Mike Berman’s Washington Watch

June 26, 2009 11:57 AM

Health Care

The healthcare system changes being pressed by Obama and being worked on by Congress, are a much bigger deal than anything else the President has proposed or is likely to propose during his Presidency.

Let there be no question as to whether the public thinks something needs to be done about the current healthcare system. 34% think it is so broken that the whole thing needs to be rebuilt. While another 51% think there is a need for fundamental change.

And by a margin of 57% to 18% they think the Democratic Party is more likely than the Republican Party to improve the heathcare system. [NYT/CBS 6/09]

The public is evenly divided on whether it thinks that the President's health care plan is a good one (33%/32%). It is also evenly divided on whether the focus of healthcare reform should be on the "cost of healthcare" or "people who are not covered by insurance" (41%/43%). They believe (64%/18%) that the focus of the President's plan is the uninsured. [NBC/WSJ 6/09]

Majorities believe everyone should be required to have health insurance coverage, some with government assistance (62%); 62% would raise taxes on people with incomes over $250,000/year; 55% would require all but small businesses to offer healthcare coverage or to pay the government to provide it.

When asked a series of questions about the current healthcare system, Americans are dissatisfied with the system overall, but are generally comfortable with how the system works for them personally.

  • 57% are dissatisfied with the overall healthcare system
  • 43% are satisfied
  • 83% are satisfied with the healthcare they receive
  • 81% are satisfied with their health insurance coverage
  • 55% are satisfied with their healthcare costs, including cost of insurance and expenses not covered by insurance.
  • 44% are dissatisfied.
[WP/ABC 6/09]

People are split on whether payments by Medicare and Medicaid to doctors and hospitals should be reduced (47%/46%); 59% oppose requiring folks with expensive health plans to be required to pay taxes on a portion of the premium costs; and they are even more vigorously opposed (70%) to the idea of all people paying taxes on the cost of their private health insurnce plans. [NBC/WSJ 6/09]

One of the most contentious issues under discussion is whether there should be a so-called public option insurance plan administered by the federal government. This plan would compete with private insurance plans.

  • 72% of all respondents favor a public plan (including 87% of Democrats)
  • 57% are willing to pay higher taxes so that everyone can have healthcare; 37% oppose paying higher taxes
  • 54% are at least somewhat concerned that, if the government starts providing healthcare more broadly, the quality of their own care will deteriorate
  • 34% are very concerned that their own access to medical tests and treatment would be more limited than now
  • a third believe they would be required to change doctors.
[NYT/CBS 6/09]

In the June 2009 NBC/WSJ survey, 76% think it is quite important that there be a public plan administered by the government, even though 47% think it is at least somewhat likely that their employer will end their current health coverage.

Those who support a public plan in the WP/ABC survey (62%) prefer to have an "independent organization" (41%) run the plan, rather than have a government agency do it (21%).

If they think the public plan will force private health insurance companies to go out of business, a 37% plurality supports a private plan. 33% oppose it. WP/ABC 6/09]

But, when all is said and done, Americans favor the President's plan by 55% to 35%. There has been no change since April. [NBC/WSJ 6/09]

$2,300,000,000 was spent on health care in 2007.

  • 53% - $1,240,000,000 comes from private sources
  • 47% - $1,061,000,000 come from public sources
How it is spent

  • $721,000,000 - hospital care including drugs administered in hospitals
  • $489,000,000 - physician and clinical services
  • $232,000,000 - prescription drugs
  • $163,000,000 - program administration
  • $140,000,000 - nursing home care
  • $582,000,000 - other spending including dental, home health care, over-the-counter medicine, medical devices, research

Even good results from healthcare reform can potentially have negative consequences.

The Congressional Budget Office, in its recent estimate of the costs of certain healthcare proposals, noted the potential downsides of certain popular changes.

According to an article in the Washington Post (6/18/09):

"In some instances, the cost of delivering preventive care to a large population would actually exceed the savings on the relatively few people who avoided illness as a result."

"....improving public health can reduce Medicare spending on particular problems. However, helping people live longer and healthier lives will increase the burden they put on the federal government, partly because they will spend more time collecting Medicare and Social Security bnefits, the CBO reported."

If they figure out how to play their hand, the recommendations of doctors for reforming the healthcare system are likely to be most persuasive with the public. 73% have that view, as opposed to 58% who are confident in President Obama. [Gallup 6/09]

The availability of doctors, nurses, physicians assistants, nurse practioners, and related healthcare personnel is a subject that is not being given as much public attention as it should. It is a problem that cannot be fixed in the short run.

The biggest shortage is at the frontline of the healthcare system -- primary care doctors. President Obama acknowledged the problem in his AMA speech.

The Washington Post (6/20/09) said it quite succintly. "Fifty years ago, half of the nation's doctors practiced what has come to be known as primary care. Today, almost 70 percent of doctors work in higher-paid specialties,,,."

"By 2000, 14% of U.S. medical school graduates were entering family practice. Five years later, the figure was 8 percent, and a recent survey of students interested in internal medicine showed that 98 percent wanted to become specialists."

The availability of other critical healthcare and other personnel mentioned above is yet another story.

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