On January 12, the Minnesota Citizens Forum on Health Care Costs released a draft report of findings it reached after a telephone survey of Minnesota residents. As chair of the 18-member panel appointed by Governor Tim Pawlenty (R), former U.S. Senator David Durenberger (R) called universal health care a “Minnesota value.”
Minnesota Public Radio quoted panelist Dr. Glen Nelson, former surgeon and a member of the Jackson Hole Group: “There seems to be strong support for universal insurance backed up by a willingness to pay for it. You could argue that, politically, the people do support universal insurance.”
Public support for universal health care, however, appears to depend on how the term is defined.
Fifty-six percent of the telephone survey’s respondents supported a universal health care system in which the government guarantees health coverage. Forty-four percent favored a private system that relies on individuals and employers to provide for their own health care needs.
Authors of the Forum report caution, however, that “the strength of the preference [for a universal system ensured by the government] is questionable.” Fifty-five percent of those who reported favoring government-run health care said they would reject such a system if it would limit their choice of doctors. Forty-one percent would reject government-run health care if it would create waiting lines for some non-emergency treatments. The term “non-emergency treatments” was not defined. In Canada, cardiac conditions can be classified as non-emergency, leaving patients to wait months for bypass surgery.
Other key findings:
- While 50 percent of survey respondents said they are dissatisfied with the cost of health care and health insurance, only 9 percent are dissatisfied with the quality of their health care.
- Only 5 percent are uninsured. Eighty percent agreed it’s important to provide health care coverage for all Americans, even if doing so means raising taxes.
- 94 percent want to choose their own physician.
- 81 percent want the government to “do something” to reduce the price of prescription drugs.
- 18 percent said people have the right to use as much health care as they want, while 82 percent agreed with the statement, “People have the responsibility not to overuse health care services because it increases insurance costs for everyone else.”
- 34 percent of households with a disabled person prefer a private system that relies on individuals and employers to provide for their own health care needs.
The survey also exposed inconsistent public attitudes regarding personal behavior, cost, and treatment decisions:
- While 62 percent of the respondents said people who smoke or do not exercise should pay higher insurance premiums, only 39 percent agreed that people who are likely to use more health care should pay higher premiums.
- Although 72 percent said the cost of treatment, along with the chance of success, are factors that should be considered in decisions regarding treatment, 67 percent said health insurance should pay for any kind of medical treatment, regardless of the cost. Sixty-two percent of respondents agreed with the statement, “Our health care system should spend as much money as necessary to try to save a person’s life.”
The Forum’s report identifies a list of “core values” about the health care system that panel members say are shared by most Minnesotans, and thus “should form the foundation of Minnesota’s health care system”:
- accessible to all
- safe, high-quality care
- promotes health
- rewards personal responsibility
Survey respondents weren’t presented with the list of values and asked to vote on them; rather, the list represents the panel’s interpretation of what respondents meant by their answers to the survey questions. Moreover, the panel does not define what it means by each of the values. It is thus difficult to determine the depth of the public’s support, or how they would prioritize and choose among competing or contradictory values.
In addition to the core values list, the panel developed a list of the public’s “preferred solutions,” based on responses submitted through an online survey (108 responses), email and letters (58), and at town hall meetings (474 attendees). Creating a cumulative composite from all sources, the panel found the top 10 solutions, or problems in need of a solution, to be:
- early intervention/prevention
- drug pricing/costs
- administrative costs and delays
- single-payer health care
- consumer-driven health care
- evidence-based medicine
- chronic disease management
- purchasing pools
- malpractice and tort reform
- universal health insurance
At the town hall meetings, proposed solutions were solicited from meeting attendees and written on flip charts. The panel did not keep track of whether the solicited solutions came from unaffiliated citizens, spokespersons for advocacy groups, or members of the health care industry.
Each participant in the town hall meetings was given four stickers to vote for his or her four preferred solutions, making 1,896 total possible votes. (474 attendees x four votes each)
Attendees were not prevented from using more than one vote on any one proposal. Moreover, only 943 (49.7 percent) of the 1,896 possible votes were in fact cast, leaving substantial doubt as to the strength of town hall participants’ support for any of the proposed solutions.
As this story goes to press, the panel is expected to release a second report on February 23, along with suggested solutions from the health care industry and panel recommendations for action. The Minnesota legislature opened its 2004 session on February 2 and may consider including the recommendations in pending legislative proposals.