Conservative Delusions and Liberal Ideology on Health Care Reform

So much in politics these days comes down to the delusions held by conservatives, whether they come from Fox, talk radio, a crazy lady writing on Facebook in Alaska, or random voices in their heads. Issues rarely seem to come down to real differences in opinion these days. Instead they are based upon the differences between reality and the delusions of conservatives. The claims of “death panels’ provides an excellent example of this. Greg Sargent has been analyzing a recent  Research 2000 poll which asked if people believe the health reform proposal contains “death panels.” Sargent noted these results among Republicans:

Yes: 26
No: 43
Not sure: 31

In this case the number of Republicans who are not sure of something which has no basis in reality is a significant finding. Adding up those who believe this false claim with those who are unsure totals 57 percent of Republicans being unaware of the facts. He also noted that only eight percent of independents accept this claim. In addition 16 percent are unsure with 76 percent of independents realizing this is untrue. The numbers are even stronger for Democrats with 88 percent answering no.

These findings are related to other findings in the poll which show that a sizable number of Republicans believe Fox  is a reliable source of information and also do not get news from other sources. During the height of the Soviet Union I doubt that Russians were as gullible as to the reliability of Pravda as Republicans are with regards to Fox. also debunked a conservative ad today which contains false claims about care for the elderly as well as several other false claims being used to scare seniors. Of course this won’t change the mind of those who are brainwashed by the right. They are told that any objective source of information is actually a biased liberal source making it almost impossible to alter the views of those on the far right with the facts.

While they show far more understanding of the actual facts, blind ideology might also become a problem from the left with threats to block health care reform if it does not contain a public plan.  In some cases this is because some on the left see a public plan as a back door way of achieving a single payer system. This is somewhat unrealistic considering how watered down the public plan already is and how few it is likely to actually cover.

The question remains as to what will happen if we reach a point where the only item before Congress is a proposal with significant improvements but without a public plan. Will liberal Democrats will really let a good bill go down to defeat over this? Some liberals are beginning to question the wisdom of this. For example, Matthew Yglesias has popularized an idea to split health care reform into more than one bill:

One bill, a filibusterable non-reconciliation bill, would set up the basic framework of a health insurance “exchange” on which individuals and small businesses could get insurance. It would feature an employer mandate, some kind of sad co-op, and some not-very generous subsidies. It would be subject to various kinds of regulation including the White House’s key eight points of consumer protection. It’s a bill liberals would find horribly disappointing, but you could imagine it getting sixty votes in the senate.

Then if you get that done, all you need is a second bill. At that point, changing the co-op rules to make it work like a real public option, making the subsidies more generous, expanding Medicaid, and other wholesome progressive stuff all becomes budget-relevant material that can be done through reconciliation with only fifty votes. It’s not clear at this point that the public option has fifty votes in the senate, but it’s close, and I’m reasonably certain that the votes could be found if the procedural path existed.

I fear that such a strategy would only give Republicans even more motivation to filibuster  the first bill, but if this were to play out I would suggest one change. The second bill should not expand Medicaid but eliminate it and move Medicaid patients into a public plan. The goal of universal health care should be to provide a decent basement level of care for all Americans without keeping many in a second class status in Medicaid. Even backers of a Republican plan support the idea of giving  “lower-income Americans a way out of the Medicaid ghetto so they can have the dignity of private insurance.” This is one Republican idea which Democrats should seriously consider.

Reconsidering Mandates

During the battle for the 2008 Democratic nomination many of us backed Obama over Clinton partially due to his opposition to mandates which require individuals to purchase insurance. This has seemed like a lost battle since, in addition to many Democrats, the insurance industry has pushed hard for mandates if there are changes such as eliminating restrictions on preexisting conditions. If the insurance industry wants something it is possible some Republicans will make some noise but in the end they will vote for it. The coalition between the Clintonistas and Republicans in the pocket of the insurance industry seemed to prevent any reconsideration of mandates, until now.

Many liberals have had qualms about mandates. Some of us have objected on libertarian grounds while others were simply concerned about forcing people to purchase products from the insurance industry with its track record for mistreating customers. With more questions as to whether there will be a public option, some liberals are again questioning a mandate. Dean Baker still thinks a mandate will eventually be necessary but supports putting this off:

If we get the sort of insurance reform that President Obama has proposed, then mandates, or something very much like them, will be necessary at some point. But they will not be necessary from day 1. After all, not everyone is going to rush out to game the insurance system. It will take some period of time before the number of free riders grows enough to be a real problem.

We know that it will be necessary to revisit health care in the not too future in any case. The lack of mandates will help to ensure that this date comes sooner. Then we can talk about measures that will allow us to control costs, like a robust public plan.

But, if we can’t get a public plan in this round, why should progressives be pushing for a regressive tax that will go into the pockets of the insurance companies and their overpaid CEOs? Let the insurance companies try to make a living in the market, when they grow up and feel strong enough to compete with a public plan, then we can have mandates.

Digby adds:

In my view the Democrats are playing with fire in the worst way if they institute mandates without offering any option for reasonably priced insurance. In effect, they will be telling all the people who are currently uninsured that unless they buy unaffordable policies upfront (for which they may receive some money back at the end of the year when they file their taxes) that they must not just live in fear of getting sick — they are now criminals. I can’t think of a more politically inflammatory thing to do at a time like this. And the right will demagogue this thing in a way that makes Sicko look subtle by comparison.

I’ve always thought it was a political risk to create a new law that forced people to give money to insurance companies. It’s worked in auto insurance, but there’s a completely different set of risk factors involved and the costs are much more manageable for the average person. To get rid of the cost control mechanism while keeping the mandate is a recipe for political backlash…

It was never going to be easy to sell mandates, but they are making it substantially harder if they tank the public plan. They’re another bullshit compromise anyway, made before anyone even got to the table, just like single payer — health care should be paid for by higher taxes on the wealthy scumbags who are the only ones winning in this godforsaken economy anymore and the elimination of health insurance’s obscene profits. But in the interest of “going to the middle” the reformers went with mandates and now, without the public option, they’ll be stuck with a regressive tax that’s going to be very politically difficult to defend.

If the administration and the congress can’t be bothered to stick on the public plan, I see no reason why the left should stick with mandates.

Camille Paglia on Health Care Strategy and Protest

I probably would have ignored Camille Paglia’s column in Salon if not for this line:

Ever since Hillary Clinton’s megalomaniacal annihilation of our last best chance at reform in 1993 (all of which was suppressed by the mainstream media when she was running for president), Democrats have been longing for that happy day when this issue would once again be front and center.

I sometimes feel like I’m the only liberal who believes health reform failed in 1993 not because of the Harry and Louise ads but primarily because of Hillary Clinton.

Paglia is also very critical of Obama’s handling of health care reform. At this point I think some of  her criticism is valid, some is not, and some is just off the wall. There is nothing totalitarian, as Paglia claims, in the White House asking for help by sending in examples of false claims about health care reform in order to provide fact checking. It is not as if they are asking for names and rounding people up. (This  is also not unprecedented. As I’m also on a lot of  conservative mailing lists, during the 2004 campaign I often passed on examples of false claims being spread to my friends in the Kerry campaign if I thought they were not yet aware of them so they could prepare responses.)

As for her less outrageous criticism,  before we can judge Obama’s strategy on health care reform we need to see whether or not it turns out to be successful. After all, much of Obama’s political strategy is to do the opposite of Hillary Clinton. Clinton tried to write health care legislation in secret and insisted on doing it her own (megalomaniaca) way. In response Obama is doing it out in the open and leaving the details of legislation to Congress (sort of how things were originally designed in the Constitution). He did try to rush the legislation too quickly  but the misinformation campaign from the right wing shows why this was desired.

If health care reform does pass, then in retrospect  Obama’s political moves which are now being criticized will be seen as genius.

Pagilia also shares my criticism of Nancy Pelosi and other liberals who have been attacking those protesting health care reform. Rember, protest is patriotic.

Update: Outside links to this post have brought in a lot of comments repeating the usual right wing misinformation.

I am not going to waste time on this post responding to the ridiculous claims that the bill will lead to “death panels” as this was recently reviewed in several posts including here, here, and here.

Nor am I interested in any of the whining that Obama supported a single payer plan in the past but now says he doesn’t. Obama has made it clear that in the past that a single payer plan was his preferred plan if starting from scratch, but the realities are that we must work with our current plan.

Sure, Obama is trying to some degree to cover himself with both supporters and opponents of a single payer plan. All politicians do this on many issues. The real issue is not what Obama’s personal views are now compared to what they were in the past but the plan which is now on the table.

For conservatives who think there is a plot to sneak in single payer: the White House has been pretty strong in rejecting the idea of a single payer plan and the proposed laws bend over backwards to try to appease the insurance companies.

For liberals who are upset that Obama is not pursuing a single payer plan: there is no chance of this passing. All the current opposition to the current plans would be greatly intensified if those who are satisfied with their own insurance, along with those who are paranoid about government plans, were really to be forced to join a government plan.

Many other issues related to health care reform are discussed in other posts here in the health care topic.

ObamaCare vs. HillaryCare

Health care reform died in the 1990’s for many reasons. Yes, the scare campaign from right played a big part but miscalculations by the Clintons were also a major factor. Despite the attempts of the right to attack health care reform today as ObamaCare and claim it is essentially HillaryCare, there are major differences.

HillaryCare went far beyond current plans. While I don’t entirely agree with Ezra Klein’s analysis, it does provide some perspective as to the differences then as compared to today. Among the differences, while managed care was around to a greater degree than it would seem from Klein’s article by the early 1990’s, healh care has changed considerably since then.

I agree with Klein’s basic premise that the emergence of managed care necessitated greater degree of government regulation to protect beneficiaries from the trend by insurance companies to deny coverage to increase profits, I disagreed with the idea of HillaryCare to cope with the situation with an overly bureaucratized and complicated plan.

The problem with Hillary Clinton was not only that her mind set was to deal with everything with overly complex government control, but that it had to be done her way. Her government philosophy is basically that of George Bush with more liberal tendencies is some areas. The health care plan was written by the Clintonistas in secrecy. Hillary convinced Bill to even threaten to veto anything which might be passed by Congress which differed, giving us essentially a choice between HillaryCare or nothing.

The situation is quite different now. The insurance crisis has become far worse with doing nothing no longer being a viable option. Obama is handling the crisis far different from Hillary Clinton. Obama is far more concentrated on seeing the problems fixed than on imposing any specific plan. Despite talk of ObamaCare from the right, the details are actually being worked out in Congress.

The unfortunate reality is that there is no perfect fix to health care. Every conceivable plan has its problems, but we need to compare plans under consideration with the problems we now face, now with a perfect world. The House Democratic plan (with all details not yet determined) has many aspects which I do not like but it is preferable to doing nothing. The plan is certainly not like it is being distorted by many scare stories from the right.

One question still out there is whether the House plan is our only option or whether other possibilities will be raised. There are still some supporters of a  single payer system but that appears to be a dead end politically in this country. The Republicans talk of offering a plan but they generally speak in generalities which are easier to support while they avoid answering the hard questions. There is one wild card remaining. Senate Finance Committee Chairman Max Baucus is still working on a plan which might achieve bipartisan support and nobody knows where he is going with this. A key difference from the Clinton years remains that, should his committee come up with a viable alternative, it would have a chance of being considered.

Cost Savings And Health Care Reform

The Congressional Budget Office is agreeing with what I’ve been saying all along. While health care reform is designed to accomplish some very good goals, it will not save money as the Obama administration has claimed.

If priority is placed spending less money we would have to go to a more scaled back plan (which the left would protest) or perhaps change to a more economical single payer system (which the right would protest). The other option is to significantly ration care–which everyone would be unhappy about.

Another option might be to consider our priorities and acknowledge that having a high quality health care system which is consistent with American attitudes towards choice, and which is accessible to most Americans, costs money but is a worthwhile expenditure.

Health Care Reform and Ideology

Will Wilkinson comments on Ezra’s Klein’s frustration with Rahm Emanuel’s being willing to compromise on specifics of health care legislation as long as the key goals are met  (which I discussed earlier). Wilkinson wrote:

Bush couldn’t reform Social Security because his plan was unpopular. Obama won’t be able to deliver a health-care bill ideological Democrats want, because what they want is unpopular and legislators know it. So Congressional Democrats want something they can cast as “victory” while doing nothing that could hurt their noble struggle for ongoing political self-preservation. Right now, strongly ideological media liberals like Klein have to decide whether they’re going to (a) act as enforcers, sending the signal to the powers-that-be that they will vocally and publicly count a “trigger” plan as a pathetic failure, or (b) sigh and prepare to declare whatever legislation passes a profound victory for ordinary Americans that shows just how great Democrats are.

I’ve noted many times before, there is widespread support in polls for health care reform, including a public option. Wilkinson is also at least partially correct in commenting:

Reform is very popular in the abstract. Even a government-run system. But most people are quite satisfied with their current plans. So support for systemic changes turns out to be shallow. This is what Clinton learned. As soon as people get the sense a new policy will force a change in their own situation, they break off. That’s what Obama’s people are worried about, and why the constantly return to the “you won’t have to change anything” refrain, even though the goal is to have everybody change into the government plan sooner or later.

When we write about the need for health care reform it only makes sense to concentrate on the millions who are uninsured, under-insured, or have been screwed by the insurance companies. The fact remains that millions of other people are happy with their current plan and prefer to remain in their plan as opposed to being forced into a government-run plan. They might be wrong, such as in thinking they have good coverage only because they have not yet run into a situation where their insurance company has tried to deny coverage, and they might be falling for untrue claims about government-run plans, but they will still vote based upon such beliefs.

A public plan could be advocated either as a way to keep the insurance companies honest or as a back door path to a single payer plan. Those who are pushing for it as a way to get to a single payer plan are unlikely to compromise. For those of us who are more concerned with changing the behavior of insurance companies, it makes sense for Emanuel to stress goals rather than drawing a line in the sand with regards to the public option.

The “strongly ideological media liberals like Klein” might only have the two options Wilkinson mentioned. Personally I chose an alternative option. I have long suspected that we will wind up with a compromise which falls short of what the progressive wing of the Democratic Party wants. The question is not whether they get everything but whether we have a bill which has positive results with regards to improving access to health care and making it more difficult for insurance companies to deny coverage. Even a watered down plan is likely to be far more comprehensive than what the Democrats were running on in 2004.

It isn’t a matter of declaring victory or proving “just how great Democrats are” but in being realistic in hoping for some improvements without expecting perfection. Our political system was set up to prevent the ideological extremes from usually getting everything they want. Sometimes this might be frustrating, but this reality was also beneficial when George Bush was in office.

Will the Left or Right Kill Health Care Reform?

It is far from certain at this point whether health care reform will succeed. Most insiders believe that Congress will enact some form of comprehensive health care reform but it is easy to envision scenarios where they are not successful. The opposition comes mainly from the right, but there is also the view (perhaps as this is more of a man bites dog storyline) that it is the left which will cause health care reform to fail. Cici Connolly of The Washington Post examines how some activists are targeting Democrats:

In recent days — and during this week’s congressional recess — left-leaning bloggers and grass-roots organizations such as, Health Care for America Now and the Service Employees International Union have singled out Democratic Sens. Ben Nelson (Neb.), Mary Landrieu (La.), Ron Wyden (Ore.), Arlen Specter (Pa.) and Dianne Feinstein (Calif.) for the criticism more often reserved for opposition party members…

Much of the sparring centers around whether to create a government-managed health insurance program that would compete with private insurers. Obama supports the concept, dubbed the “public option,” but he has been vague on details. Left-of-center activists want a powerful entity with the ability to set prices for doctors and hospitals.

But in the Senate, where the Democrats do not have the 60 votes needed to stop a filibuster, members are weighing alternatives such as a nonprofit cooperative or a “fallback” provision that would kick in only if market reforms fail.

Pushing for the public plan does have popular support but Connolly notes that this does not mean that a majority supports the entire agenda of those on the left who see a public plan as a means of transitioning to a single payer plan. She notes that, “While recent polls show high initial support for a government option, the number declines if told the insurance industry could fold as a result.” Many who support providing the option of a public plan also desire to continue with their current insurance.

There are signs that this pressure is influencing some Democrats but others fear this is counterproductive:

One Democratic strategist who is working full-time on health reform was apoplectic over what he called wasted time, energy and resources by the organizations.

The strategist, who asked for anonymity because he was criticizing colleagues, said: “These are friends of ours. I would much rather see a quiet call placed by [Obama chief of staff] Rahm Emanuel saying this isn’t helpful. Instead, we try to decimate them?”

If this effort is based upon pushing Democrats to support the public plan there should not necessarily be adverse consequences on the success of health care reform. Of greater concern is talk among some progressives of voting against a health care reform bill which does not contain a public plan. I can envision scenarios where Republicans have enough votes to filibuster a bill which contains a public plan, but a bill without a public plan could also fail if both Republicans and some progressives vote against it.

The goals should be to reduce the number of people who lack insurance and to reduce insurance problems such as people being cut off when they develop a serious illness. These are serious problems which need to be addressed and there are multiple possible solutions. Ideological battles such as over whether to have a single payer plan should not be used to prevent meaningful reform, even if the reform will inevitably fall short of what some desire.

Paying Doctors

There’s been a lot of talk lately about changing how physicians are paid as a part of health care reform. Many have recommended that pay for primary care physicians be increased, arguing that this will increase the number of doctors practicing primary care, leading to higher quality care along with lower costs. As a primary care physician I totally agree with this. There have also been bad ideas raised, such as returning to capitation despite how badly this idea has failed in the past. Today The New York Times has a round table on physician reimbursement.

Elliott S. Fisher, a professor of medicine and director of the Center for Health Policy Research at Dartmouth Medical School, recommends:

One approach that has shown some early promise is to combine the fee-for-service with “quality bonuses” and “shared savings” payments when they reduce spending growth for all of their patients. Doctors, hospitals and society should realize that slowing spending growth would not require dramatic cuts in income under a system where providers would be rewarded for better care, not just more care.

In general that is what some are now trying, but so far such ideas have been poorly implemented. One major problem is that it is hard to measure quality and tell what is really going on in all the offices around the country. At present incentive payments are so low that it often isn’t worth the administrative expenses to submit the data to qualify. General measures of quality often do not apply in specific cases. While practice guidelines are often written for a specific disease, in the real world patients have multiple problems and sometimes the recommended care for any specific condition is not the appropriate care for the individual patient.

Sometimes insurance companies will try to analyze whether a patient is receiving all the appropriate medications based upon diagnoses submitted. The entire concept is flawed as often diagnosis codes are used for suspected ailments to justify testing, and sometimes one person seeing a patient enters a diagnosis into the system which is simply incorrect. Even if they have the correct diagnosis, particular medications might be not be tolerated by certain patients, or a patient might simply refuse to take them. Sometimes the actions of doctors to help patients turns out to be counterproductive with regards to quality measurements. We might give a patient samples, or switch the patient to a generic medication they can receive for less than their insurance co-pay at certain pharmacies. To the insurance company it appears that the patient is not receiving a needed medication.

Steffie Woolhandler and David Himmelstein, associate professors of medicine at Harvard Medical, note that every system has its flaws:

There are a variety of bad ways of paying doctors, but no particularly good ones. Fee-for-service health care rewards the overprovision of care; capitation (a set monthly fee per patient) rewards underprovision; and salaries reward just showing up. The minority of physicians (and hospital administrators) who are motivated mostly by money will find a way to game an incentive system rather than do the hard work of providing excellent care.

Even paying doctors based on quality measures (using data from medical records that the doctors themselves create) can be fudged.

They support a single payer system, noting the tremendous cost savings on administrative expenses, but that still leaves the question of how to pay doctors unanswered.

Liam Yore, an emergency room physician, points out a serious problem with the current system:

The underlying cause, however, is a bias within the physician compensation system that extravagantly rewards surgical procedures performed compared to “cognitive” services like diagnosis and medical management. In the E.R., for example, sewing a facial laceration pays far better than accurately diagnosing a heart attack. The same principle applies to any procedure — from angiograms to colonoscopies.

The predictable consequence is that physicians gravitate toward lucrative procedural specialties. They perform more and more procedures, using expensive new technologies, driving costs ever higher.

Meanwhile, office-based primary care doctors struggle. The compensation for an office visit is a tiny fraction of that for the simplest procedures. The family physician must rush from patient to patient just to keep pace with static or diminishing reimbursement. Fewer and fewer medical students are going into primary care.

What we need to do is rebalance physician compensation away from procedures and toward primary care. Surgeons can easily earn three to five times the average salary of a family doctor. The compensation for surgical procedures should be reduced, and the savings realized should be applied toward increasing pay for primary care physicians.

Better-compensated primary care specialties would attract more doctors who would be able to spend more time with their patients. They would require fewer expensive diagnostic tests like M.R.I.’s and rely less on specialists. Accordingly, the use of expensive and invasive procedures would decline. Prevention, wellness and chronic disease management would be encouraged: enhancing quality and patient satisfaction, but at a far lower cost.

Primary care is the linchpin to successful health care reform. Ignore it, and reform will fail. Make it an appealing career choice, and the odds of success increase greatly.

The Public Option and Ideology

Nate Silver provides a strong argument that opposition to a public plan as part of health care reform can only be justified based upon adherence to conservative ideology. After all, the facts clearly show that Medicare, the government plan that a public option would be modeled upon, provides health care coverage far more efficiently and economically than private insurance does–and even receives greater satisfaction in polls from beneficiaries.

The only  reasons to be strongly opposed to offering a public plan as an option would be either a financial interest in the insurance industry or a knee-jerk opposition to government action regardless of whether it is actually beneficial. Of course those who hold such views typically get their information from conservative sources which cherry pick the facts to show what they believe.

While Silver is right that opposition to a public plan is primarily based upon ideology, the same can also be said about those who see a public plan as crucial to the point of attacking supporters of health care reform who are wavering on this issue. Many who insist upon a public option are actually supporting this as a means of ultimately establishing a single payer system. Of course conservatives who believe that the private market is always better than government should have noting to fear as their ideology clearly argues that government cannot compete with the market. Silver points out that this is true in many areas, but health care coverage is different.

If health care reform was truly successful then a private option would not be necessary. There are really two reasons to insist upon a public plan. In many cases it is every bit as ideological as those who oppose the public plan. In other cases such support is based upon pragmatism, as many fear that, regardless of the laws that are passed, it will be impossible to prevent insurance companies from continuing to game the system to maximize profits by finding ways to deny needed care.

Update: Paul Krugman is kind to provide an example today of support for a public plan which is largely motivated by ideology. Obama, in contrast, provides an example of pragmatism in recognizing that it is foolish to risk reform by drawing lines in the sand. We saw where that got us with HillaryCare.

Sharyl Attkisson of CBS provides a good example of the misinformation which is being spread to attack the public plan. She writes:

And if you do choose a public plan, you may want to keep your favorite doctors but they may not want to keep you. Under government health care, they could be paid 20 to 30 percent less.

With suggestions that the public plan will pay at 10% over the Medicare rate (or even at Medicare rates in the worst case scenario) this fear mongering doesn’t hold up. As I noted when the first outlines of the Senate Health Choices Act were leaked out, this would be very beneficial to physicians in primary care. I noted that a quick review of reimbursement for common charges such as office calls showed that most private plans paid more than Medicare but by less than ten percent.

Primary care physicians would likely make more money from patients in the public plan than from employer-paid health care. It is likely that some subspecialties will come out behind, but as long as primary care physicians are doing better under the public plan than from private insurance there will not be major issues with regards to access to care. It is difficult for surgeons and subspecialists to refuse to accept referrals based upon insurance coverage, especially if a plan has many subscribers.

There are some physicians who do not accept Medicare, but there are also private plans I do not accept as they pay significantly less than Medicare. In making such comparisons it is also important to consider the cost of participating in a plan. While it is necessary to increase staffing due to the burdens imposed by some plans, Medicare is simple to bill to and pays reliably. With clams sent electronically to Medicare my collection rate is pretty close to 100%, with the rare rejections generally resolved after correcting a minor error in the initial claim.

Poll Shows Report For Health Care Reform

The New York Times has published yet another poll on health care reform. The polls  shows the same results as most earlier polls:

Americans overwhelmingly support substantial changes to the health care system and are strongly behind one of the most contentious proposals Congress is considering, a government-run insurance plan to compete with private insurers, according to the latest New York Times/CBS News poll.

The poll found that most Americans would be willing to pay higher taxes so everyone could have health insurance and that they said the government could do a better job of holding down health-care costs than the private sector.

Yet the survey also revealed considerable unease about the impact of heightened government involvement, on both the economy and the quality of the respondents’ own medical care. While 85 percent of respondents said the health care system needed to be fundamentally changed or completely rebuilt, 77 percent said they were very or somewhat satisfied with the quality of their own care.

The first two paragraphs show why the Republican arguments against health care reform have not been very effective. Americans see a need for increased government involvement and are not swayed by Republican chants of “socialized medicine.” While some Democrats have backed away from the public plan, the poll showed that 72% support a government run plan like Medicare while only 20% are opposed. Americans are even willing to pay higher taxes to achieve health care reform.

Proponents of health care reform are most likely to quote the first two paragraphs and ignore the third. It must be remembered that while there are tens of millions who are uninsured and under-insured, there are also a tremendous number of people who are satisfied with their coverage. In some cases this is because they have been healthy and are unaware of the risk of losing coverage should they develop a serious illness and actually need the coverage. In other cases they really do have good coverage.

Regardless of the reason, a large majority are satisfied with the quality of their own care. While economically a single payer plan would make more sense, politically this is not feasible. If a plan is going to be accepted in this country, it is necessary that it be designed to help those who do need help and leave those who are satisfied with the option of continuing their current coverage. Legislation should ensure that those who are happy with their current coverage really have the coverage they believe they do, and that the coverage not be terminated once they become seriously sick.

There are also ambivalent feelings with regards to government involvement in medical decision making:

Three of four people questioned said unnecessary medical tests and treatments had become a serious problem, suggesting that they would support calls by health researchers for a payment system that would better reward appropriate care. But an even higher number, 87 percent, said the inability of people to have the needed tests and treatments was a serious problem.

Being concerned with both appropriate care and ensuring the ability to have needed tests and treatments makes sense. While calling for appropriate care in principle makes sense, it is very difficult to actually measure this. Treatment guidelines are often helpful and more should be done to ensure that they are followed when appropriate. However treatment guidelines cannot be strictly applied in every case. Individuals do vary in their response to treatment. Individual preference does often make it necessary to make changes. Treatment guidelines are typically written for a specific disease but individuals typically have more than one medical problem making the recommendations for one condition inappropriate for each individual patient. While health care reform should encourage appropriate care, it could also be dangerous if this is decided on a bureaucratic level.

Update: Maggie’s Farm questions the results because “73% of respondents who said they voted in 2008 only 34% voted for McCain and 66% for Obama. The actual vote was 46% (corrected) McCain.” This is most likely explained by the considerable decrease in people identifying as Republicans since the election. I suspect that any poll taken now would show that far more people will claim they voted for Obama than McCain as opposed to how they actually voted.

Regardless, this objection is only a concern if the exact numbers are an issue. The key results of the poll, such as support for health care reform, higher taxes to pay for it, and support for a public plan, have been present in multiple other polls. At worst this poll exaggerates the numbers on these issues, but more likely it is a case of less people saying they voted Republican than actually did.