- More than 3/4 of Americans (at the low end) consider it extremely or very important that health care reform allow them to keep their current plan, allow them to make critical medical decisions with their doctors (aka NO RATIONING), and control costs. These are the focal points of all the various Republican proposals, and we should emphasize this. (An additional note: Controlling costs continue to big a larger priority for the public than expanding coverage by a 10+ point margin.)
- People strongly support raising taxes on the rich and penalizing employers for not offering health care, while they oppose controlling Medicare costs, cutting the home mortgage interest deduction, or limiting the tax credit for employer-provided benefits. This does not mean that Republicans should change our views of where new revenue (if necessary at all) should come from; we need to explain ourselves better. Penalizing employers who don't offer health care will destroy jobs as small businesses go under while the economy slowly recovers, and any tax raises on the rich should be saved for general revenue to pay off the massive debt Bush and Obama have been building. Republicans need to explain how the mortgage and employer-based health care tax credits are extremely regressive and favor the rich, and how fixing medicare is the central necessity for any plan meant to control health costs.
- A near-majority of Americans believe doctors are best suited to lead health care reform, while only 10% believe Republicans are so qualified. Since doctors and hospitals trend Republican by significant margins, we need to a) consult with them concerning which parts of our plans could be refined to improve its feasibility, and b) let the public know we are working with the medical professionals while the Democrats are working with 30-year Washington beauracrats.
- Finally, majorities of Americans favor mandated health insurance and a public option. Again, we should not back down on these points. They contradict what the public says they want, as mandated health insurance leads to rapid cost inflation (see: Massachusetts), while a public option pushes other insurers out of the market and leads to rationing (see: Maine, most European countries.) Again, messaging is everything. Lets take advantage of the support we get from doctors and display which party is basing their proposals on empirical fact and which is basing theirs on strict party ideology.
See the full numbers for yourself at: http://www.pollingreport.com/health.htm
Wednesday, July 15, 2009
New Health Care Polls Show Republicans Winning/Losing
In the last couple of days, CBS News and USA Today/Gallup have released fairly comprehensive polls concering the health care debate currently raging in Congress. They provide a pretty good playbook on how Republicans should approach this topic, where we are currently succeeding, and where we need to do better.
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Couple quick things...
ReplyDeleteFirst, your title is misleading... Of your four points, 3 technically indicate that America does not agree with you... 25% win is usually a loss.
I agree doctors should be running it( also, Doctors split evenly, it is the hospital administrators that fall heavily for the Republicans). They know the costs and they usually know what should and should not matter. But I will say it is unfair to say rationing will occur if the Gov. gets involved, as IT ALREADY HAPPENS. Depending on coverage type and the plan, you are already limited by the current health insurance policies about who you can see, how often you can see them, and what they can do for you when you do. Bureaucrats already are a part of the system, they are just private officials instead of government ones. Now, I am not saying government is better, but it is always unfair to say that we will all of a sudden have something if we already have it in the current system.
Currently, medicare covers a bunch of random things, and will pay out (regardless of how necessary/effective it is) almost every time if the doctor approves the procedure. In other words, it makes sense for hospitals to be inefficient because they get paid more the more random shit they do (this also happens to the private insurance groups, which means higher premiums). A friend of mine who is a doctor actually was told by the administrators at the hospital to run a CT and MRI, as well as 2 chest Xrays and a a full blood screening for a small cough and runny nose (turns out it was allergies, which my friend had already diagnosed). He explained that the hospital would receive approximately 5k from the tests and medical procedures from the mans insurance and his personnel bill. This hits me as ridiculous.
Now, I (and amazingly Obama) support COMPARATIVE EFFECTIVENESS testing. This means we research the most effective (MEDICALLY<-NOT COST) way to treat patients. Mayo Clinic, one of the top ranked hospitals in the world, already does it, and a lot of doctors also back this. This testing looks into if a procedure is worth doing in a situation, or if a there is 10 medications for a single illness on the market, which ones work the best (and if it works best for different groups/ethnic groups, have notes of which groups are best effected by it, and who isn't). What is really scary is that THIS ISNT DONE because hospitals DO NOT want to be efficient MEDICALLY cause it costs them precious insurance dollars, OR because drug companies could lose millions because they were trying to sell an ineffective product (FDA approval is versus placebos), PLUS insurance companies do not want to try and change their payment structures by determining the actual merit of a procedure's effectiveness (because if a procedure costs 10 times more but is 20 times more effective than the other procedure and people know this, the people will want the more expensive one carried). So, I am just saying that this maybe should be looked at, even if it pisses some people off...
Well, I need to take a break...Let me know what you think...
Ok Charles...
ReplyDeleteFirst, #1 and 3 are both good for Republicans, #2 and 4 are bad. I'll agree that #3 is iffy, but I needed to write a headline that is intriguing, and I stand by it.
On Doctors favoring Republicans, you are correct that it is closer now (55 - 45 Republican in donations, which is the best way to find how an interest group feels), but that is because we are in Democratic political time. Normally, they are much heavier in favor of Republicans, and as the field becomes more balanced, it will happen again. You live in Massachusetts, so I could accept that it may not be that way in your state, but as long as Democrats oppose Tort Reform that drives insurance costs up, it will be hard to win the Doctor vote.
I also completely agree with you that the current funding system is bunk. Since we pay doctors and hospitals by the procedure, and people never see the actual cost of the procedure, it isn't a true free market. People have every incentive to go straight to a specialist or unnecessary procedure, and hospitals have every incentive to give it to them.
I will also note that, even though I didn't explicitely say so, I was referring to Comparitive Effectiveness when I made my off-hand mention of rationing. I was just noting that the public opposes it. Not all "public plans" would need to have it. The public plan has enough cost-inflating, incentive-distorting problems on its own; that was not what was being attacked.
The problem with so-called "comparitive effectiveness" is that, while Mayo Clinic is a private, market-driven (see their site) non-profit, "comparitive effectiveness" would be run by the government, which does not heed the market, but instead special interest groups and a diverse array of constituencies. Your heart is in the right place, but "C.E." would quickly turn into rationing as the incentive to innovate will be taken away and the government would be in a place it should never be, determining whether an innocent person can take another shot at living.
Listen, private does not mean that it is immune to special interests or constituencies (like the rating groups on wall street that were being paid by companies to give good ratings, to name a recent example). Now, what I would propose would be a separate institution, like the Fed, that would not be political but instead comprised of the best doctors and other medical officials whose job would be to review the procedures and literature and propose the best solution. The AMA already does this to an extent, though it mostly focuses on whether the procedure should be used, not if it is better than the one already in use. I do not understand why the government does not pursue such a path.
ReplyDeleteBecause think of it this way:
If you allow the insurance companies to do it, they will be skewed to choosing the cheapest procedures.
If you allow hospitals to do it, it will be skewed towards the procedure that they can charge the most for.
And if you allow drug companies to perform it, how can you trust their results if they find their drugs to be the best?
And we know that their is no such thing as an unbiased private informational research group, as all of them receive backing from constituents interested in the results (in this case the insurance, drug and medical industries). So how do expect to accomplish a national level of coherency and transparency unless you remove those groups from the picture?