FOLLOW-UP: Health Reform and Public Opinion
It isn't often that you get to give a Harvard professor a homework assignment, but that's what Swampland commenters did yesterday. This came after I posted this Kaiser Health News column by Robert Blendon, the Harvard School of Public Health professor who is one of the leading experts on the intersection of health policy and politics.
Commenters immediately wanted to know where he was getting this stuff. A sampling:
Trifecta55: Where is his poll data coming from KT? Genuinely curious.
Deconstructiva: Agreed! Which polls? Whom got polled, how, etc.? e.g., Rasmussen is known to have a conservative slant; others vary.
Stuartzechman: We really need to know what data Robert Blendon is reading, because this seems silly:
Many of those who will be most influential will not be political figures working in Washington.
.
Polls suggest they may be leaders of physicians' and nurses' groups, seniors' groups, and organizations advocating for patients with serious illnesses.What polls is he talking about, KT?
These seemed like reasonable questions to me, so I put them to Blendon, and this morning he emailed back an answer:
Karen,
Most of the polls mentioned in the Kaiser Health News piece can be found in our recent NEJM article and the Polling Report (links below). There is a "table" near the end of the NEJM article listing the polls we used. For the 2009 polls, if you click on the date of a poll, you'll be linked to the complete results of that poll.
Here is the 1965 Medicare question that was cited:
Harris Survey [February, 1965]
Do you favor or oppose President (Lyndon) Johnson's program of medical care for the aged under Social Security?
62% Favor
38 Oppose
Methodology: Conducted by Louis Harris & Associates during February, 1965 and based on personal interviews with a national adult sample of 1,250. Sample size is approximate. As reported in The Washington Post.[USHARRIS.030865.R1]Data provided by The Roper Center for Public Opinion Research, University of Connecticut.
Robert Blendon
Much appreciated, Professor Blendon.
UPDATE: Pollster.com's Mark Blumenthal also talked to Blendon, and reports:
He points to the Gallup result showing 26% of adults who say the health care bill will “make your own health care situation better,” 36% who say it will make it worse and 31% who think it will not make much difference. “In the absence of not having a fixed view of what this [reform bill] is and how it will work out for me,” he said, Americans are “more susceptible to advertising.”
In the same context, Americans are also watching the news coverage focused on the legislative process and “getting more scared.” He said he watched the cable news coverage following passage of the bill on Saturday night and saw “not a word telling you why you should care if the thing passes.”
Blendon still believes, as he and Benson argue in NEJM, that “public opinion is still fluid on the key question about the impact of the legislation.” Again, the percentage that say they will be worse off still falls far below a majority, and Gallup has tracked in increase in the initial “not sure” response (from 22% to 33%) over the last month. Proponents of health care, Blendon argues, must invest time telling seniors and others who stand to benefit “how they will be better off…that's the thing they have to do to turn this around."
-
1
What is the problem? We have two opposing factions, the far right, and the far left. Both are trying to polarize the public with Ideological purity. The losers in this game is the American Public.
Franly this guy makes sense
-
2
The wording on the Medicare question seems likely to push people toward a favorable response. Who's against "medical care for the aged"?
Consider the result if you asked:
Do you favor or oppose President Obama's program of providing medical insurance to all Americans?
-
3
Prof Blendon seems to be very through in his analysis of ALL polls. I was glad to see and read most of the results.
.
To me from what I read, most Americans agree with a public option so long as it competes with private insurance to bring about fair competition and cost control.
.
For the vast majority of other questions and answers, the Democrats and President Obama do not seem to fair well at all. Although I shall also note, and Republicans should take note that their own favorability rating looks bleak as well. However, I think since the controlling partners in all of this are Obama and Pelosi, et al. They stand to lose the most in my opinion.
.
Thank you for bringing this to our attention, Karen. And thank Professor Blendon for his time and efforts. It is important to keep the people informed.-
3.1
stuart:
.
Yes, fault lies with again our government for all the bailouts and TARPS. Not to mention the Autobailouts as well.
.
The Government should never have interferred. They simply took our money, our tax dollars and bet on the stock market, and other big business.
.
Now we see big business running away with our tax dollars.
.
As deconstruc correctly points out, CIT did go bankrupt and we as tax payers lost.
.
If the others you mention also go bankrupt, then we will loose as well.
.
Again, Government should have stayed out of it, and allowed the big business to risk their money, not ours. We could have rebulit later becoming stronger for it all.
.
Now the risk is that the ENTIRE US of A will go bankrupt. How does that make you feel stuart?
-
-
4
Interestingly enough KT, while I doubt you meant to validate my critique of your writing throughout this entire debate, you have inadvertently done so. This article seems to make the one point that I have been trying to make throughout this entire debate -- that the public's opinion will not be formed by what's in the bill but rather from the assessment of others including major media figures. Of course, I would go even further and say its predominantly the media because while they might be influenced from support coming from the AMA and the AARP, the media has managed to down play those two huge endorsements. After this historic vote in the House, you do remember that Clinton didn't even get a vote, the most repetitive theme was "the house passes health care reform by only two votes." If health reform legislation doesn't pass it is because the media has buried it under its journalistic imperatives..
-
4.1
Oh Dee such a naysayer. I have to give the media, and Karen Tumulty great points for their coverage on health care reform. They have done a great job covering the facts. Even the opinion shows I watch seem to be giving them all a fair assessment.
.
It is simply a fact that the America people do not trust the Government to do an adequate job at anything they attempt. The Governments track record is quite clear. They will bankrupt anything they try to do.
.
Post Office - bankrupt.
.
AmTrac - bankrupt
.
TVA (Tennesse Valley Authority) - bankrupt
.
Fannie Mae and Freddie Mac - bankrupt
.
The Government can't even run a simple flu vaccine program. How in the hell do you expect it to run over 1/6th of GDP in this country? -
4.2
Rustydog:
The Governments track record is quite clear. They will bankrupt anything they try to do.
No, no, no.
.
AIG - bankrupt.
.
Lehman Bros., Merril Lynch, Bear Stearns - bankrupt.
.
GM, Chrysler, Ford - bankrupt.
.
Citigroup, Bank of America - bankrupt.
.
Boston Globe - bankrupt.
.
Don't you get it?
.
It's not that government f*cks everything up, it's that the current elites of our political economy are corrupt and incompetent, and must be replaced. Our elites' system of incentives and disincentives has failed, or slid/been perverted into a congenitally weak aristocracy, which needs replacing with meritocratic, transparent market and civil service.
.
Look at the private sector's recent record, Rustydog! A more dismal record of failure and golden-goose killing in a market economy can't be imagined!
.
Are you really going to worship at the alter of those geniuses? -
4.3
...also add -
CIT - bankrupt
As if the housing lending collapse wasn't enough, this is wrecking commercial lending, both for real estate and especially small / medium biz lending. Look out! -
4.4
add to that: 120 banks eaten this year alone by the FDIC.
The largest number of bank failures in a year since 1992, when 179 institutions failed.
Next time a Republican becomes President, first thing I'll do is get my money out of the bank. I'm never going to trust a Republican with my savings again.
-
-
5
KT:
.
I can't tell you how grateful I am (and so many of us are) for taking our questions and concerns so seriously that you would take the time and effort to followup with a source --and obtain the source's source.
.
This is transparent, interactive, crowd-sourced journalism 3.0 in action. It's forward-looking professionalism incarnate.
.
This kind of thing speaks volumes about your value to engaged news consumers, KT. I've said it before, and I'll say it again: if there were a "contribute" button next to your name on this blog, you'd be able to have some material sense of that value (you'd see the reverse trend-line of Time's subscription rate).
.
Thank you, thank you, thank you.
.
...Now, on to examine the polling data!-
5.1
So here's what I'm going to try to answer (from my commentary on yesterday's cited thread):
The obvious, immediate question for Robert Blendon would be:
.
"How did your polling account for the various levels of funding that would allow for some to influence perceptions more than others?
.
Did that polling factor in the amount of advertising dollars available to each entity seeking to influence public perception, in terms of predicting who/what would be most influential?"
.
If Robert Blendon isn't taking into account the money needed to compete in today's sophisticated messaging campaigns, then how valuable can his work be?
.
Is he, KT? Or is he assuming "all funds being equal"...?If Blendon's data doesn't factor in the amount of money, and the relative capacity of mass media to influence voter perceptions, then these comparisons are less than worthless.
.
When Robert Blendon says "Polls suggest [those who will be most influential] may be leaders of physicians' and nurses' groups", and those polls assume an equal level of paid access to mass media and sophisticated public relations campaigns, those responses are completely disconnected from reality.
.
Does anybody really imagine that "those who will be most influential" are not those who have the most resources to create and efficiently disseminate effective messaging?
.
If I can determine that this is the case, i.e. that this study did the economists' equivalent of "assuming everything else is equal", then the only value to be obtained might be for someone designing a position advocacy ad campaign, so that they might know with relative empirical certainty that calling their astroturf organization "Seniors for Reliable Health Care" fits right in with the polls' demonstration that "seniors' groups" will be more trusted than "political figures working in Washington". -
5.2
i don't think resources explain all. For instance, if you have a kid with spina bifida, are you going to be more influenced by chamber of commerce ads, or by something you hear from the spina bifida association? Will you trust the club for growth, or the concerns that your doctor is talking about as she performs your physical? That's in part why modern political organizing focuses so much on "spheres of influence" -- union members talking to other union members, church members talking to others at their church.
-
5.3
"i don't think resources explain all...Will you trust the club for growth, or the concerns that your doctor is talking about as she performs your physical?"
.
They aren't really mutually exclusive, are they? Your doctor is just as likely to believe Club for Growth manufactured lies, especially as they remain uncorrected (or are even corroborated) by whatever sources of news and commentary the doctor enjoys. Resources may not "explain all" but they still determine critical proportions of public opinion - just look at the complete bullsh*t that vast numbers of people believe! You know better, Karen. -
5.4
Shepherd: Actually, my doctors talk to me about health reform a lot. (One of the perils of being a health care reporter is that you find yourself having a lot of serious policy discussions when you are wrapped only in a paper sheet.) I have yet to hear any of my doctors recite anything from the Club for Growth. What I have heard are a lot of their experiences in dealing with the current system--the hassles of dealing with private insurance, but also frustrations at inadequate reimbursement from Medicare. There is also anxiety on what the future would hold, and specifically, that it would limit their flexibility to practice medicine the way they believe they should. These are real concerns, and that is what I think Blendon's research gets at.
.
I suspect a lot of other Americans are hearing the same things from their docs. Commenters? -
5.5
Well Karen, consider yourself lucky (as well as the usefulness of anecdotal evidence). I have only medical bankruptcy insurance ($5,000) deductible, so I'm not spending a lot of time with my personal physician. And she seems like the sort who would choose good sources of information and be well-educated about the issues.
.
However, male doctors, who dominate the industry, trend conservative (some might say authoritarian) and I've had long chats with more than one (and heard similar stories from others) who, apparently, learned every single thing they thought they knew about politics and policy from listening to Rush Limbaugh (seriously, everything). Try that with somebody pointing a laser knife at your neck. -
5.6
KT, I've fortunately avoided docs for awhile (being out of work now but still healthy, is not a bad thing – I do have a private policy w/ 2500 deduct. + dental, whew), but dentists keep grinding along. My dentist faces insurance hassles and now refuses a few carriers (mine ok). One interesting issue results from advancing teeth technology – fewer cavity fillings over recent years, prevention is better. She does cosmetic work and it's profitable. Some dentists in my area promote it heavily but mine doesn't. But you guessed it – the insurance companies resist paying for it. My dentist won't starve; she lives / works in an upper income suburb that's an evil mirror image of Wisteria Lane (and very Republican). Is this advancing tech vs. “party of no” insurance battle also a problem with other medical fields?
-
5.7
Decon: I don't understand that facet of this debate nearly as well as I should, which is why I've got an interview scheduled on Thursday with some folks from the dental industry.
-
5.8
KT, we need to learn more about this too. How much is that field changing now? Good luck with the interview, drill them hard!
.
I googled cosmetic dentristy and found advertising galore for them, wow. But here's a blog from 2001 –
http://www.myhealthsense.com/F20011023_dentistry.html
.
…and Medicaid issue – poor kids with no dental coverage
http://washingtonindependent.com/63449/a-cavity-in-medicaid-dental-coverage
-
-
6
There's no reason to be so suspicious of the 1965 poll. It was done in person so there no accounting for the bias that might have been introduced by the poll taker and we know it probably wasn't as inclusive as today's polls. But regardless of those factors, we were a different country in 1965, and Americans hadn't yet been indoctrinated with conservative selfishness, While we may have gone through a bit of cultural upheaval, the reason why the civil rights movement could be so effective is because that despite the country being at the height of its racism, average people rejected that kind of cruelty regardless when it was up close in personal. Decent Today, out society seems so much more tolerant of cruelty they would have found abhorrent only a few short decades ago. But the Reagan revolution was transformative and we went from a society of common purpose to a society where its common not give a crap about anyone but oneself.
-
7
Maybe others have already made the point, but comparision with Medicare is problematic. Though it was also met by doomsayers, it was easier to explain since it represented an entitlement that did not directly threaten to impact existing health care for all individuals. Plus how many individuals had health insurance via their employers in 1962 - wasn't the HMO movement an offshoot of Nixon era policy?
Also, the current plan is difficult to compare with Clinton's, as a vote has been taken in the House and will be taken in the Senate. Rather than assessing impact of national polls, which are certainly important, it would be much more relevant to compare district by district and state by state polls, focusing on those Members who are in competitive districts or states that have a clear preference for or against reform. That's a lot to ask, I know, but applying national polls to what is now a vote for each Member (who as Charlie Cook says all belong to the 're-election party') is inherently problematic. Could be, for example, that a big chunk of opposition exists in Southern districts and states, which would water down impact of national polls.
-
7.1
My first point is more or less moot, since about 75% in the US had health coverage in mid-1960s. More comparable than I had thought.
-
7.2
From what I've read about that debate, it does seem there are parallels. There were lots of "socialized medicine" charges in the air, and the AMA (then a much more powerful organization than it is now) was fighting it hard.
-
7.3
Here's an interesting link:
.
http://www.larrydewitt.net/Essays/MedicareDaddy.htm -
7.4
Especially this part:
The first obstacle was the opposition of the Republican Party to what were Democratic initiatives. During the debates on Truman's proposals stalwart Republicans like Robert Taft of Ohio counterposed plans which did not require the creation of government programs. Taft's plan, and similar alternatives during the Eisenhower years, were generally based on providing subsidies to private insurance companies to create incentives for them to cover the aged population. So the parties were divided over how to best approach the problem of medical care for the aged. Since the strength of either party was never overwhelming during this period, this divide was a serious obstacle to action. (The strength of the two parties was roughly equal, despite some ups and downs, until the landslide victory of Johnson over Barry Goldwater in 1964 Presidential election.)
.The second, and most powerful obstacle, was the organized opposition of special interest groups, especially the American Medical Association (AMA). The AMA's campaign against the first Truman proposal actually marked the start of the AMA's role as a political lobby. Throughout all the various proposals, up to and including the final bill in 1965, the AMA was a major block to any change in the status quo. The AMA argued that any involvement by the government in the medical care profession was the equivalent of socialized medicine. This argument, especially during the height of the Cold War hysteria, had real force.
.The AMA's campaign against Medicare also marked the beginning of the political career of another rising force in American politics-Ronald Reagan. Most conventional histories of Reagan's political career date his emergence as a political figure from his nominating speech on behalf of Barry Goldwater at the 1964 Republican Convention. But in 1963 Reagan was the AMA's spokesman for their campaign against Medicare. The AMA, in what was called Operation Coffee Cup, organized thousands of small meetings in homes all across the land, hosted by the wives of AMA physicians. At these informal "coffees" the women would organize local efforts against the pending Medicare legislation. This would include letter-writing campaigns to members of Congress, petition drives, networking with other civic groups, and the like. The central event of each meeting was the playing of a recording made of Reagan presenting a short, dramatic, speech against the evils of Medicare. Reagan played the socialized medicine theme to the hilt, suggesting that the idea of government sponsored medical insurance was little short of the entering wedge of socialist domination of America.
-
7.5
Thanks, very interesting.
Jill Quadagno in 'One Nation Uninsured: Why the US has no Health Insurance' also has a chapter covering the regional/racial aspect of the Medicare debate. She writes that:
"For two-thirds of a century, southern politicians had resisted national health insurance for fear that federal financing of health care services would lead to federal monitoring of racial practices. Their agenda was compatible with the desires of physicians, who had their own reasons for opposing government intervention in the health care system. Mediare realized these fears by requiring hospitals to provide health care services without regard to race. As federal officials began certifying hospitals for Medicare eligility on the basis of equality, the also forced the hospitals to prove they were not discriminating...Thus the dismantling of racial segregation also allowed federal officals to monitor internal hospital affairs, penetrating the barrier between providers and the federal government and undermining sovereignty in the pursuit of racial justice.' (page 93)
Now, I am definitely not saying that racial factors are driving the current debate (see e.g. Rep. Artur Davis), but it is clear and Davis' vote underscores that regional differences based on views of the federal government, state sovereignty etc are playing a big role, which isn't captured in national polls.
-
-
8
Thanks, KT. You rock. Prof. Blendon's NEJM article is much better – just like a research paper (or term paper? ha!) he lists his sources. Since he studied polls across the spectrum, it looks like public fear about HC reform is the challenge. Education about this should alleviate the fears. Your pieces are helping to do that, KT, so keep up the great work.
-
9
Unfortunately, even in this discussion KT you are deliberately ignoring a critical factor, perhaps because you consider it media critique and therefore out of bounds. Nevertheless, it seems pointless to have any real discussion of the issues impacting public opinion of health reform without discussing the impact of the media narrative. KT while there is much you have written about health reform that is factual and so should be applauded, there is also the impact of the cynicism that you readily admit exists that comes across in your writing. A kind of disbelief that it will actually happen that is transmitted through the words you choose and the angles you choose to pursue.
.
Of course it's not just you KT, it's a narrative that the entire village tends to share and frankly, it is what is behind the public's defeatist attitude and it's infecting this country in a way that is paralyzing. It's as if we no longer possess the gumption to regroup and overcome. the wingnuts make fun of Obama and his theme of hope and change, but frankly, what's the alternative -- resignation and defeat? Is that even an option in any one's mindset?
.
Since I came to this site I have been repeating the mantra that you people aren't just journalists, you are also Americans and constantly tearing down the country in the hopes of producing another Watergate triumph has so far succeeded in only tearing down the country. As you villagers love to say its all about expectations. You keep writing that the country is incapable of getting off its knees and pretty soon people begin to belive that's where they belong and stop trying to get up.-
9.1
Dee:
.
I ask this at the thread's peril, probably, but here goes:
.
What are you talking about?
.
Briefly, what is your beef with Tumulty's reporting, and what can you link to that supports that specific criticism?
.
When you write "the impact of the cynicism", what are you talking about? Church of the Savvy stuff? I'm not knee-jerk defending --I have my own criticisms, obviously-- but I can't make out what your problem is. Believe me when I honestly say that it's incoherent to me.
.
Where do you see or have you seen Karen writing that "the country is incapable of getting off its knees"?
.
All I see for the most part is her reporting that the situation in the Beltway is what it is, and us coming to the reasonable conclusion that the system is broken.
.
Briefly (I know, that's a hoot coming from me), so that the point isn't lost in a diatribe, what do you mean, specifically, and what are examples you can link to of this phenomenon?
-
-
10
"There is also anxiety on what the future would hold, and specifically, that it would limit their flexibility to practice medicine the way they believe they should. These are real concerns..."
.
They are but please do me a favor and next time you get the chance ask them, based on their experience with the private-insurance-based system, should they have more to fear from reform than perpetuation of the status quo? In other words, aren't insurance companies the major impediment to them "practic[ing] medicine the way they believe they should"?
.
At least the architects and managers of any government reform will have to answer to the people every few years for whatever they create. What leverage do your doctors have now to change the current system for the betterment of their practice of medicine?-
10.1
I have indeed had these conversations. (My current primary care doc no longer takes my insurance; I had to switch my longtime OB-GYN when he dropped my insurance. Both of these resulted in long heart-to-heart conversations about the practice of medicine and what it has become.)They know the system has to change, they want it to, but they have not yet been made comfortable with what is being proposed.
.
They worry about a new health care system that would impose what a couple of them have described as "cookie-cutter medicine," that something will get in the way of their ability to use their best medical judgment. They see it happening already. For the two who dropped my insurance companies, walking away from those companies was how they did it. But they fear that the government is not something they can walk away from.
.
These are the real concerns that good doctors have. These are not ideological talking points. I do not practice medicine; I don't have the experiences they do. But I do know that these are people who got into this business because they wanted to help people, not because they wanted to get rich.
.
This is what Blendon is talking about. The fact is, this whole debate is very, very complicated, and you can't just dismiss people's concerns as being irrational or ideological. People are worried because this is an issue at the center of their lives. They want change. But they fear it, too. Please read Blendon's NEJM piece.
.
-
-
11
So here's the $600 billion question: do you think that their "real concerns" are being stoked by irrational fear-mongering propaganda and, if so, what's the cure? And what's the price the country pays in public policy terms if that cure isn't implemented?
-
11.1
My doctors--and the scores and scores of doctors that I have interviewed in the course of reporting the health reform debate--tend to be very rational, smart, relatively apolitical people. They base their views on the experiences they have day in and day out. I have a lot of respect for them. I think most people do--which is why I think Blendon is right, when he says people like them are likely to have a big influence on public opinion. Please read again Blendon's description of "trusted intermediaries":
.Most Americans are not health policy specialists, and they are unlikely to read a long and complex piece of legislation. Instead, they will rely on trusted intermediaries to clarify its likely impact on them. The President and congressional leaders play a critical role, but public confidence in leaders in Washington is not universally high. Less than half of Americans say they have a great deal or a fair amount of confidence in the Democratic (45%) and Republican (39%) leaders in Congress to do the right thing when it comes to health care reform, and 56% have confidence in President Obama (Pew). Polls show that the public has greater trust in the views of some nongovernmental groups, including physicians' groups (in which 65% of the public expresses a great deal or a fair amount of confidence), nurses' groups (79%), groups representing seniors (64%), and groups representing patients (70%) (NPR). If the leaders of these groups and others address the public's bottom-line concerns about the impact the legislation will have on individuals, they may have a substantial effect on the ultimate state of public opinion and the legislation that is enacted.
-
-
12
PS, I already read the Blendon piece and it barely begins to answer the causation question, and only then by working backwards from provably false beliefs.
-
13
"Polls show that the public has greater trust in the views of some nongovernmental groups, including physicians' groups (in which 65% of the public expresses a great deal or a fair amount of confidence), nurses' groups (79%), groups representing seniors (64%), and groups representing patients (70%) (NPR)."
.
Yes, of course, and those are just the people I see all time on the TV and hear on my (talk) radio. C'mon Karen, if those "trusted intermediaries" were driving the debate then we wouldn't have spent the summer on "death panels" and "government takeovers" now would we?
.
We're getting seriously into horse-to-water territory here. If everybody's so godamned rational and invested in trustworthy sources of information, then why is the debate so dominated by the twisted and irrational?-
13.1
Depends on which debate you are listening to. I don't think most Americans follow cable news all that closely. People at the White House tell me that they don't worry about the "death panels" and the nuttier stuff we see on the internet. They don't worry about charges that this is "socialist." But they do worry about the kinds of issues that Blendon raises in his analysis. Americans haven't yet reached the point where they are comfortable with the idea that this, somehow, won't leave them with less than they have now. (I certainly heard a lot of that last weekend when I was visiting the retirement community where my parents live; older people hear that billions will be taken out of what is being spent on the medicare program, and they just don't believe that, somehow, it won't mean less for them. They don't believe that this can just be wrung out of waste and inefficiency. Is that irrational?)
.
And that is where the President himself acknowledges that his real communications challenge lies. I got at a little of this in this story that I wrote the morning after Obama's speech:
.
http://www.time.com/time/politics/article/0,8599,1921554,00.htmlObama also dealt with these kinds of concerns in my interview with him in July.
."This has been the most difficult test for me so far in public life," he said. "When I see polls saying that it's 50-50 and people are still worried about whether this is going to somehow increase their costs when every bill that's out there would lower them, or that this is going to mean that they lose their doctors, or their health care is rationed, or, you know, all the other things that they're worried about, it leads me to spend a lot of time thinking about how can I describe this in clearer terms so that we can get the health care that the American people deserve."
.
Now I've got to get back to my story for this week's mag. Will check back here later. -
13.2
”They don't believe that this can just be wrung out of waste and inefficiency. Is that irrational?)”
It's irrational if you know that: 1) every industrialized nation on earth pays half what we pay and delivers better health care to all of its citizens, 2) that most of the “waste” that needs to be wrung out is the result of for-profit insurance industry practices and 3) that government-delivered social services are generally more cost-effective than private, for-profit alternatives. So how many of those Medicare recipients don't know those facts and how much of their ignorance and belief (rational or not) that government can't wring out waste and efficiency are driven by general, “conservative” anti-government propaganda, as well as specific, industry-generated anti-reform propaganda (and much of that propaganda is more clever and subtle than “death panels” or “socialism”)
.
Anyway, if you can't come up with a number bigger than zero or satisfactorily explain the other crazier beliefs held by tens of millions of people, then you've got a very troubling blind spot (for a journalist) to deal with. -
13.3
KT:
I certainly heard a lot of that last weekend when I was visiting the retirement community where my parents live; older people hear that billions will be taken out of what is being spent on the medicare program, and they just don't believe that, somehow, it won't mean less for them. They don't believe that this can just be wrung out of waste and inefficiency. Is that irrational?
No, not at all.
.
It's the only rational thing to believe, when one doesn't know that Medicare greatly overpays on average for hospital stays, medical procedures, laboratory tests and prescription drugs compared to other developed countries --along with the rest of the private sector in the US.
.
If you believe that health care prices in the US are giving you the best quality care for the money, then talk of "bending the cost curve" --or worse, "cutting costs"-- would scare the hell out of any normal person who heard it.
.
Many people are irrational, to be sure, but most aren't. Most people are acting rationally on the information they have. Is the information most Americans have about their health care system adequate to judge reform proposals? Yes, the system is complex, but at the end of the day, isn't the question of whether Americans are getting the best value for their money a simple "Yes" or "No" that virtually everyone can understand?
.
Health care proponents haven't really answered the question:
.
"If there's hundreds of billions of dollars of waste in Medicare, why does it take changing the entire system --and going through this entire process to fix that?"
.
, have they, KT?
-
-
14
From the NEJM report:
Most Americans are not health policy specialists, and they are unlikely to read a long and complex piece of legislation. Instead, they will rely on trusted intermediaries to clarify its likely impact on them.
Oh, really?
.
Groan...
.
So far, it seems that the report doesn't cite polling data that measures what the American public knows or doesn't know about the facts regarding what the proposals do or don't do, and --most importantly-- about the American health care system in which they participate.
.
It seems as if Blendon regards knowledge, e.g. the objective truth that the US pays in most cases double in health care costs per person per year than the rest of the developed world pays, as a factor in public opinion unworthy of even an afterthought.
.
Apparently measuring what people know about the problem isn't nearly as important as the assumption that "Most Americans are not health policy specialists", as if basic facts about their health care system (like how much it costs compared to other nations) are beyond our capabilities.
.
Does it require the average American poring through "a long and complex piece of legislation" to know that US health care costs have been rising faster than the rate of wealth produced in this country --unlike any other post-industrialized nation?
.
Does it require the average American to be a "health policy specialists" to know that the Japanese live longer than us, and get better health care than we do --even though they pay less than half of our price?
.
Does it require the average American be a Harvard professor to know that the price of prescription drugs in Canada are almost always higher than in the US (link to online comparison shopping, Lipitor - Brand Version : 10 mg)?
.
Why wouldn't the NEJM bother to comb through data to find out what Americans do or don't know about health care, and then correlations (if there were any) between how much we know and attitudes on Health Care Reform?
.
If Americans were to believe --contrary to objective facts-- that their health care system is the best outcome-producing, greatest accessibility, most cost-effective in the world, then mightn't that mistaken belief have a significant correlation to this datum:"Most, but not all, of the polls show that among people who see the plan as affecting them personally, more believe they will be worse off personally and in terms of the cost and quality of their care than believe they will be better off."
Oh, really?
.
Is that because most Americans are at least aware that premiums will continue to increase, and health care benefits will continue to decrease, Robert Blendon?-
14.1
Does it take a Harvard professor to know the difference between the words "higher" and "lower"?
.
I should really stop writing until I have more time to proof what I'm writing.
.
This is bad, it should read:
.
"Does it require the average American be a Harvard professor to know that the price of prescription drugs in Canada are almost always lower than in the US"
.
I really must also blame this on the preview script, which cuts off the rest of my text after a hyperlink it doesn't like...
-
-
15
Pollster.com's Mark Blumenthal also talked to Blendon, and asked him specifically about the coverage. He does believe it is too focused on process, and made this observation:
.
http://www.pollster.com/blogs/whats_up_with_the_health_care.php
.He points to the Gallup result showing 26% of adults who say the health care bill will "make your own health care situation better," 36% who say it will make it worse and 31% who think it will not make much difference. "In the absence of not having a fixed view of what this [reform bill] is and how it will work out for me," he said, Americans are "more susceptible to advertising."
.
In the same context, Americans are also watching the news coverage focused on the legislative process and "getting more scared." He said he watched the cable news coverage following passage of the bill on Saturday night and saw "not a word telling you why you should care if the thing passes."
.
Blendon still believes, as he and Benson argue in NEJM, that "public opinion is still fluid on the key question about the impact of the legislation." Again, the percentage that say they will be worse off still falls far below a majority, and Gallup has tracked in increase in the initial "not sure" response (from 22% to 33%) over the last month. Proponents of health care, Blendon argues, must invest time telling seniors and others who stand to benefit "how they will be better off...that's the thing they have to do to turn this around."-
15.1
Thanks so much for this additional followup, KT!
.
You really are perseverance incarnate.
.
I hope that E Klein is paying attention to what you're doing..
-
-
16
"Proponents of health care, Blendon argues, must invest time telling seniors and others who stand to benefit "how they will be better off...that's the thing they have to do to turn this around."
.
And journalists, who's job is to tell the people the important truth, need to invest time telling everyone who's lying i.e., "advertising" (I guess it's not even a euphemism any more) and what the actual truth is. Though, I suppose as long as even otherwise good journalists refuse to even admit that industry propaganda promulgated by mass media is a major factor in the abysmal public understanding of policy issues, we're pretty much screwed.-
16.1
Am I to assume that is a shot at me? Have you been reading what I have been writing? I have devoted many, many, many hours of reporting to separating fact from fiction in this debate, and to presenting the most accurate, unbiased information available. (Please see the grief I got from commenters on both sides who didn't like what CBO estimates indicated at various points, and blasted me for even reporting them.) I also have not shied away from using the word "lie."
.
http://swampland.blogs.time.com/2009/09/27/latest-lie-death-panels-by-proxy/ -
16.2
Karen,
I've read every word you've written here and I use the term "good journalist" all too sparingly these days. You are certainly in the vanguard of media working to separate truth from lies and a I salute you for it. But (there had to be one) liberals think that it's axiomatic that public understanding is a direct product of the mass media (not "physicians groups") and that public understanding of the issues surrounding the debate is awful. I understand your reluctance to criticize your own industry but when you ignore (or avoid admitting) its effect, you hurt your credibility. It's also a basic liberal critique that corporate media pretends it has no effect on public opinion and therefore, politics and policy.
.
It's a ludicrous pretense that seeks to avoid legitimate criticism of journalism itself as well as break the clear link between industry propaganda and how it is inculcated in the public mind. In other words, the pretense that the corporate media, in general (nothing personal), isn't a conduit for industry disinformation that often leads to public misunderstanding and bad public policy, is itself a very destructive lie.
-
- ktumulty Ivana Trump should also be put on a no-fly list: http://bit.ly/8Vhchx - 4 hours ago
- ktumulty al Qaeda offshoot claiming responsibility for the Pants-on-Fire bomber. - 4 hours ago
- ktumulty New Blog Entry, "Janet Napolitano" - http://tinyurl.com/ybnhk2w - 7 hours ago
Most Popular »
- Heckuva Job, Janet
- Is This the Best Week to Buy a Car?
- Janet Napolitano
- Vacation Robo-Post: What Changed TV in the '00s
- Blue Boobs: The Avatar E-Mail Chain
- Runner Trend: Going Barefoot
- What Is Even the Deal with People Liking Sherlock Holmes?
- The Five Most Underrated Sci-Fi Masterpieces
- The Top 'Recession Porn' Stories of 2009
- The Year of Living Cheaply: A Retrospective
- No Churchgoing Christmas for the First Family
- Will the World's Largest Cruise Ship Sink or Swim?
- Is Running Bad for Your Knees? Maybe Not
- Christmas Box Office: 'Avatar' Beats 'Sherlock' and 'Alvin'
- Israel vs. Hizballah: Drumbeats of War
- In U.S. Defense Tests, Iranian Missiles Are Cast As Foe
- U.S. Schools' War Against Chocolate Milk
- Meet Magnus Carlsen, The New King of Chess
- On a Holy Day, Protest and Carnage in Tehran
- Why It's So Hard to Name the '00s
Quotes of the Day »
RSS