by Ken Feltman
He spent hours and hours and hours practicing these conjuring tricks. It’s just such a curious thing.
– Simon Callow
Fifth of a series
Whenever a new public opinion poll is completed, news reports concentrate on who is up and who is down, the horserace, the snapshot of public opinion at the time the survey was conducted. Most people do not think of polls as brief stops along the winding journey of changing opinions. But tomorrow’s headlines are often hidden in the cross-tabs and footnotes. That is the case with evolving attitudes about healthcare reform.
Centrist Americans – independent and middle-of-the-road voters who supported President Obama in large numbers in November – do not believe that Obama knows what he is talking about when he says that healthcare reform can bring both universal coverage and cost savings. It is as simple and as foreboding as that. A possible result: The president may have lost his ability to be an effective leader in the fight for healthcare reform.
First, the centrists do not buy the argument that the uninsured do not receive healthcare. That argument was implied by administration supporters in the early days of the reform battle. Many others, especially those on the political left, seemed to equate lack of medical insurance with lack of medical care. But centrists understand that emergency rooms and clinics are filled with uninsured patients who do receive treatment. The middle-of-the-road voters also understand that the treatment received by the uninsured is not as comprehensive and continuous as their own. Still, it is better care than many patients have ever before received, especially for immigrants and the working poor.
The uninsured and rationing care
The centrists want to know how much the nation spends on care for the uninsured. They realize that a trip to the emergency room is more costly than a trip to the family doctor. The most reasonable and widely accepted figures suggest that the current annual cost to treat an uninsured patient is between half to three-quarters of the cost incurred for the typical insured patient.
The middle-of-the-roaders figure that insuring those who are currently uninsured will drive up the cost of healthcare because people with medical insurance consume more care than those without. Proponents of universal coverage concede that usage is likely to increase as coverage is extended. They argue, however, that universal coverage will catch critical and costly illnesses while they can be treated at a lower overall cost. Very little in the experience of other nations suggests that argument is correct. Human behavior is hard to change and availability has led to greater usage time and again.
Next, the centrists think that their quality of care may deteriorate or be rationed to accommodate the increase in care for those currently uninsured. Surveys show that 75 percent to close to 90 percent of currently insured Americans are happy with their current care, despite growing concerns about rising costs. The middle-of-the-road voters have been paying more attention to this debate than the partisans of the left or the right. They are concluding that other countries control costs by rationing treatment through deferring care with waiting lists and denying care for certain conditions or for patients in, for example, advanced age groups. They do not want such a system in the United States.
Paying more for less
These middle Americans have concluded something else. They have concluded that employers, unions, hospitals, doctors, pharmaceutical companies and others in the healthcare industry have lined up behind reform because they want to be winners, or want to contain their potential losses in reform. Someone will pay more. Someone will get less. These centrists figure that they are the ones who may get stuck paying more for less.
They have listened and read about the current proposals. They voice concern that Obama and the Democrats are trying to gloss over the fact that the retired and others who receive care through various government programs will face higher costs and benefits cuts. This troubles them because they have parents in the vulnerable category and because many of the middle-ground voters are approaching retirement age.
These voters want to slow down the rush to pass a reform bill. They believe that politics is driving the debate. They are disappointed that Obama’s role has been to exhort the nation and Congress to support reform while exerting little policy leadership. They see the Congressional Democrats’ push as a political strategy, designed to get something, perhaps anything, passed so Obama can claim credit. These voters think the Republicans are playing politics by obstructing progress instead of contributing to a solution. They are wary. They do not trust their national leaders to come up with the best solution, not now, not yet, not before a lot more fact-finding and analysis of the ramifications of the various reform proposals.
One man from Nevada put it this way: “I don’t want them to vote before we all understand what it will mean. I don’t want a vote before they understand what it will mean. They don’t even read the stuff they vote for. I don’t think we have enough information for a decision yet. All we have is mostly speeches. The speeches paint a good picture but this is not the campaign. This is real life. This is too important to trust to platitudes and speeches without specifics. It’s time to put the cards on the table or fold your hand.”
That man’s attitude may be behind tomorrow’s headlines. Healthcare reform may fail because many currently insured Americans find reform more threatening than the current system. Reform may fail because middle-ground voters no longer see Obama as a capable leader of the reform effort. Reform may fail because most Americans believe that politics, not policy, is driving the process.
Also buried in the cross-tabs and footnotes: The centrists have picked up quickly on a change in nomenclature by the Obama administration. “Healthcare reform” is now often called “medical insurance reform.” Few people like the insurance companies and their gatekeepers standing in the way of treatment. Is it possible that Obama’s bold reform effort will end up gouging the insurance industry and not much more?
Another enlightening finding in the footnotes portends bad news for malpractice lawyers. The centrists want Congress and the Obama administration to reform medical malpractice laws to eliminate the cost of defensive medicine. They understand that the Democrats receive huge campaign contributions from lawyers. Now, before Republicans breathe a sign of relief, they should realize that the footnotes suggest that the middle-ground voters think the Republicans are too cozy with big employers and the insurance industry. The three least respected entities involved in healthcare reform are insurance companies, lawyers and big business.
The list of the most respected now has doctors (and other caregivers) at the top. Obama has dropped from the top of the list in March to the middle of the list now, behind labor unions and even Congress. The middle-ground voters are paying attention. They are looking for leadership and they believed that Obama would provide it.
Leadership is fresh ideas and consensus. Leadership involves policymaking but Obama has left that to Congress while he makes speeches and conducts rallies. Obama is doing an excellent job in speechmaking and rallies, but those activities are the political parts of healthcare reform. Politics is about pushing for action. Politics is public appearances and setting deadlines. People see Obama’s role in healthcare reform to be different from what they expected. They see him as one of many players in the middle of the pack.
How can Obama retake the lead? One thing is certain: He cannot lead from the middle of the pack. All he can do now is push.