Consumer Power Report #175

Published April 24, 2009

If you don’t do anything else today, read this blog, “The Data Model That Almost Killed Me.” It is by Joe Bugajski and describes his experience with electronic health information during a personal medical crisis. It is a tough read. No fun. It is also “just” an anecdote that will be dismissed by statisticians. But, my friend, so is your life–“just an anecdote.” It is also the best description I have ever seen of why the concierge, direct practice, medicine movement is so important. You don’t need a computer when you are at risk of death. You need a doctor who knows you, knows your family, and will be your champion in dealing with the medical bureaucracy that is the current “Medical Center.”




The Rasmussen Survey firm finds the great divide in America is not between Republicans and Democrats but between most Americans and the “political class.”

It asks three questions when segmenting these populations:

  • Generally speaking, when it comes to important national issues, whose judgment do you trust more–the American people or America’s political leaders?
  • Some people believe that the federal government has become a special interest group that looks out primarily for its own interests. Has the federal government become a special interest group?
  • Do government and big business often work together in ways that hurt consumers and investors?

Those who answer two of the three questions one way are considered populists and those who answer the other way are put in the political class. Rasmussen finds that 55 percent of the population fit in the populist group while only 7 percent are in the political group. The populist group is split evenly, with 37 percent being Republicans, 36 percent Democrats, and 27 percent independent.

The differences in attitude show up in profound ways when looking at issues. For instance, the survey finds that 51 percent of the public viewed the recent tea parties favorably, while only 13 percent of the political class did. Rasmussen says, “Among the Political Class, not a single survey respondent said they had a Very Favorable opinion of the events while 60 percent shared a Very Unfavorable assessment.”

A similar divide exists on the bailout. The public opposed the bailouts by a 59 percent to 26 percent margin, while the political class supported them by 61 percent to 23 percent.

This helps explain the baffling disconnect between what you see in your life and what you hear from the media. The political elite is drawn to positions of influence and dominate the universities, politics, and media. Rasmussen finds that 22 percent of government employees are in the political class while only 4 percent of private-sector workers are.


The Kaiser Family Foundation, Harvard School of Public Health, and National Public Radio are cosponsoring a series of public opinion polls on health care issues. These surveys have Bob Blendon’s stamp all over them and he is without question the best pollster in the country on these issues.

For instance, they released one survey as part of their ongoing tracking poll about public attitudes on health reform issues, which we’ve reported on here before. The survey finds wide support for the need for health reform–56 percent say the country would be better off and 43 percent say their own families would be better off if health reform is passed.

Most pollsters would stop there, but this poll goes way beyond that to ask what people mean when they say they support reform. It offers eight specific reform ideas and finds the most popular is making Medicare available to people at age 55 and the least popular is single payer. The poll also finds a strong partisan divide on many of these issues, with 71 percent of Democrats but only 39 percent of Republicans supporting a public option.

But much of the support changes when people get more information. Support for an employer “pay or play” mandate is high at 71 percent in favor vs. 25 percent opposed, but when told that such a requirement would cause some employers to lay-off some workers support plunges to 27 percent vs. 65 percent opposed. But when people are told that some employers offer coverage while others do not support rises to 78 percent vs. 17 percent opposed. There are similar effects on other specifics and the authors conclude that public opinion is “malleable.”

SOURCE: KFF Tracking Poll


The same team conducted another survey of public attitudes on the health care delivery system. The findings do not support the current push for health information technology, comparative effectiveness research, or moving away from fee-for-service medicine.

The most interesting part of this was the findings about opinions on electronic medical records and privacy. Again, the initial finding is that 75 percent of the public think EMRs are very or somewhat important, but when you drill down the picture gets more cloudy. Seventy-six percent think it is very or somewhat likely that “an unauthorized person would get access to your medical records” if a system were adopted that was available online, but 72 percent think their own doctor would do a better job of “coordinating your care,” yet most people (52 percent) do not think such coordination is a problem. That is true even for people who have seen four or more doctors in the past two years: 50 percent say coordination has not been a problem.

People do not think health IT would lower health care costs, with only 22 percent thinking the nation’s costs would go down and 34 percent thinking costs would rise. For their own families, only 12 percent think EMRs would lower costs while 39 percent think they would raise costs.

People also think under-treatment is a bigger problem than over-treatment, with 49 percent saying people getting too many tests or treatments is a “major problem,” but 67 percent saying NOT getting the tests and treatments they need is a major problem. And yet, in their personal experience neither of these have been a “major problem.” Only 16 percent say they themselves have received unnecessary care and 14 percent say they did not get care they needed.

Importantly, 72 percent of the public believe there is not always “clear scientific evidence” for the care that patients receive. They have less confidence in government agencies recommending effective treatments than in “independent scientific organizations.”

They also do not believe their own doctor has ever recommended an expensive test or treatment when a less-expensive one was available (9 percent think that has happened but 87 percent think it has not happened) or recommended a less-effective test or treatment because it was less expensive. And 70 percent support fee-for-service payment over capitation or salaried payment of physicians (25 percent).

The survey asked the uninsured how much they would be willing to pay for health insurance coverage and found a large majority (64 percent) would be unwilling to pay more than $100 a month.

SOURCE: KFF Delivery System Survey


I was invited to be one of the speakers at a briefing of the Congressional Health Care Caucus, chaired by Rep. Michael Burgess, M.D. (R-TX) in the Capitol this week. I was joined by Rick Scott of Conservatives for Patient Rights and Nicholas Gettas, MD, chief medical officer at CIGNA. There were about 40 people in the audience, mostly media, including television crews from Japan and China.

The event was written up in Congressional Quarterly and summarized in the Kaiser Network Daily Report. It was also web cast and is available at the Caucus Web site.

I also had a letter to the editor published in Business Insurance responding to a commentary by Joanne Wojcik that disparaged this publication. I work too hard on these things to be so easily dismissed.

CHCC member Bob Hamilton, MD, has had op-eds published in several newspapers in Illinois urging readers to “Beware of a Federal Takeover of Health Care.” He writes that the Feds are already botching their responsibilities–“The Medicare Trustees calculate the current, unfunded liability of Social Security and Medicare to be $101.7 trillion, $85.9 trillion of which is due to Medicare.”

Dr. Hamilton ticks through all the straw men that are used to justify a federal takeover of health care and shows how ill-informed they are. He then suggests a number of more reasonable remedies to the current problems and concludes, “It is critical to allow the private sector to innovate without being suffocated by Fanny Med foolishness, legitimized by Congress through the inappropriate use of the Budget Reconciliation Process. Your control of your own health care, with assistance from health care professionals of your own choosing, requires that we make wise health care reform decisions now.”

SOURCE: Alton Telegraph

Another CHCC member, Dr. David McKalip, had a similar op-ed in the St. Petersburg Times that focuses even more on the prospect of care being rationed by the federal government. He begins by saying, “For decades, American physicians have provided the best medical care in the world to Americans and others who come to our shores to escape the medical systems established by their governments.” But all that may change if the current push for government control continues.

He cites as an example of what will likely happen: Britain’s NICE program that rations care based on the value of a “Quality Adjusted Life Year,” which has been placed at $45,000. “Medical care above that cost is denied, like the life-saving drug Herceptin for breast cancer.” He says there are two ways to solve the problem of Medicare costs–“Change Medicare to an economically sustainable program through sensible reforms that respect patients’ rights and individual savings, or ration health care. Congress has chosen the latter.” He describes what can happen in such a system and concludes, “There are better ways to provide high quality medical care at the lowest cost. They are based in the traditions of American freedom and ownership of an individual’s savings to pay for their own health care.”

SOURCE: St. Petersburg Times

Rick Scott spells out his vision for “Conservatives for Patient Rights” on (of all places) Matthew Holt’s Health Care Blog. He proposes “four pillars” of patients rights: “choice, competition, accountability, and responsibility.” He says, “the danger of Washington’s recent willingness to spend inordinate sums of money on anything deemed to be a problem, is that we are conditioning ourselves to believe that our government has unlimited resources–and that any problem can be solved by simply spending vast amounts of cash.”

Obviously Mr. Scott is right. But the reaction from Mr. Holt’s readers is stunning. The vitriol is without limit. And these are the people who call Republicans “mean spirited?!?!” Very sobering.

SOURCE: The Health Care Blog.

Speaking of Rick Scott, his company, Solantic, issued a report a few months ago on how much money can be saved by using its physician-staffed urgent care centers rather than a hospital emergency department for conditions such as minor lacerations and upper respiratory conditions. The study estimates that Jacksonville, Florida alone could have saved $112 million per year, and it has done similar estimates for other Florida locations.

SOURCE: Solantic press release