San
Diego Union-Tribune (CA) April 2, 2019
April 02-- Apr.
2--Though the ruinous consequences of high health care costs don't follow party
lines, Republicans tend to believe they're getting more for their money than
Democrats and independents do, according to the results of a new nationwide
survey released today by San Diego's West Health.
The nonpartisan and
nonprofit organization created by philanthropists Gary and Mary West worked
with market research firm Gallup to poll 3,537 randomly-selected Americans
across all 50 states and the District of Columbia, asking questions designed to
gauge the impacts of and attitudes surrounding health costs.
West, also known
for its work building health care clinics and other resources for seniors, has
made health care costs its main policy focus convening its sixth-annual Health
Care Innovations Summit in Washington this week.
The survey results
come at a particularly polarized moment as the Trump Administration reportedly
works behind the scenes with a handful of conservative think tanks to build an
Affordable Care Act replacement as it simultaneously pushes forward with plans
to have the legislation eliminated. Meanwhile, Democrats are coming forward
with their own health reform ideas amid cries of Medicare for all.
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While much of the
national health care debate tends to revolve around specific proposals that
increase health insurance coverage for one group or another, Tim Lash,
president of the West Health Policy Center, said the organization thought it
was important for policy makers to get a fresh take on how regular Americans
are impacted by health care costs, which continue to rise despite already being
the highest among industrialized nations.
Pollsters found
that 26 percent of the people they surveyed said they did not seek treatment
due to the cost of care. That ratio was similar regardless of political party,
and that fraction, Lash noted, translates to about 65 million Americans who are
actively avoiding needed treatments and medications with price tags they find
affordable.
"Republicans,
Democrats, independents, the rich, the poor, the middle class, they're all
skipping treatments, they're all not filling prescriptions, they're all
borrowing money to afford care," Lash said.
And yet, despite
suffering these indignities across the board, survey results showed a
significant disparity in terms of the perception of American health care
quality. According to survey results, 67 percent of Republicans thought their
nation's health care system was "among the best in the world"
compared with just 38 percent of Democrats and 46 percent of independents.
Academia has long
found that America, despite spending the most, does not rank near the top in
most broadly based measures of health care outcomes.
"When you look
at just about every measure of performance -- we're 28th in life expectancy,
31st in infant mortality, 16th in heart attack mortality -- we're only No. 1 as
it relates to cost," Lash said.
These disparities
have been studied in depth over the last 20 years by the Commonwealth Fund, a
nonpartisan health care think tank which examines 1,200 different health
measures across 30 industrialized nations to paint a picture of differences and
similarities from country to country.
Dr. David
Blumenthal, the fund's president, said Monday that, through those 20 years of
research, it's clear that America does not get the kind of health care results
that other nations do per dollar spent.
But that disparity,
though it has been reported to the public for many years, has not universally
affected the average American's perception of health care quality. That
probably, experts say, because not everyone sees outcomes like average infant
mortality or average life expectancy to be the main measure of quality. Some,
Blumenthal notes, are more open to these kinds of stats than others.
"It's very
hard to present these kinds of data to people in the United States in ways they
find convincing if they're not already critical of the health care
system," Blumenthal said. "That may be why Democrats are more prone
to accept that information. Their leaders are more prone to talk about it, and,
therefore their followers are more likely to be aware of it."
But there is an
alternative narrative that explains the political disparity on health care
quality.
Lanhee Chen,
director of domestic policy studies at Stanford University's Hoover
Institution, one of three think tanks rumored to be working with the Trump
administration on an ACA replacement, said many Americans think of factors like
the ability to choose which provider they want to see and access to
cutting-edge treatments when they're asked by a pollster to opine on American
health care quality.
"Most
progressives, I think, would argue that equity is a paramount value in health
care, whereas conservatives might say the important factors are choice,
optionality and access to innovative cures," Chen said.
But, regardless of
political affiliation, a vast majority of Americans -- 76 percent -- believe
that the cost of health care is too high relative to quality delivered.
And here, Lash
said, is where West believes the public should focus. He noted that survey
results found that only about one in 10 Americans had recently contacted their
elected representatives about bringing health care costs down. And that's a
shame, he added, because there are several first steps that could be taken to
shrink the health care price tag, such as giving Medicare power to negotiate
drug prices, mandating that doctors move away from quantity-based payment and
requiring health care price transparency.
Lash said the
consequences of public disengagement on the issue are stark. He cited a recent
study in the Annals of Emergency Medicine, which estimated that 125,000
Americans die every year because they haven't taken prescribed medications, and
of those, about two-thirds of those people aren't filling their prescriptions
because they're unaffordable.
"That data
suggests that roughly 85,000 people die every single year just as a result of
not being able to afford their medications. To put that in context, during the
entire Vietnam War roughly 59,000 soldiers were killed in action," Lash
said. "Where are the protests in the streets over this?"
To start a more
regular dialogue on the issue among those outside the world of health care
economics, West is planning to launch a new website, healthcostcrisis.org,
this week.
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