Americans’ views on health care
are much like their views on airline travel, observed Dr.
Robert Blendon, director of the Harvard Program on Public
Opinion and Health and Social Policy, in a lecture he delivered
at Penn’s School of Nursing in October. “They’ll pay $90 to go
to Florida. They’ll squinch their knees, they’ll eat lousy
peanuts, they’ll be late” — but they won’t tolerate an increased
chance of the plane crashing. Similarly, with managed care, he said,
“People will choose the less expensive plan. They’ll put up
with hassles, they’ll put up with less choice, but they’ll not put up with an increase in the risk of dying.”
In the same way that the Valu-Jet crash jolted public
interest in airline-safety regulation, explained Blendon, who also
serves as a professor of health policy and political analysis
at the Harvard University School of Public Health, publicity
about seriously-ill patients being denied coverage in certain
cases has fed a backlash against managed health-care and a
movement toward increasing consumer protections. He illustrated
his point by flashing a Boston Globe headline — “Father
Says HMO Stinted on Cancer Treatment” — on the screen behind him.
“Here’s my Valu-Jet,” he said drily.
While more
research is needed to determine how often that sort of
care-withholding situation occurs, Blendon noted that a majority
of Americans “believe that if you’re very sick with cancer, some
number of plans will not give you the care you need.” Forty percent
base this perception on personal experiences (though not
necessarily the life-threatening kind), the rest on friends and
family and media coverage.
Blendon, whose
program uses existing data and conducts its own surveys to
determine how public opinion shapes health-care and other
domestic policies, said that while people in “heavily managed
care” plans may be satisfied with them on a daily basis, they are
significantly more worried that treatment would be withheld if they
got very sick than are those with traditional medical
insurance.
What the managed-care industry could learn
from public surveys, Blendon said, is that, “You cannot have a
consumer industry that runs just on price. We are not a
Wal-Mart nation [when it comes to medicine]. You have to say to
people that 10 years from now, the quality of service will be
better.” And the health-care industry, he admonished, should
also exercise discretion in the “rare dramatic cases” when some
care may be denied because of a technicality.
The
public’s concerns about health care don’t necessarily translate
into an interest in complex policy debates, said Blendon. “If
you can solve the problem and the premiums don’t go up $40 a month for
people, Americans want this fixed.” In addition to not wanting
it to cost too much, they basically want to know if their
families will be better off, worse off, or unaffected by a
plan.
Despite the consumer backlash, Blendon believes
managed care will survive in the United States for the simple
reason that “it’s a politician’s delight.” Elected officials,
he noted, “have discovered that they don’t want to be involved
directly in reducing health- care costs … Along come these
plans which are going to do things like merge and close
hospitals in Philadelphia and reduce payments and eliminate
choices, and the legislators can come in and say, ‘Tell me more. That
sounds terrible.'” While the plans will probably look different,
and the government will set some guidelines, Blendon said, “I
don’t think we’re going to go back” to traditional
health-insurance coverage.
Blendon’s lecture
was in honor of Dr. Linda Aiken’s being named to the first
Claire M. Fagin Leadership Chair in Nursing. Aiken has served
as the Penn Trustee Professor of Nursing, professor of
sociology in the School of Arts and Sciences, and director of the Center
for Health Services and Policy Research.
