Trim the Fat, Not the Bone

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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.

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