the tragedy of the 5-year senseless political fight over the ACA is that it’s made sensible fixes over the last few years impossible.

Be part of the solution to that, and refuse to perpetuate the problem.

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To understand how repeal of the ACA would drive the deficit up and leave 19 million uninsured, click here.

June 30, 2015
For good reason, public not focused on health plan quality and price information

A new Kaiser poll shows that Americans are not focused on health plan quality and price information when making health care choices. Only a tiny fraction of Americans say that they use this information to make health care choices. In fact, this data really should not be driving people’s health care decisions. Most available price and quality data is not yet ripe for meaningful use.

Ideally, people would be able to know whether particular doctors and hospitals were delivering value (good quality at a good price) and which health insurance plan would deliver them the health and financial security they need, with good access and predictable costs. But, a public plan, like Medicare, with open access to doctors and hospitals and predictable costs, is not available to them through the health care marketplace. And, data that adds value in choosing doctors is limited even for people with Medicare. It’s often unavailable. Indeed, few Americans–less than 20 percent–say they have seen comparative information about doctors, hospitals and health plans.

Even when price and quality information is available, there’s no evidence it’s reliable or comprehensive enough to tell you which hospital and which team of doctors will best meet your needs. To quote Drew Altman, President of the Kaiser Family Foundation, “pretty much everyone in the health-care sector agrees that the ”state of the art” in the development of rigorous and reliable quality and price information has a long way to go.” This all said, it’s still important to take time to choose your doctors, hospitals and other care providers. Read more here about how to choose a doctor, here about how to choose a good hospital and here about how nursing home ratings can be misleading.

Unlike quality information, which is in its infancy and largely unreliable, price information can be trusted and should be available. But prices for doctor and hospital services tend to be hard if not possible to learn. Almost two-thirds of survey respondents (64 percent) said it was difficult to find out the costs of medical services. In fairness doctors sometimes don’t know exactly which services they will be performing in advance of treating patients. But, unlike Medicare, health plans do not offer predictable out-of-pocket costs that allow people to budget for their care. In many cases, rates insurers negotiate with doctors and hospitals are considered trade secrets.

What’s the solution? Providing everyone in America with the choice of a public health insurance plan like Medicare that reins in prices and offers predictable costs and easy access to doctors and hospitals would help ensure people’s health and financial security. And, for now, choosing your doctors and other care providers as wisely as possible. Time will tell whether reliable quality information will ever be available.

May 5, 2015
New poll shows a slight majority of public favors health care reform

A new Kaiser Family Foundation health tracking poll surveying adults for their views on the Affordable Care Act reveals that a slight majority of the public favors health care reform today. Forty-three percent support the law and 43 percent oppose it, with 14 percent having no view.

Views about the law diverge tremendously based on political party affiliation, gender, race and insurance status. Seventy percent of Democrats, 42 percent of Independents and only 16 percent of Republicans favor the law. By gender, a much larger percentage of women support the law, 47 percent, than men, 40 percent. And by race, White Americans favor the law far less, 36 percent, than African Americans, 64 percent, and Hispanics, 53 percent. Curiously, people with insurance are far more likely to favor the law, 47 percent, than people without insurance, 34 percent.

In sharp contrast, by income levels, support for the law is fairly constant. Forty-five percent of people earning less than $40,000 support the law, 44 percent of people earning more than $90,000 support the law and 40 percent of people earning between $40,000 and $90,000 support the law.

The Affordable Care Act has its benefits and weaknesses. Its success at ensuring 16.4 million more Americans have insurance is far and away its biggest benefit. But, people often don’t see that value until they need costly health care or they lose their employer coverage and find that they can’t find an insurer to cover them or that the coverage is unaffordable. And, the overwhelming majority of the population under 65 needs relatively little health care. The Affordable Care Act subsidizes the premium on a sliding scale for people with incomes up to four times the federal poverty level.

The weakness of the Affordable Care Act is its exclusive reliance on private insurers to provide coverage that people need. The private insurers have never been able to rein in costs. What’s worse, the insurers make it stressful and draining to get care even when you have coverage because of all their rules and restrictions. And, with insurance, out-of-pocket costs can be thousands of dollars, and you may struggle to get care from the doctors and hospitals you trust. A public health insurance option, like traditional Medicare, would have driven competition in the health insurance marketplace, provided greater choice at lower cost and pressured the insurers to deliver better coverage at a more affordable price.

April 29, 2015
Government drug price negotiation is top policy issue for a strong majority of Democrats and Republicans

A new poll of likely voters shows that allowing government drug price negotiation ranks as the top policy issue for Americans. A Medicare buy-in for all ranks eighth and expanding Social Security benefits ranks 13th. Based on poll results, economic security issues are of paramount concern to Americans.

More than three quarters of likely voters, 79 percent, support government negotiation of drug prices. Almost 90 percent of Democrats (89 percent) support government drug price negotiation and more than three-quarters of Republicans (76 percent). Of note, the question posed concerned lower drug prices for people with Medicare and Medicaid and not everyone in the country. Every other wealthy nation negotiates drug prices for all its residents.

Seven out of ten likely voters (71 percent) support giving all Americans the choice of buying into Medicare as a way to drive competition in the health insurance marketplace. More than three quarters of Democrats (77 percent) support this policy, along with a healthy majority of Republicans (63 percent).

Seven out of ten likely voters (70 percent) also support expanding Social Security by having wealthy Americans pay Social Security contributions throughout the year, like everyone else. Eighty-five percent of Democrats support this policy, as do a 62 percent of Republicans.

April 2, 2015
Strong support for Social Security across broad swath of Americans

A new survey by the National Academy of Social Insurance (NASI) to understand Americans’ views about Social Security and how to strengthen it reveal strong support for Social Security. An overwhelming majority of Americans across the political spectrum value Social Security.

Almost three out of four survey respondents (73 percent) said they did not mind paying into Social Security because it’s important for themselves and their families as well as the security it provides older adults and people with disabilities. Most respondents (86 percent) felt that Social Security today does not offer enough income security for retirees. And, nearly three of four people surveyed (73 percent) thought the benefit needed to increase over time.

A large majority of people (77 percent) said that to keep Social Security strong into the future, it would be worth having working Americans make larger payroll contributions to Social Security. More than seven of ten people want to see reforms that put more money into the Social Security Trust Fund and increased benefits over time.

They support a ten-year gradual lifting of the cap on Social Security contributions, which is now $117,000 so that the six percent of the population who earn more than that continue to contribute. There is no cap on Medicare contributions. They also support a one-percent increase in the payroll contribution by employees and employers from 6.2 percent to 7.2 percent over 20 years.

November 20, 2014