Experts prefer Democratic candidates' health proposals
Some 22 health care experts surveyed for the 13th Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey strongly support reform proposals applying a mixed private-public market approach, while saying proposals focusing on tax incentives to purchase private health insurance are not an effective method for controlling the rising costs of health care or achieving universal coverage. Thus, the experts tend to prefer the overall approach taken by Democratic candidates over that of the Republicans.
With 30% of Americans saying health care is the top domestic issue in the 2008 presidential campaign, the survey went to health care leaders in academia and research; health care delivery; business, insurance, and other health industries; and government, labor, and advocacy groups. Survey questions were based on health care proposals put forward by Republican candidates Rudy Giuliani, John McCain, Mitt Romney, and Mike Huckabee and Democrats Hillary Clinton, Barack Obama, and John Edwards.
The Republican proposals generally would create tax incentives to encourage coverage through the individual insurance market. The incentives would take the form of tax credits or new income tax deductions. The Democrats' plans would build on the current mixed private and public group insurance system, often with a requirement that individuals purchase coverage and a requirement that employers either offer coverage or help pay for it. They also would expand Medicaid and SCHIP and provide new group insurance options (connectors or exchanges) with financial support for premiums and out-of-pocket expense for lower- and moderate-income households.
Some 61% of the health care leaders surveyed said they favor the mixed private-public group insurance system reform proposals of the Democrats as an effective approach to achieving universal health care coverage, with 65% of academic leaders and half of business/insurance/other health care industry leaders voicing support.
Tax incentives seen as ineffective
Proposals relying on tax incentives for the individual market were seen by the same experts as an ineffective method for achieving the goal of universal coverage, with 59% of respondents saying they were not effective. More business leaders (20%) think tax incentive-based reforms are effective than academic (4%) or health care delivery leaders (4%).
Respondents also supported key elements of the mixed private-public reform proposals. Thus, 83% support a requirement for everyone to have health insurance, with premium assistance for low- and moderate-income Americans, and 86% support implementing private market regulations against risk selection, such as guaranteed issue and community rating in all states. Some 71% of respondents support requirements for employers to either offer coverage to employees or pay a percent of their payroll to help finance expanded coverage, and 66% of business leaders favor such a plan. And 78% of respondents back expansion of Medicaid and SCHIP to include adults at the poverty level or above.
There was little support among those surveyed for single-payer reforms that would replace private markets with public insurance (37%) and even less for preserving the private insurance markets with reduced regulations (11%).
The Democrat-backed mixed private-public health reform proposals would require substantial financial investment by federal and state governments, employers, households, and other stakeholders. A diverse range of health care opinion leaders strongly support such shared financial responsibility. An overwhelming majority (88%) favor an increase in taxes on tobacco or other harmful products to finance expanded health coverage. Health care delivery (82%), academic (91%), and business (85%) leaders agree on this recommendation. Survey respondents also support requirements for employer "play or pay," in which companies must either offer coverage to employees or pay a percent of their payroll to help finance expanded coverage (50%), repealing or allowing the tax breaks for families with incomes above $200,000 (75%) to expire, and revenue assessments on insurance companies (50%).
Recognizing the U.S. health care system has significant gaps in the quality of health care provided to its patients (a recent study found that American adults receive appropriate health care only 55% of the time), most presidential candidates have put forth lists of proposals to address the quality and efficiency shortfalls in the system. Health care leaders were asked about the potential effectiveness of a list of features from the presidential candidates' health reform proposals.
Improve IT use
A majority (70%) voiced support for increased and more effective use of information technology. Another 65% support increased use of "medical home" models of care. Some 61% of respondents said rewarding providers who provide higher-quality care is an effective way to improve health care quality. A majority of respondents (61%) also said uniform quality reporting and transparency of information on providers' quality of care would be effective in improving health care quality. Few opinion leaders (26%) thought that holding hospitals accountable for ethnic and racial disparities in quality of care would be an effective way to improve quality.
When health care leaders were asked whether the next president should focus first on quality, coverage, efficiency, or costs, 70% said the president should pursue universal coverage at the same time as developing policies to improve quality, efficiency, and cost control. Some 73% of academic leaders and 75% of health care delivery leaders think all four fronts should be simultaneously tackled, while 20% of business leaders thought cost control and quality improvement should come first, compared with 11% of academic experts and 4% of health care delivery leaders.
With the United States spending a far greater share of gross domestic product on health care than other industrialized countries, and with citizens still spending more out-of-pocket on health care, proposals that increase coverage through the individual market have the potential to raise administrative costs, while those that provide large group coverage, especially through Medicare, have the potential to significantly lower administrative costs.
When the survey asked how effective the two general approaches would be in controlling health care costs, 64% said tax incentives would be ineffective in controlling rapidly increasing health care costs. In contrast, more than half the opinion leaders said the mixed private-public approach is a very effective, effective, or somewhat effective mechanism for controlling costs.
Asked to consider specific cost-control mechanisms put forth by the candidates, 65% of opinion leaders said allowing Medicare to negotiate prescription drug prices would be effective, 65% agreed with correcting the imbalance between primary and specialty care payments, and 62% backed using benefit design incentives to encourage use of preventive services and chronic condition management.
General public agrees
The Commonwealth Fund report says health care opinion leaders' views on presidential candidates' reform plans track those of the general public. A Fund public opinion poll found that 86% of Americans feel the candidates' views on health reform will be an important factor in their voting decision. Two-thirds of Americans think responsibility for health insurance should be shared by individuals, employers, and government, and that sentiment is felt across income levels. In addition, 68% of adults support a requirement for everyone to have health insurance, with the government helping those unable to afford it. The public overwhelmingly agrees (81%) that employers should either provide health insurance to their employees or contribute to a fund that would help cover workers without health insurance.
The opinion leaders' views also are in line with the recommendations of the Commonwealth Fund's Commission on a High Performance Health System, which has issued a report recommending the next president simultaneously embrace five key strategies for changeensuring affordable coverage for all, aligning incentives and effective cost control, providing accountable and coordinated care, aiming higher for quality and efficiency, and creating accountable leadership on the national level.
Download the opinion leader survey report at www.commonwealthfund.org/publications/publications_show.htm?doc_id=655995. Also download a comparison of the candidates' proposals at www.commonwealthfund.org/publications/publications _show.htm?doc_id=647708.
Some 22 health care experts surveyed for the 13th Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey strongly support reform proposals applying a mixed private-public market approach, while saying proposals focusing on tax incentives to purchase private health insurance are not an effective method for controlling the rising costs of health care or achieving universal coverage.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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