Wednesday, February 5th, 2014 | Stephen C. Schoenbaum, MD, MPH
Stephen Schoenbaum is a physician, former executive director of the Commonwealth Fund Commission on a High Performance Health System, and a special advisor to the president of the Josiah Macy Jr. Foundation.
Passage and implementation of the Affordable Care Act raises questions about how to achieve cost control, including how best to replace the current fee-for-service payment system and how to rethink what exactly our health insurance plans cover.
But beyond these important policy questions, this research raises concerns about some Americans’ values related to health care. Persons in most developed countries are used to the idea that every member of society should have coverage and is entitled to access to health care. They do not understand, and frankly neither do I, why in the United States a sizeable minority of the population feels that health care is a privilege.
Wednesday, January 29th, 2014 | Nancy Metcalf
This commentary offers reflection on the findings and implications from "Curbing Health Care Costs: Are Citizens Ready to Wrestle with Tough Choices?" Nancy Metcalf is a senior editor at Consumer Reports magazine who reports on health. She has answered thousands of consumers’ questions about health care and insurance in her “Ask Nancy” column.
Here is what consumers in other advanced industrial democracies need to understand about their health care systems: practically nothing. From cradle to grave, their health care needs are met nearly automatically by mechanisms that operate behind the scenes. No one has to worry about picking the “wrong” health insurance plan, or not being able to afford the cost of a serious illness or injury. There are no serious public debates about whether doctors make too much money, whether governments are in the pocket of the drug companies, or whether some people are “free riders.” It just never comes up, because these countries long ago reached a political consensus that health care is a human right, and that “social solidarity,” a term that most Americans have never heard, dictates that it be available on an equal basis to all.
The citizen groups convened by Public Agenda illuminate how Americans interpret their experience with an impossibly complex system that offers far less and demands far more of them as consumers than any other country’s.
Thursday, January 23rd, 2014 | Daniel Yankelovich
This commentary offers reflection on the findings and implications from "Curbing Health Care Costs: Are Citizens Ready to Wrestle with Tough Choices?" Daniel Yankelovich is a public opinion pioneer and cofounder of Public Agenda.
Though the recent Public Agenda study on health care costs is small in scale, it leads to several far-reaching conclusions. I want to use my nickel to comment on one of them.
The study presented three strategies for health care cost containment to average, older adult Americans (ages 40 to 64): make the public pay more for services; hold doctors and administrators responsible for reforms in efficiency; and/or, have the government control prices. Frankly, I am surprised by how clear-cut the implications of these discussions were. For a variety of reasons, the first and third strategies seem hopelessly impractical, leaving only the second for consideration. I have spelled out below the reasoning behind this conclusion.
Thursday, January 16th, 2014 | Jean Johnson
How many experts view rising health care costs.
(Via IMDB, Copyright 1981 - Lucasfilm, Ltd.)
Remember Harrison Ford as Indiana Jones, running away from an enormous boulder, glancing over his shoulder, racing to avoid being crushed? For the Congressional Budget Office (CBO), health care is the boulder that could devastate the federal budget if we can’t figure out better ways to contain rising costs. Many experts see this issue as one of, if not the, most urgent budgetary threats we face.
The federal government spent roughly a trillion dollars on health care in 2013, including Medicare, Medicaid, and the Children’s Health Insurance Program. With an aging population, more of us will be on Medicare. Due to The Affordable Care Act (ACA), more people are being covered by Medicaid and receiving government subsidies to buy their own insurance. According to the CBO, rising health care costs will "pose a challenge not only for the federal government’s two major health insurance programs, Medicare and Medicaid, but also for state and local governments, businesses, and households."
There has been some good news lately -- health care costs haven’t been rising as quickly as in the past, and there’s vigorous debate among policy wonks over why this is happening and whether costs could start rising more quickly again. The White House Council of Economic Advisors, for one, believes that some reforms in the ACA are helping slow the growth in costs.
But health care costs are still rising -- by 3.7 percent in 2012.
Polls repeatedly show broad support for "reducing health care costs," and on the face of it, people do seem to grasp that the U.S. spends an awful lot of money on health care.
Wednesday, January 15th, 2014 | Thomas Workman, Ph.D.
This commentary offers reflection on the findings and implications from "Curbing Health Care Costs: Are Citizens Ready to Wrestle with Tough Choices?" Thomas Workman is the Principal Communication Researcher and Evaluator in the Health Program at the American Institutes for Research, where he leads its Center for Patient and Consumer Engagement.
As is evident in "Curbing Health Care Costs: Are Citizens Ready to Wrestle with Tough Choices?", there are disconcerting contradictions and inconsistencies in Americans’ views on health care that indicate the need for continued public information and deliberation. Several of these contradictions are worth noting, as they may hold a key for developing successful approaches to engaging the public in policies and practices that enable quality care and controlled cost.
As the report notes in its introduction, the current cost crisis is certainly not new, yet public consciousness and a sense of urgency have begun emerging only in the past five years. The reasons are many: unlike all other consumer services, the majority of health-care costs are indirect, handled through a third-party payer. Out-of-pocket costs were historically an issue only for the poor, uninsured and underinsured. The rest of the nation remained fairly protected and blissfully unaware. But those days have passed.
Thursday, December 26th, 2013 | Public Agenda
We are saddened to report that Public Agenda’s Deborah Wadsworth, who led our organization between 1986 and 2003 and served on our board after her retirement, died on December 24, 2013.
As many of you know, Deborah was a woman of astonishing warmth, intelligence, integrity, and commitment. In fact, her contributions to our work began even before she joined Public Agenda. As a program officer at the John and Mary R. Markle Foundation in the 1990s, Deborah introduced Public Agenda founder Daniel Yankelovich to Kettering Foundation President David Mathews, setting in motion an institutional partnership that has endured for decades, bolstering our common mission of engaging citizens in addressing national and local challenges.
Thursday, December 12th, 2013 | Allison Rizzolo
What is your vision for a future in which our national political leaders collaborate, in spite of their differences, and do the work their people want and need them to do? Can you even imagine it?
For former Senator Bill Bradley, a Democrat who represented the people of New Jersey for 18 years, there are a few variations of such a future.
Senator Bradley joined us this week for the latest installment of our Policy Breakfast series. On a snowy, messy New York morning, Bradley addressed a full room at the Graduate Center at the City University of New York, our partner in the series.
Adam Davidson, of NPR's Planet Money and The New York Times Magazine, spoke with the former Senator about the past, present and future of American politics.
Senator Bradley fondly recalled a time of personal relationships among members of Congress. "It was a time when there were personal relationships among members of Congress… People lived in Washington and socialized with each other. It made a big difference," he said.
Tuesday, December 3rd, 2013 | Jean Johnson
Welcome to Beyond the Polls, our regular commentary on what Americans are thinking about pivotal issues our country and communities face. Each month, we offer a second look — a deeper look — at public opinion. We try to put survey results in context and enrich them by drawing on our extensive experience listening to citizens in both research and community settings over the years.
Our aim is to explore and understand the hopes, values, concerns, and priorities people bring to today’s issues — the public questions and controversies we think about every day. Just as important, we want to juxtapose the views that polling typically captures with what happens to those views when citizens have a chance to absorb and weigh different options for addressing issues and hear what other citizens have to say about them.
So what led us to develop Beyond the Polls? Here is some of what’s behind the series:
Tuesday, December 3rd, 2013 | Jean Johnson
It’s reasonably clear that younger and older Americans think differently about tattoos. And maybe there’s a divide over e-mail versus texting. But now that Congress and the President are resuming talks about long-term federal budget issues, proposals to reform Social Security to stabilize its costs are back on the table.
In contrast, opinion leaders like Paul Krugman and Senator Elizabeth Warren say we should expand Social Security, arguing that current retirement policies will leave too many Americans living in poverty in their later years.
So that raises a question: Are the views and preferences of younger and older Americans really at odds when it comes to Social Security? What do polls show, and what happens when Americans of all ages have a chance to talk together about this issue?
The answers to these questions will be important for us to explore as we and our elected officials discuss and negotiate solutions to the issue of Social Security.
A quick glance at some recent polling does seem to show some wide gaps among the generations:
11.13 3 Ways the White House’s College Scorecard Can Better Serve Adult Prospective College Students
Wednesday, November 13th, 2013 | Christopher DiStasi
When the White House released a new ‘College Scorecard’ earlier this year, Secretary of Education Arne Duncan wrote, “Too often, students and their families don’t have the right tools to help them sort through the information they need to decide which college or university is right for them.” The White House’s scorecard aims to fill this gap by providing, in an easily digestible format, information like graduation rates, average costs and loan default rates. Policy makers say such data are important to judging the quality and performance of our schools. But the College Scorecard may not be reaching the students who need it most.
Earlier this year, we sat down with adults who are considering going or returning to college. It had been years since these individuals had seen a high school guidance counselor or a college prep class. For them, a tool like the College Scorecard could be immensely useful. But, in our focus groups, we found that the White House’s strategy does not line up with the habits of adult prospective students. In order to reach this group, which sorely needs unbiased college information and advice, the White House must better align the scorecard with their college search practices and priorities.
The following are three simple ways that the College Scorecard could be improved, based on our research.