Americans #1 health care priority for the President: reduce costs

Reducing health care costs far outranks improving quality and safety, improving the public’s health, and upping the customer experience as Americans’ top priority for President Obama’s health care agenda, according to a post-election poll conducted by PwC’s Health Research Institute.

In Warning signs for health industry, PwC’s analysis of the survey results, found that 7 in 10 Americans point to the high costs of health care as their top concern in President Obama’s second term for addressing health care issues.

Where would cost savings come from if U.S. voters wielded the accountant’s scalpel? The voters have spoken, saying,

  1. Reduce payments to health care providers, hospitals and doctors, cited by one-half of survey respondents
  2. Cutting investments in health IT, according to 42% of U.S. voters
  3. Reduce spending on public health and prevention, 31%
  4. Raise the Medicare eligibility age for seniors, 29%
  5. Reduce Medicaid and other subsidized care for low-income Americans, 27%
  6. Cut investments in research and development for new medicines and therapies, 21%.

There’s a Mars/Venus difference in Americans’ health agenda priorities. Women tend to prioritize public health and prevention investments, while more men prefer reducing government’s role in health care.  In racial differences, more African Americans like the idea of more education for health decision making and improving customer experiences than Whites.

PwC polled 1,202 U.S. voters online on November 9-10, 2012.

Health Populi’s Hot Points:  The big aha! moment in this poll is U.S. voters’ lack of value in health information technology investment, notwithstanding a huge government subsidy for providers’ adoption of electronic health records that was incorporated into the American Reinvestment and Recovery Act (ARRA) stimulus bill’s HITECH Act in February 2009.

More Americans have begun to see EHRs as part of their doctors’ offices and exam room experiences in the form of receiving a printout summary from their visit, or accessing personal health information on a portal. Yet a large proportion, 42%, of people polled cited “reducing investments in health IT” as the second most likely place to cut Federal health spending after reducing payments to doctors and hospitals.

Other stakeholders missing-from-action in this survey question is reducing spending on prescription drugs and medical technology, usually culprits cited by consumers under the question of reducing health costs. “Big Pharma” has been long seen has a contributor to high medical spending in other consumer health surveys.

Consumers put their own health providers at the top of the cost-cutting priority list. This, too, is a conundrum as one’s own doctor is the most trusted node in people’s personal health ecosystems. The personal doctor is also the stakeholder most well-known to the consumer. As people pay more out-of-pocket for health care, I would expect the PCP and her staff to feel the wrath of growing patient empowerment and economic force. Yet it’s a key role for the PCP in accountable care payment regimes to more closely engage with patients. Furthermore, health IT plays a pivotal role as infrastructure for accountable care. PwC’s findings do indeed signal “warning signs” for the health industry as we see stakeholders on very different pages.

3 Responses to Americans #1 health care priority for the President: reduce costs

  1. S Mulkey November 28, 2012 at 11:56 pm #

    Nice perspective! The general populace fail to realize that by cutting payments to the doctors that they will have to assume more payments themselves for the same quality of services they want.

  2. Kevin Dorsey-Tyler November 29, 2012 at 7:31 am #

    With the enormous(!) sample of 1000 voters, conclusions tend to be of limited value. However, the most obvious conclusion is that the sampled voters are a little out of touch with reality.
    Firstly, cutting payments to doctors and hospitals might seem attractive, but neither is in a position to accept deeper cuts than they have already suffered, without corresponding decreases in services provided. Second, health IT will have initial setup costs, but it has the potential to identify real economies and efficiencies in the longer term.
    Medicare is actually fairly efficient in provision of care, compared with commercial insurance, especially when the age and comorbidity level of the covered group is factored in. Progressively lowering the Medicare eligibility age, moving gradually toward a single-payer non-fee-for-service model, is actually more likely to control aggregate national costs than increasing eligibility age.
    Cost savings will come when:
    Patients and physicians accept that newest is not necessarily better, both with respect to medications and surgical toys.
    Patients have real “skin in the game” by replacing employer-paid plans by increased wages and concurrent requirement to buy individual insurance (and leveling the differential between group and individual premiums).
    Medicaid and other state equivalents allow only coverage of generic medications until a clear scientifically valid advantage for the non-generic is demonstrated by independent research, both medically and economically.
    Doctors are once again paid on actual service in treating patients, not on the number of bullet points scored in irrelevant and repetitious documentation.

  3. Jane November 29, 2012 at 11:34 am #

    Kevin, agree with you re: sample size. In cases such as these I look at the general trend and note that cost far outweighs other considerations. I concur, too, that providers have seen substantial cuts. It’s the re-engineering of the care itself, and that overtreatment is a major culprit. I think that skin in the game is important, too, when health consumers become smart at “consumption” and are educated as true consumers. This is one of the big chasms in the consumer-directed model and why people do un-healthful behaviors like skipping meds when prescribed, delaying tests when necessary early in a diagnostic work-up, all to opt out of paying a copay or visit charge to “save” the funds in the savings account for “when I’m really sick.” Thanks for your thoughtful observations on cost-savings. JS

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