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Fear Rules Health Care Reform

There are two groups of Americans that tend to oppose the public option so vigorously discussed in the present national debate about health care reform. Each fears something different. Younger Americans with no direct experience with the major federal health insurance and provision programs, Medicare, Medicaid and the Veterans Administration program, have been made to fear a federal option by the enormous advertising and propaganda efforts by the health insurance industry. Many have no experience with private health insurance. Ironically, older Americans and veterans have very positive views based on solid experience with government run programs, but they too often oppose the public option and other reform efforts because they fear losing some of the benefits they now enjoy, especially because they hear demands for cost cutting.

There are many fascinating survey and poll results that merit your attention.

A recent ABC News/ Washington Post poll found 62 percent of Americans expressing support for "having the government create a new health insurance plan to compete with private health insurance plans." Other pollsters describing the public option as "government administered" and "similar to Medicare" gauged even more positive reactions: 67 percent in a Kaiser Family Foundation poll in April and 72 percent in the most recent CBS News/ New York Times poll.

Consider some results about trust obtained by the Kaiser tracking poll. When asked how much they trust various health care players "to put your interests above their own," respondents rank doctors (78 percent trust "a lot" or "some") and nurses (74 percent) at the top of the list. Among those insured through Medicare, however, "the Medicare program" (68 percent) scores nearly as high. Among those with private insurance, "your health insurance company" earns much less trust (48 percent).

More data come from a set of surveys known as the Consumer Assessment of Healthcare Providers and Systems. CAHPS is an initiative of the Department of Health and Human Services that developed a standardized survey questionnaire used by virtually all health insurance plans -- public and private -- to assess patient satisfaction. Thanks to CAHPS, we have a massive collection of data comparisons of how patients experience and rate Medicare, Medicaid and private insurance. Those comparisons show the depth of Medicare's popularity. According to a national CAHPS survey in 2007, 56 percent of enrollees in traditional fee-for-service Medicare give their "health plan" a rating of 9 or 10 on a 0-10 scale. But only 40 percent of Americans enrolled in private health insurance gave their plans a 9 or 10 rating.

Sounds right when you learn about things like this: health insurers reject 1 in 5 medical claims. Six of the state's largest insurers rejected 45.7 million claims for medical care, or 22 percent of all claims, from 2002 to June 30, 2009, according to a recent California Nurses Assn.'s analysis of data submitted to regulators by the companies.

Moreover, the higher scores for Medicare are based on perceptions of better access to care. More than two thirds (70 percent) of traditional Medicare enrollees say they "always" get access to needed care (appointments with specialists or other necessary tests and treatment), compared with only 51 percent of those with private insurance.

Both the ABC/ Post and Kaiser surveys found that while Americans react favorably to the basic concept of a public option, they are easily swayed by arguments about having an unfair advantage against private plans or being the "first step toward single-payer, government-run health care." Using the latter argument, the Kaiser survey moved support from a 67-to-29 percent majority favoring the public option to a 41-to-50 percent margin opposing it. Apparently, many people really don't understand that Medicare is a single-payer system.

In other words, despite the positive experience with Medicare, many people seem easily talked out of expanding on it. This can be explained.

First, younger Americans not enrolled in Medicare do not share the enthusiasm of seniors for the program. Six years ago, the Kaiser Foundation asked a national sample of adults to rate the Medicare program. Medicare was hugely popular among those aged 65 or greater. An impressive 80 percent rated Medicare favorably. Similarly, more than half of seniors (62 percent) considered Medicare "well run" compared to only 28 percent willing to say the same of "private health plans such as PPOs and HMOs that people get through their jobs." A rather striking finding that should make the public favor the public option.

However, those under 65 had very different views. Only 45 percent rated Medicare favorably. Only 36 percent considered it well run, as compared to 47 percent who said the same about private health plans. While 73 percent of those over 65 said Medicare allowed patients to choose any doctor, only 28 percent of those under 65 agreed. Apparently they have not spoken to enough older people.

Here is another problem. Older Americans who like Medicare see little to gain from the public option since they like the coverage they have now. Uncertainty breeds fear. Democratic pollster Stanley Greenberg finds "little support among seniors" for reform. A recent survey conducted by Greenberg's Democracy Corps found a narrow plurality among all voters favoring "President Obama 's plan to change the health care system" (43 percent to 38 percent), but net opposition among seniors (34 percent to 50 percent). This indicates that promises must be made to keep Medicare benefits, despite cost-cutting efforts. But why should seniors believe Obama and other politicians?

Here is the logical conclusion: Americans experienced with "government-run" health insurance like what they have and don't want to change it and younger Americans are ignorant or fooled; they really don't know what they're missing or what the private insurance industry wants to withhold from them. It is also apparent that there is real merit in offering Medicare for everyone, rather than preserving the highly profitable but awful private health insurance industry that no one in their right mind should trust.

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Joel S. Hirschhorn has succeeded as: a full professor, University of Wisconsin, Madison; a senior staffer, U.S. Congress (Office of Technology Assessment); head of an environmental consulting company; Director of Environment, Energy and Natural Resources, National Governors Association; now an author and consultant. Recent books are: Sprawl Kills - How Blandburbs Steal Your Time, Health and Money, and Delusional Democracy - Fixing the Republic Without Overthrowing the Government. He has published hundreds of articles in newspapers, magazines, journals and on many web magazine sites. He has given hundreds of talks at a wide range of conferences worldwide. He focuses on American culture, politics and government, and health issues.