Temperatures Rise Over Costs Of Care | Polls Find Public, Doctors Favor More Government Involvement
There ought to be a law. Or some kind of government intervention, anyway. That’s what most Massachusetts residents say when it comes to the cost of health care, according to a survey by the Blue Cross Blue Shield of Massachusetts Foundation.
And most doctors agree there needs to be government involvement in the way health care is administered and paid for in the state, according to a separate survey by the Massachusetts Medical Society.
The Blue Cross survey found that 88 percent of Massachusetts residents think it’s important for the state government to take major action on health care costs. A full 74 percent consider it very important.
Robert J. Blendon, one of the researchers behind the report, said the public seems to feel that, with the fairly popular state health care reform law, the government is already so involved in the health care system that it needs to be part of whatever comes next.
Blendon said it’s not at all clear what kind of state intervention the public might favor. He said the buzzwords popular among experts and legislators — accountable care organizations, globalized payments and so on — don’t mean much to the average citizen.
And the public is prepared to be disappointed with any action state leaders decide. Fifty-one percent are “not very” or “not at all” confident the government could reduce costs.
“People want them to try, but they have skepticism,” Blendon said.
He said they’re likely to remain skeptical of the kinds of solutions being proposed on Beacon Hill because the public has a very different vision than the experts and legislators of what drives up health care costs. While policy proposals tend to focus on the overuse of expensive procedures like MRIs and expensive facilities like teaching hospitals, Blendon said the public is much more concerned about excessive charges by insurers, hospitals and pharmaceutical companies.
“If you think the problem of cost is that people use too much that’s too expensive, a lot of the citizenry isn’t there yet,” he said.
Higher Sentiment For ‘Single Payer’?
Presumably, doctors are more familiar than the general public with the pressures driving up health care costs, and an overwhelming majority of them also say there needs to be some government involvement in the health care system. A survey by the Massachusetts Medical Society this fall found that 41 percent of doctors thought the best option for health care reform in the U.S. would be to adopt a single-payer system like Canada’s. That number was up from 34 percent in 2010.
Another 23 percent favor a mix of public and private plans, while 17 percent support reforms along the lines of the 2010 national health care reform act, including an individual mandate like Massachusetts’. Fifteen percent favor a system in which insurers can sell limited-benefit and high-deductible policies and the government gives subsidies to help low-income people buy insurance.
Lynda Young, president of the Massachusetts Medical Society (MMS) and a Worcester pediatrician, said doctors who favor a single-payer system may see it as a way to avoid administrative burdens. She noted that a recent article in the policy journal Health Affairs found that Canadian doctors spend two or three hours a week on administration, compared with about 10 to 15 hours for doctors in the U.S.
But Young said it’s significant that the majority of Massachusetts doctors’ don’t favor single-payer.
“The medical society feels that rate setting is a very real risk,” she said.
Young said the MMS supports other means of driving down costs, including insurers adopting tiered networks to encourage members to seek care that is high quality but less expensive than the options they might ordinarily choose.
Of course, the government is necessarily involved in health care in many respects since programs such as Medicare and Medicaid pay for a large percentage of care.
Government Action
“I think the government is going to need to step in and do something because they’re paying a good part of the bill,” Young said.
If the medical society thinks both government and the private sector need to have a role in health care reform, the public agrees. The Blue Cross survey asked who state residents think should take the lead in controlling health care costs. Thirty-two percent picked the government, but another large block, 27 percent, chose health insurance companies. Nineteen percent picked doctors and hospitals, and 13 percent chose individuals.
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