Amy Walter, editor-in-chief of The Hotline, is an excellent polllster. The numbers below show that the strongest supporters of healthcare reform tend to be Democrats who earn less than $100,000 and are under 65. This has been true from the beginning of the current debate on reform, though overall the number of people who support an overhaul grows.
But it is worth remembering that not everyone shares our enthusiasm.
High Public Support for Major Overhaul of Health Care
Partisan Divide over Scope of Health Care Legislation
Taxing Health Benefits Strongly Opposed
New York, June 10, 2009 – With President Obama's push for health care reform stirring debate about the costs of a plan, the Diageo/ Hotline Poll of 800 registered voters conducted by FD from June 4 – 7, 2009, finds that the majority of voters support a major overhaul of health care.
High Public Support & A Sense of Urgency for Health Care Reform
The Diageo/Hotline Poll finds that 62% of voters support "the President enacting a major overhaul of the U.S. health care system," with 38% of voters strongly supporting a major overhaul.
For the most part, support for major reform is strong across the board, though there are differences in support based on partisan affiliation, age, and income levels.
Specifically, one-third (35%) of Republican voters, 64% of Independent voters, and 87% of Democratic voters support a major overhaul of health care.
Among age groups, while a majority all age groups support reforming health care, senior citizens age 65+ are the least supportive, with 56% of them supporting reform.
Likewise, a majority of income categories support reform, but those earning $100K+ in annual income are the least supportive, with 58% supporting reform.
Support/Oppose Overhaul of Health Care System Among Partisans
Support/Oppose Overhaul of Health Care System by Age Group
Support/Oppose Overhaul of Health Care System by Income
"President Obama and the Democrats start with strong public support for their desire to make major changes to health care in this country," commented Amy Walter, Editor-in-Chief of The Hotline. "Even so, those who are likely to be the happiest with the status quo – or at least most worried about change (those over 65 and those in the upper income bracket) – are probably the first to abandon reform once the details are revealed."
The Poll also finds supporters of health care reform bring a sense of urgency to the issue: among those who do support a major overhaul, the vast majority (94%) says that it is "important" for "Congress and the President to pass health care legislation this year."
Controlling Costs vs. Expanding Coverage
The Poll finds that, despite broad agreement on the need for health care legislation, there is some division over which aspect of reform should be more of a priority. In other words, voters (49%) say that "controlling the cost of health care" should be a bigger focus than "expanding coverage for Americans without health insurance" (35%).
Furthermore, there is some divide on the specifics, based on partisan affiliation. Specifically, 58% of Republican voters say that "controlling the cost of health care" should be a bigger focus than "expanding coverage," compared with 49% of overall voters, 54% of Independents, and only 36% of Democrat voters. Conversely, 52% of Democrats say that "expanding coverage" should be the larger focus, compared with 35% of overall voters, 26% of Republican voters, and 30% of Independent voters.
Controlling Costs of Health Care vs. Expanding Coverage among Partisans
The Poll also finds an age dynamic to priorities of reform. Specifically, the older the voter, the less likely they are to put priority on expanding coverage.
Controlling Costs of Health Care vs. Expanding Coverage by Age Group
Taxing Benefits to Pay for Health Care Reform Is a "Non-Starter"
While public support for health care reform is strong, when it comes to paying for health care reform, voters are decidedly against the idea of taxing health benefits. Specifically, only 26% support taxing health benefits, while 68% of voters oppose, with 51% strongly opposing taxing benefits.
The Poll finds opposition to taxing benefits spans the partisan divide. Specifically, taxing health benefits is opposed by 79% of Republicans, 73% of Independents, and 51% of Democrats.
General Direction of the Country, Obama's Ratings
For the first time since the Diageo/Hotline Poll began fielding (January 2005), the percentage of voters who say that the country is generally going in the 'right direction' (45%) has surpassed the percentage voters saying it is on the 'wrong track' (43%).
President Obama's ratings have remained high since his Inauguration, with over two-thirds of registered voters (67%) saying they have a favorable opinion of him and 65% saying they approve of the way that he is handling his job as president.
Despite these high ratings, there is a steadily decreasing sense of confidence around whether Obama "will be able to bring real change to the way things are done in Washington D.C." In the January Poll, 75% of voters were confident in his ability to bring real change, compared with 65% in today's Poll. While the current confidence level is still high, it does represent a 10 percentage point drop since the beginning of Obama's presidency.
Confidence in Obama to "Bring Real Change": January – Present
Obama's Approval Ratings on Most Issues are High
President Obama's approval ratings on most issues are high, as he has a 62% approval rating on the way he is handling Foreign Affairs, 61% for his Energy Policy, and 60% for the way he is handling the Economy and Terrorism. Obama's approval rating on health care is relatively lower at 55% and his lowest approval rating is "social issues like abortion and same-sex marriage," at 45%.
President Obama's Approval Rating on Issues
To obtain complete Poll results, please see www.diageohotlinepoll.com.
To schedule an interview with Ed Reilly, contact Selin Kent at (212) 850-5735 or Selin.Kent@fd.com .
Interesting.
I think that the two most interesting data sets are the approval of health care reform by income group, where majorities of every income class support reform, and the fact that support for Obama’s health care efforts is lower than the support for reform in general.
I would like to think that higher income people support health reform out of altruism, concern that the people in lower income classes are not receiving needed health care. However, if I had to bet, I would bet that concerns by people in high income classes that they themselves — or their children — could end up with health care problems are the main factor. They would be right, since many higher income people are potentially vulnerable to misfortunes leading to loss of coverage and other disasters. Ask your friendly financial professional about that one, if you can catch him between sending out resume’s.
The other data set suggests that there are people who support health care reform but do not support Obama’s approach. Although some of that comes from the right, I think a good share of that comes from the left. I have regular contact with people who are very left wing, and to a person they are upset with Obama on health care, feeling that he is not going far enough, and especially annoyed that he has rejected single payer.
As in all things, many people are influenced by their perceived self interest, but that is not the whole story.
Democrats are more likely to support reform, (particularly if it takes the form of a single payor) – that is not a surprise.
Older people are less likely to want reform – also not a surprise since Medicare is a very good health insurance plan.
Wealthier people not wanting reform – also not a surprise. If you have good insurance and access to good information it is possible to get very good healthcare in the US, although not cheaply.
What I feel, as a (relatively) wealthy, 50 something year old is that we have an unsustainable system that is progressively showing its cracks and allowing more people to fall through them. Even if it is around for me when I need it, it won’t be around for my kids, grandkids, etc.
In addition, the costs of our system are taking a toll on our nations competitiveness and leading us down the road to being a second rate power. How much of GM and Chrysler’s bankruptcy was due to the cost of funding retirees health care costs? This is something we need to turn around before it is too late.
Access to money is no guarantee to access to quality healthcare in this country. Does anybody remember what happened to Dennis Quaid’s newborns? That’s just one recent famous example of the major failure in our ability to deliver quality care no matter how much it costs or who is paying for it.
Polling can be deceiving. The above poll suggests that most GOPs oppose major overhaul and most DEMS support. These numbers, I think, are more a referendum on Obama’s major overhaul. For example, I think major surgery is necessary on the system, but I don’t support the Obama/Kennedy/Pelosi health care platform. For starters, before I ‘buy in’ to something, I want to know what it will cost and who is going to pay for it. http://www.MDWhistleblower.blogspot.com
Lisa,
There are no “guarantees” to anything in life.
– Ask the passengers aboard Air France from Buenos Aires to Paris
– Ask the people who invested with Bernie Maddof
– Ask the people who worked for GM and Chrysler for 30 years
The problem with American Health Care is not that it doesn’t provide “guarantees” for everyone – no such guarantees exist in Europe, Canada, or anywhere else. The problem is that it costs too much and leaves too many people uncovered/poorly covered.
Legacy flyer,
You should read carefully the 1999 IOM report:
http://www.iom.edu/Object.File/Master/4/117/ToErr-8pager.pdf
Indeed there are no absolute guarantees, but systematic changes/reforms that prevent the needless maiming and killing of people by healthcare providers is the least we can expect from the system. Access and affordability are not the only problems in my view, not by far! Having medical errors as one of the largest causes of death surely is outside of what we can expect.
One of my pet peeves (I have many) are poorly designed polls.
The concept of “overhaul” of the health care system is so vague that it means whatever the person answering the question wants to think.
For example, a person might want to see an overhaul because waiting times are too long in his doctor’s office.
Then the demographic breakdown is meaningless. What does a 25 year old newly minted Wall St lawyer have in common with a 25 year old unemployed HS drop out? Why should we lump them together?
Wouldn’t it make more sense to group people in to relevant categories, like employed with/without insurance, unemployed, retired, etc.?
All I get from this poll is the truism that “liberals” are more open to new ideas and change than are “conservatives” (the proxy being party affiliation). This is, of course, a tautology – conservatives are in favor of the status quo, that’s what conservatism means.
I assume someone paid for this poll. It would be interesting to find out who and what their agenda is.
NG,
Of course I am in favor of having as few medical errors as possible and support efforts to accomplish that objective.
I know of no evidence suggesting that error rates are higher in the US than they are in Britain, Canada or Europe. Whereas there is data showing higher costs and greater access problems in the US than in Europe or Canada.
There are problems with studies that measure error by retrospective review (although there may not be a better way) since we are all much smarter after the fact.
My point is that the idea that we can eliminate all errors in medicine, particularly when we are trying to cut costs and improve access is naive.
Legacy Flyer said:
“My point is that the idea that we can eliminate all errors in medicine, particularly when we are trying to cut costs and improve access is naive.”
——
The airline pilots have a great incentive to try an systematically reduce errors, and that incentive is their own lives! I sometimes wonder how health care providers would treat if their lives or another part of their bodies were at stake if errors were made??
No, we cannot end all human errors, but the conservative caveat emptor, public hands-off approach to healthcare is not even a logical way to proceed to better results and cut down errors. Yet here we have all the bullcrap again about how any public involvement is bad bad bad. Well where are the alternative voices telling about poor results and errors like in this IOM report that most lay people have never heard about. What about the absolute lack of sustainability of the current model? Why is that??
“before I ‘buy in’ to something, I want to know what it will cost and who is going to pay for it”
I think this gets to the heart of the matter. I’ve written about the need for every interest group to give up something in order to reform the system several times before. In that vain, I would like to see a poll that answers the following questions:
1. For individual patients / consumers, what percentage of YOUR gross income are you willing to pay in taxes for health insurance completely financed by taxes, whether single payer or vouchers? For those who currently have employer provided health insurance, assume that your (taxable) wages will increase by the amount your employer is currently paying on your behalf for health insurance less what the employer will have to pay out in FICA taxes on the increased wages. Alternatively, would you support taxing at least some of your health benefits to extend coverage to the currently uninsured? If not, how would your raise the money needed to cover the uninsured?
2. For doctors, a few questions. First, would you support using comparative effectiveness and cost-effectiveness research to drive coverage and payment policy? Second, would you support bundled pricing for expensive surgical procedures? Third, would you support tiered copays based on your group’s practice pattern efficiency? Fourth, would you accept more oversight and less independence? Fifth, would you support capitated payments for the management of chronic disease for large accountable care organizations?
3. For hospitals, would you accept the risk that your hospital may have to downsize or even close if we are successful in driving down utilization by reducing preventable readmissions, embracing a more sensible approach to end of life care, and performing fewer surgical procedures of dubious value? Will you use electronic records to reduce duplicate testing and adverse drug interactions?
4. For drug and device manufacturers, would you support comparative effectiveness and cost-effectiveness research to drive coverage and payment policy? Will you support banning DTC advertising?
5. For insurers, would you accept tighter regulation including guaranteed issue coupled with a mandate to acquire insurance, developing standardized claims processes to reduce administrative expenses, the establishment of insurance exchanges to facilitate comparison shopping and state run insurance cooperatives to provide additional market competition?
6. For trial lawyers, would you support taking medical dispute resolution out of the hands of juries and giving it to specialized health courts? Would you favor insulating doctors from lawsuits if they follow established evidence based guidelines? If not, how would you reduce defensive medicine driven by a fear of litigation based on a failure to diagnose a disease or condition?
7. For labor unions with generous employer provided health insurance, will you support taxing at least some of those benefits to help pay for extending coverage to the currently uninsured? If not, how would you raise the necessary revenue?
The bottom line here is that every interest group needs to make substantial and probably painful contributions in order to bend the medical cost growth curve down toward something the society can afford and sustain. Preventive care won’t save any money to speak of and there aren’t enough rich people to increase taxes on to cover the uninsured and underinsured without also raising taxes on the broad middle class.
Legacy Flyer,
One of the significant problems in healthcare, which is also a significant cost driver, is the lack of quality.
Lisa —
I agree with your point.
Fortunately, there are a lot of very bright people (starting with Atul Gawande) working on this problem.
One of the potential strengths of a national health care plan featuring a strong federal alternative (Medicare Part E or the equivalent) and a strengthened MedPAC able to and willing to use their muscles to oppose special interests is the ability to institute and require meaningful quality control.
That alone would save thousands of lives and improve hundreds of thousand of others, as well as saving billions of dollars.
Pat S.
Yes, I suspect that on the left those who want reform but are upset wtih Obama are single-payer advocates, as well as people who think that we should have universal coverage immediately and worry about costs later.
These two groups overlap.
Many of single-payer folks engage in magical thinking and believe that administrative costs are the main problem: if we just had single payer, everyone could have whatever they want and it just wouldn’t cost that much.
Many high-income people who I have run into in Manhattan are ambivalent, at best, about covering everyone because they suspect (rightly) that this will mean higher taxes for high income people.
A friend of a friend in Westchester county was opposed to Obama becoming president because, as she put it, “He’s just going to give all of our money to the poor people.” By “our money” she meant Bush’s tax cuts for the wealthy.
Legacy Flyer–
I agree completely. None of this is surprising–this is how the polls have broken down since discussion of reform began.
What high income people don’t understand is what a toll our exorbitantly expensive healh care system is taking on the whole economy–as Gawande points out in the commencement address I posted this afternoon.
They also don’t seem to reocgnize that it is unsustainable–or to think about their grandchildren. I imagine they assume that their grandchildren will be among the 3% that can afford concierge medicine.
Lisa–
Access to $ isn’t a guarantee, you’re right.
By just checking in to most U.S. hospials, you’re exposing yourself to more risks of complications, infections, etc than should be the case.
That said you are far more likely to die of a treatable disease if you don’t have $$$ or very good insurance.
Michael–
Who is going to pay?
Short answer: you and I.
Probably you more than I because you’re an M.D. and so probably earn more than a writer who works for a non-profit.
It’s impossible to estimate how much it will cost because we don’t know exactly how much catch-up care the uninsured and underinsured will need.
We also don’t know how successful we will be in persuading doctors to join in the battle to control costs (see Gawande’s commencement address that I just posted.) That is key.
We also don’t know whether we will be subsidizing people up to 5 times the poverty level–$110,000 for a family of four (the Senate) or 4 times the poverty level –$88,800 (the House)
Finally, we don’t know how much the insurance will cost. How good will the coverage be? Will it be as good as what most employers provide now? Or will universal coverage include a great many cut-rate plans?
If young, healthy, affluent people are able to buy cut-rate plans for a realtively small sum, there won’t be enough money in the pool to cover older, sicker, poorer people –so tax-payers will have to pay more in subsidies.
One of the Democratic plans now on the table lets insuers charge older people twice as much as younger people. That means a great many people in their 50s and early 60s won’t be able to afford the insurance, and will need greater subsidies. (This has been a problem in Massachusetts where insurers charge older folks twice as much.)
Bottom line: universal coverage will cost more than we expect.
And in general, Republicans have been much warier of any change than Democrats- all the way back to Truman.
Richard Nixon was an exception. He actually backed a very generous plan for everyone. He and Ted Kennedy had reached an agreement.
Barry,
Thanks for your comment.
I agree that for this to work, everyone is going to have to give something up.
Your insight on this point is key–something that everyone needs to understand.
But unfortuantely, both polls and what industry representatives say indicates that in virtually every group that you name, no one wants to giving up anything.
Consumers are strongly opposed to taxing employer based benefits. Many wealthier people are opposed to paying higher taxes to subsidize the poor adn the middle class. Young people are strongly opposed to being in an insurance pool where they have to help support older people.
When it comes to doctors, a great many do support comparative effectiveness research, but the majority don’t want to give up any of their independence.
The vast majority are solo practioners or in small practices. They are opposed to capitation because they don’t want to take on the risk. (Capitation makes sense for very large medical groups, but I agree it is too hard to predict the cost of caring for a relatively small group of patients.)
Most doctors don’t want their efficiency judged and measured. (Here again, I think individual doctors and small practices are right–it’s really not possible to measure efficiency for doctors treating a relatively small group of pateints.)
I think we could measure quality for a hospital and the virtual network of doctors who refer to that hospital and work in that hospital. I think we need to reward large teams–as teams–for quality.
But the majority of doctors strongly feel that it would be too hard to divvy up the bundled payments. The doctors and hospital would get into a huge battle over this.
It seems to me they might use Geisinger as a model–it uses bundled payments. But I am afraid that enough doctors and hospital CEOs are money-driven that it would be a food fight.
Hospitals–99% of all hospitals would fight downsizing or closing tooth and nail.
Device-makers and drug-makers have made it very clear that they are against comparative effectiveness research if it is in any way going to affect decisions on what is covered –or co-pays and fees. They also have made it clear that they want to have a major role in controlling the research. (Which automatically means it will be biased.)
Insurers would accept #5 because you are not asking them to giving up a penny.
Under the scenario you describe, they could continue to sell policies that don’t deserve to be called insurance–low-cost policies filled with holes, and they could continue selling high-deductible plans to low-income and middle-class people who cannot
afford to use the policy.
Insurers need to be tightly regulated in terms of what they must cover in all plans.
On high-deductible plans– Even if they were only sold to very wealthy people, that would mean taking those wealthy (and by definition much healthier people) out of the general pool. We need their premium dollars in the general pool to help cover poorer, less healthy
families..
Insurers also should not be able to raise premiums without permission from the state (like old-fashoined utilites. ) Health care, like electricity is a necessity.
There should be a cap on exectuive salariers at insurance companies. ($20 million CEO salaries set the wrong tone for a company that is providing a public good.)
Insurers refuse to accept any regulation that might cut into profits—not to mention those fat exectuive salaries (and not just for the CEO). ..
I can’t speak for trial lawyers– just don’t know enough of them. Though the few I do know are very honest, have great integrity, and are trying to protect people from an industry that, at its worst, is reckless in its greed.
To sum it up, As Dr. Don Berwick, founder of the Institute for Healthcare Improvement has said:
“This country may not be mature enough for (meaningful) health care reform.”
Most people don’t want to sacrifice anything for the greater good.
This is why the necessary sacrifice won’t be entirely voluntary.
Congress is going to have to pass laws that require that everyone gives something up. President Obama will be able to speak eloquently about the need for us to take a collective view–and he will persuade some people.
I’m not sure that he will persuade the majority–just as LBJ could not persuade the majority about the need for civil rights and school integration.
Nevertheless, as a nation, we have to do what is right–or suffer the consequences.
Sometimes leaders have to be ahead of the curve–leading people in a direction that they are not quite ready to be led.
(FDR did this when he took us into WW II–one of the few wars which I think was necessary.
I believe that Obama is one of those presidents.
NG,
I have heard the comparison with the airlines many times before. It is true that the major airlines have a very good safety record, even though we have recently run into a bad stretch; Buffalo and Air France to name two. I would submit that the comparison between medicine and aviation is not all that enlightening. Many of the patients that I “fly” would have been grounded as “unairworthy” if they were planes.
You say that medicine needs more public involvement to improve quality. Let me tell you about two of the forms of “public involvement” that currently exist; JCAHO accreditation and malpractice.
I have been unfortunate enough to be the Chairmen of a Hospital Department during JCAHO inspections. JCAHO inspections have NOTHING to do with real quality. They have everything to do with whether the proper “policy and procedure” manuals have been recently signed and dated and whether other useless bits of paper have been filled out. JCAHO inspectors can’t tell a quality X-rays, reports or procedures from a bad ones. It is a farce that wastes tremendous amounts of time and money.
As for malpractice, that is even worse. I have reviewed in the range of 100 malpractice cases over the past 20 years. The real purpose of malpractice is to extract money from doctors, hospitals etc. primarily for lawyers and only secondarily for patients. It serves no valid purpose in improving quality that I can see.
So as much as you may say that public involvement in quality is good, the two ways in which the “public” is currently involved do NOTHING to improve quality
I respectfully disagree with Don Berwick that we as a nation are not mature enough to cooperate and sacrifice for meaningful long overdue US Health Care reform.
I agree with Maggie Mahar that Obama is repeatedly calling us to a renewed committment to “the common good” on many issues including health care.
We are ready to hear him.Pinch yourselves- We are living in historic times.
Dr.Rick Lippin
Southampton,Pa
Legacy Flyer, Dr. Rick, NG, Legacy Flyer (second comment)Robert
Legacy Flyer–You write: “Many of the patients that I “fly” would have been grounded as “unairworthy” if they were planes.”
Nice point–and it made me laugh out loud.
But I do think that airline safety rules can be applied to hospitals to a limited degree: “Checklists” are an excellent idea. And also , the idea that anyone–a nurse, a resident, a co-pilot, a stewardess should speak up immediately if they see a mistake being made that could hurt the patient is very important.
In addition pilots are supposed to (and do) report near-misses. They are not penalized and everyone can learn from the information.
We need that kind of openness (and protection against recriminations) in medicine.
Anesthesiologists have learned a lot from the airlines and some years ago, instituted new rules that greatly reduced the number of deaths due to something going wrong with the anesthesia.
That’s the kind of self-improvement that we need.
That said, human bodies are more complicated than airplanes and not as predictable. Every body is unique. I remember a general surgeon telling me that when you open up a body– sometimes you are surprised. Everything is not exactly where it is supposed to be . . .
I completely agree about the accreditation agency. It’s a joke
And I don’t think malpractice significantly improves the quality of care.
It does mean that patients who have been hurt are compensated but I agree that our current system is not the best way to do that.
Also, see my response to NG below.
Dr. Rick–
I have to say I sympathize with Don Berwick.
A great many people in this country think about healthcare in terms of “me and my family” rather than collectively–in terms of the common good.
For instance: younger Americans don’t want to be in an insurance pool with older Americans–they don’t want to help pay for their care.
As a result, the reform plans proposed by House and Senate Democrats let insurers charge old people more. (They have to ignore prior conditions but they can discriminate by age.)
One of the propoals lets them charge older people twice as much.
Why? Because Congressmen know that the majority of younger Americans really dont’ care whether people in their late 50s and early 60s can afford insurance.
I think both Obama and Berwick need to continue preaching.
And perhaps the silver lining to this eocnomic despression will be that it teachers people empathy. Maybe they will realize–“there, but for fortune.” Either that, or the Depression is going to make the upper-middle class very, very mean.
NG– STudies have shown that pilots are extremely sensitive to safety rules because their own lives are at stake–and because a mistake means that they take a couple hundred people with them.
That’s a horrifying thought.
An airline crash is a tragedy and a catastrophe.
By contrast, in a hospital, when one person dies, usually that person was already pretty sick. Death is commonplace in hospitals. Healthcare workers aren’t usually “horrified.”
Healthcare workers become accustomed to death.
Studies have suggested that this is an understandable reason why healthcare workers are not
as vigilant as pilots.
Also, healthcare workers typically work longer hours.
Good airlines make sure their pilots are not tired.
See also my response to Legacy Flyer above–and below
Legacy Flyer-
The rate of avoidable deaths and injuries in U.S.
hospitals is higher than in other developed countires.
When it comes to Methiliccin resistant staph “Among developed countries, the United States has one of the worst records for curbing, not only MRSA, but other drug-resistant infections. The CDC itself noted a 32-fold increase in MRSA hospital infections between 1976 and 2003. 25 years ago Denmark, Finland, and the Netherlands faced similarly soaring rates of MRSA, but have nearly eradicated it.”
An article in Slate points out: “killing off hospital infections. Why isn’t the United States following suit?”, Arthur Allen writes, “If you are an American admitted to a hospital in Amsterdam, Toronto, or Copenhagen these days, you’ll be considered a biohazard. Doctors and nurses will likely put you into quarantine while they determine whether you’re carrying methicillin-resistant staph…If you test positive for MRSA these European and Canadian hospital workers will don protective gloves, masks, and gowns each time they approach you, and then strip off the gear and scrub down vigorously when they leave your room. The process is known as “search and destroy.”
After five years of deliberation, the CDC continues its refusal to endorse search and destroy. Allen adds, “…This is a bitter pill for many infectious-disease experts, who have been joined by the relatives of dead patients, Consumers Union, and even a few Congress members in pressing the CDC.”
We don’t we follow the European model?
Money. Many hospital CEOs would rather spend the money on cosmetics–and expansion–rather than on prevetning infections.
As I have mentioned before, hopsitals in Germany are Spartan –but very, very clean. They don’t spend money on hotel-like amentities because they don’t see themselves as a business competing for customers.
They are trying to provide a public good–better health. Period.
In the U.S. we have for-profit hospitals, and as non-profits compete with them many are beginning to behave like for-profits. Also many MBA CEOS really think a hopsital is a “business” like any other, and that it’s there job to attract wealthy customers and build empires.
Finally, I recall one or more articles in Health Affairs pointing out that we have more medication mix-ups (sometimes fatal) wrong limb surgical mistakes etc in part because we don’t have electronic medical records, and in part because are hospitals are so hectic.
In Europe you may spend more days in the hopsital, but hey don’t “do as much” to you. We tend to overt-treat patients and in the chaos, mistakes are made.
Robert– Amy does these polls for the National Journal– a well-respected public policy magainze.
There is no hidden agenda here. The National Journal is a progressive magazine
A liquor company sponodors the poll just as they might take an ad. I don’t think liquor companies have much of an aze to grind re healthcare reform.
Different polls try to do different things. This one is trying to break down attitudes toward refrom by income, age and party. (Other polls break views down in others ways.)
What does a 25 year old on Wall Street have in common with a 25-year-old h.s. drop-out. They both probably don’t worry a lot about dying (even though the hs drop-out is more vulnerable) and they proably don’t want to pay much for health insurance. They definitely don’t want to have to pay to help provide insurance for older people.
So while they are more open to change than older people only 48% support expanding coverage.
I’m surprised the percentage isn’t higher, but think that the fact that they don’t feel a pressing need for insurance, and don’t want to pay for older people explains it.
No it’s not a surprise that conservatives oppose change. But it is somewhat surprising just how many conservatives are opposed to an “overhaul.” You would think that nearly everyone would realize that our system is too expensive, that it is a scandal that so many people don’t have good access to care and that the high cost is hurting hte economoy.
“Major overhaul” is purposefully vague– she’s trying to capture everyone who recognizes the need for “signficiant structural reform” (which overhaul suggests) for whatever reason.
Finally it is also startling (and depressing) to see the percentage of wealthier people who are far more concerned about the cost of care (their own care) than whether or not everyone is covered.)
Also seniors are not that concerned about covering everyone.
That is why I posted the poll. I think HealthBeat readers need to know that
we face a battle. A great many Americans don’t support what we would call
“meaningful reform” that leads to high quality, affordable healthcare for everyone.
Most are more concerned about cost (to them) than covering everyone.
And in general, most Americans don’t want to pay for universal coverage.
Significantly, they are dead-set against taxing employer-based insurance
(even though this is an extremely regressive tax exemption that by and large favors the wealthy who have more expensive insurance and are in a higher tax bracket.)
Finally, the fact that Obama still has such high support–and particularly on health care–suggests to me that he is going to win the battle with coservatives and blue dogs in Congress. It may take a while –it may not all happen this year. But I think he will get the legislation he wants, including a public-sector plan.
Maggie,
I think you are perpetuating two urban legends.
You say:
“In addition pilots are supposed to (and do) report near-misses. They are not penalized and everyone can learn from the information.”
I am a pilot and familiar with the enforcement actions of the FAA (having been subject to them more than once). There is a NASA form that a pilot can use to report an incident which allegedly does not have any penalty associated with it. (Actually that is not entirely true, but that is another discussion) But to characterize the FAA as an agency that does not penalize is completely wrong. There is a regular column in several flying magazines that deals with FAA enforcement actions. As the joke goes: “We’re from the FAA and we’re not happy until you’re not happy”
I can’t comment on Commercial Airlines but I doubt that your statement is accurate with respect to their policies either. Air Traffic Controllers can definitely be disciplined for a “lack of separation” or a “near miss” in layman’s terms.
Second urban legend:
“Anesthesiologists have learned a lot from the airlines and some years ago, instituted new rules that greatly reduced the number of deaths due to something going wrong with the anesthesia.”
I believe that the progress in reducing anesthesia related deaths was primarily due to the availability of cheap and accurate pulse oximetry. This was largely a one time event and had nothing to do with lessons learned from the airlines. If there are any anesthesiologists out there who know better, please correct me.
Legacy Flyer–
I know an aneshthesioloigst newho was the head of the A-society for the state of Pennsylvania.
He is also a pilot.
He gave me this information—which I checked with other sources.(There is much info on how anes have reduced erros (unlike other speicalties) and there is much info on using airlines safety rules (See Atul Gawnade on the Checklist)
Everything that I post is fact-checked (I’m a journalist and that is what I what I am trained to do.)
I wish that people who comment on the blog would also fact-check what they say before they say it. It’s not that hard to Google certain facts.
I apologize for not doing more fact checking about anesthesia, but you will note that I did say that I would welcome correction from an anesthesiologist.
As for the pilot information, I stand by what I said. The implication that pilots are free to report mistakes without concern about FAA enforcement action is not correct.
Legacy Flyer–
I said that pilots are free to report “near misses”–not mistakes
,
Legacy Flyer,
It is well known to patient safety advocates that JCAHO accrediation is a joke. I’ve said myself many times all they do is make sure everybody’s paperwork is in the right binder and are totally ineffective at improving quality, or even monitoring it for that matter. They should go away quietly in shame. So, we agree there, however, for you to describe JCAHO accrediation as “public involvement” is totally inaccurate. There’s nothing public about JCAHO or their accrediation process.
Legacy Flyer,
Your comment about the patients you “fly” being “unairworthy” is very telling to me and you sound just like the hospital administrators that worked in the hospital my husband had the misfortune to visit. Is it the patient’s fault there was a diagnostic error? “Oh, well, he was burned pretty bad and was going to die anyway.” Is it the patient’s fault the ventilator was suffocating him because it was clogged with water? “Oh, heck boys his lungs are so full of acinetobacter he was lucky to live this long, anyway.”
I could keep going but I won’t. So what if the FAA does or does not enforce consequences for mistakes or near misses? There’s no question whatever has taken place in aviation safety IS WORKING and what’s taken place (virtually nothing) in patient safey ISN’T WORKING and it isn’t the patient’s fault. I will also now comment on malpractice litigation and it’s “failure” to improve quality. Lawsuits didn’t improve quality because nobody bothered to share information about what went wrong so it won’t happen again, not amongst themselves or with institutions and/or providers nationwide. All that has resulted from malpractice litigation is institutions and providers getting better and better and better and avoiding culpability when they make a mistake. They’ve gotten better at covering it up. “You’re mistaken, that didn’t happen.” “Oh, well, we’ll never know because he wasn’t photographed when he was admitted.” Lies, errors, ommissions and cover-ups in the medical records have become commonplace. Puh-leeze, again let’s just blame the plaintiff’s (patients/consumers) it’s all their fault. Now since we consumers have caused all this trouble we have to pay to fix it. Right.
Lisa–
I agree that, too often, in our hospitals, there is a tendency to blame the patient.
And while I don’t think hospitals can ever be as safe as the airlines (hospitals are filled with sick and dying people and human bodies are must much more complicated and unpredictable than airplanes) the gap between hospital safety adn airline safety is ENORMOUS.
We should be briding that gap, and we haven’t been making much headway.
Perhaps the greatest argument for a public option being included in the coming reform is the practice of post claim underwriting. I was not up to speed on this practice used by the “soul eating bastard” industry (aka: the health insurance industry). It is just unfathomable to me how a company can take premiums for what is years sometimes and then retroactively cancel someones coverage when they seem to need it most. Of course The “SEB” industry claims it is only weeding out those that commit fraud, but it sure didn’t sound that way in a recent congressional hearing where VICTIMS of these companies related their stories under oath. The following panel of SEB CEOs whined about how they couldn’t handle doing business any other way. Oddly when they were quizzed about their own applications, they didn’t have a clue on what some of the questions meant, even though they use these questions to rescind coverage retroactively.
Health Care and Health Coverage are not interchangeable terms.
Lisa,
I am sorry that your husband was (in your opinion) a victim of malpractice or negligent care. I certainly do not deny that mistakes happen or that the system can be improved.
I wish I could join the happy chorus about how everything would be wonderful if only doctors, hospitals and nurses just listened to what the public wanted and implemented reforms x, y and z (whatever is popular this month). I can’t.
I think the comparison between Medicine and the Airlines is like comparing apples to oranges. The “unairworthy” comment was meant to highlight the number of patients that have multiple underlying diseases and very limited life spans under the best of circumstances.
To the prior two forms of “public supervision” that Medicine enjoys (suffers from) – JCAHO and Medical Malpractice, I will add one other that is, in my opinion is equally useless. Most hospital boards are composed of various community members (representatives of the public) who are theoretically there to supervise the hospital, make sure that it maintains its mission, blah, blah, blah. Although I have never sat on a hospital board, my experience is that they are equally clueless and as uncommitted to quality as the hospital administration.
So tell me, what form (exactly) would the ideal involvement of interested parties take in the supervision of medical care?
O?O & Legacy
O?O Thanks for the comment.
Yes, the practice of retroactively canceling premiums is outrageous.
And the testimony made it clear that insurers are not simply (Or mainly) going after fraud.
Legacy, when you see the film of MDM, you will realize that Lisa’s husband was the victim of negligent, horribly unco-ordinated care.
When he went into the hospital, he was a young man with serious burns. Otherwise, he was in excellent health. This was not someone suffering from 5 chronic conditoins.
During his time in the hospital, virtually very organ in his body came under attack, due to total lack of co-ordination in his care. The left hand had no idea as to what the right hand was doing.
He almost lost his eyesight.(His eye-balls were drying out. For many days, Lisa and her sister (who is an MD) asked for an opthamalogist to come in and look at him. Lisa had plenty of excellent insurance–payment wasn’t the problem.
When the hosptial finally called in the opthatmalogist, he told Lisa: “This man is lucky he has people who care for him. He nearly lost his eyesight. His eyeballs are permanently scarred.
Lisa and her sister (a doctor) witnessed all of this.
Lisa didn’t sue, in part because she knew that in any settlement she would have to sign a confidentiality agreement.
She thought it was more important to tell her story.
I agree that most hospital boards are useless.
They need to be replaced–with doctors, nurses, public health experts and medical ethicists who have no affiliation with the hosptial in question.
They also should not be “friends” of the hospital CEO or hospital management.
As you may know, the law has been changed so that the JCAHO is no longer the only group that can accredit and inspect hospitals.
Some state hospital inspectors are very good.
They shoudl be given funding–and teeth.
Finally, we need laws requiring hospitals to disclose infection rates, and mistakes that hurt patients. They should be required to provide records and make nurses and doctors available for interviews and full disclosuire of what happened. (These nurses and doctors should be protected from suit based on what they said.)
With full disclosure–and apologies–fewer patients and famlies sue, and many more cases can be resolved in some sort of arbitration–which is less expensive for everyone.
Finally, when things have been sorted out, the facts of the case should be available to local reporters, so that hte public becomes aware of some hospitals have a particualrly high rate of
errors that hurt patients.
Finally, hospitals should be able to sue newspapers if they don’t get the facts right. Reporters and editors would have to be careful–checking facts with the arbitrator rather than simply talking to the family.
(This is just my very rough back-of-the-envelope plan for creating greater openness and accountabliity while reducing suits.)
Lisa and Maggie,
Again, I am sorry for what happened to Lisa’s husband. I don’t know the facts, but I will take your word that the care he received was bad. This episode should be followed up on, dissected, lessons learned and steps taken to prevent any repeats. Hopefully, Lisa can get some satisfaction from knowing that the system that didn’t work for her husband has been fixed and will work better for others.
Unfortunately, I have seen cases like this myself – train wrecks in slow motion. But more frequently, I see people who are at the end of their natural lifespan with multiple co-morbidities who end their lives in ICUs, enduring a flurry of heroic, painful and ultimately unsuccessful treatments – instead of in a clean bed, on adequate pain medication with their family around them (the way that I want to go).
As for your specific suggestions:
• hospital boards …. need to be replaced–with doctors, nurses, public health experts and medical ethicists who have no affiliation with the hospital in question. They also should not be “friends” of the hospital CEO or hospital management.
• we need laws requiring hospitals to disclose infection rates, and mistakes that hurt patients
• With full disclosure–and apologies–fewer patients and families sue…
• When things have been sorted out, the facts of the case should be available to local reporters, so that the public becomes aware of some hospitals have a particularly high rate of errors that hurt patients.
• Finally, hospitals should be able to sue newspapers if they don’t get the facts right. Reporters and editors would have to be careful–checking facts with the arbitrator rather than simply talking to the family.
I can’t say that I disagree with any of them. (even “sorry works”, which has no good objective data to back it up – and yes I “Googled” it.)
However much of the above sounds like the fable of the mice who decide to put the bell on the cat so they can hear it coming – until one little mouse said: “Which one of us is going to put the bell on the cat”.
Which hospitals have signaled their willingness to have their boards replaced with doctors, nurses, public health experts and medical ethicists? And if they are not willing, how do you propose to accomplish the overthrow of the Board of a (theoretically) charitable, non-profit organization, many of which are owned by religious orders?
As for a hospital suing a newspaper to get the facts right – puhleeze. I used to work at a hospital that had an infection sweep through its nursery in the early 80’s (citrobacter diversus). Apparently, at the same time, this infection was in other hospital nurseries (including a local nationally ranked teaching hospital). A newspaper got hold of (part of) the story and publicized the infection in “my” hospital, but did not publicize the infection at other hospitals in town. The result; multiple million dollar lawsuits against “my” hospital and a significant decreased hospital census resulting in layoffs of nurses and other hospital staff. Of course the infection was ultimately brought under control at all hospitals, probably by action that the Pediatricians and State Health Dept. had initiated before the publicity. You may have great confidence in newspapers, etc. to get the story right and for an enlightened public to draw the right conclusions, I do not.
“I don’t know the facts, but I will take your word that the care he received was bad. This episode should be followed up on, dissected, lessons learned and steps taken to prevent any repeats. Hopefully, Lisa can get some satisfaction from knowing that the system that didn’t work for her husband has been fixed and will work better for others.”
Legacy Flyer, pull your head out of the sand. If you want to know the facts email me your address I’ll send you a book. The system that failed my husband and I HAS NOT been fixed.
My sister is a nurse with a Master’s in Health Infomatics, not an MD.
It is really surprising that anti-bacterial solution dont work with viruses much. Doctors and operation assistants must use proper cleaning agents or soap & water to wash their hands.