The Health Care
Debate We Are Not Having
Chairman
of The Harris Poll explains need for addressing health care “rationing”
Rochester, NY—May 14, 2003—HumphreyTaylor, chairman of The
Harris Poll at Harris Interactive®, argues that the United States, like
countries almost everywhere, faces a serious health care crisis of public
confidence and that the biggest reason for this crisis is barely understood.
There is a serious mismatch between the potentially infinite demand for medical
care and the finite resources that we want to spend on obtaining it. As a
result, every country rations care, whether by limiting reimbursement or
limiting the supply of services. But no
governments have been willing to tell their voters that their systems ration
care. They perpetuate the myth that the “system can be fixed,” implying that
there is no need to ration care (even though the fixes often involve more
rationing.)
Taylor believes that leaders should explain why it
is necessary to ration care (even if they don’t use the “R” word itself) and
that every country needs to have a major national debate about how they
should ration care, who should do it, and what criteria should be
used to do it. Without such a debate,
expectations will greatly exceed performance and the public will always be
deeply dissatisfied.
The
following some of the highlights from the full article on “The Health Care
Debate We Are Not Having” by Humphrey Taylor, found in Harris Interactive Health
Care News, which is posted at http://www.harrisinteractive.com/news/newsletters_healthcare.asp
in downloadable pdf format.
All Health Care Systems Are In Trouble
In almost every rich,
developed country, there is a sense that the health care system is in crisis.
This is a big change since 1990 when a Harris survey in ten countries found
that substantial numbers of people in some of them (Canada, the Netherlands,
West Germany and France) were reasonably happy with their systems and felt
“only minor changes” were necessary to improve them. Not any more. In most
countries, including Canada, most people now believe that something is
seriously wrong with their systems. Many people have difficulty getting the
care they need; costs are growing much too fast; there are long waiting lists;
hospitals, doctors and nurses are under too much pressure; there are too many
medical errors; too much poor quality care; and, in the United States, forty
million people with no health insurance and many more with inadequate
insurance.
After the1990 survey,
Taylor wrote that we already knew that the American health care system was the
most expensive in the world but that we now realized that it was also the most
inequitable, least cost-effective, and most unpopular system of the ten
countries surveyed.
The U.S. health care
system is not the most unpopular today, but that is only because the health
care systems of many other countries have become far more unpopular than they
used to be. But the U.S. system is still uniquely expensive, inequitable and
inefficient (with its very high administrative costs). This of course is a
criticism of the American system, not of American medical care.
Wealthy, developed
countries have many and varied health care systems. Almost every country’s system is unique in some respects. Some
have national health services. Most have universal, or almost universal, health
insurance. And yet they all seem to be in some sort of crisis. Whatever this
crisis is, it seems improbable, therefore, that it can be solved by tweaking
the system or by changing to a system used in another country. There seems to be something wrong with all
systems.
The
Gap Between Demand And Finite Resources
With the development of
new treatments and tests and more knowledgeable, and therefore more demanding
consumers, the gap between demand and finite resources seems to be growing.
Taylor comments, “Every
year we are likely to disappoint more people because we won’t pay for all the
technology and care that doctors would like to provide and patients would like
to have. Another problem is that most people are not aware that this problem,
this gap, exists. Our leaders don’t talk about it. There is no national debate
on the issue. Instead we debate the details of the Patient’s Bill of Rights,
the price of prescription drugs and the design of a possible Medicare drug
benefit. Obviously, these are very important issues, but they are not the
central issue that we should be debating. The central issue, in all countries,
should be how we should allocate finite resources or, to put it bluntly, how
we should ration care.”
We Ration Care But Do
Not Admit It
Virtually all experts
recognize that care is rationed now: by what is reimbursable (by both the public
and the private sectors). Many countries ration supply by limiting the numbers
of doctors, hospital beds or high-tech equipment. In the U.S. care is rationed
by price and the use of high copays, coinsurance and deductibles—and by not
providing insurance coverage to forty million people.
However, the U.S. public
is not told that care is rationed. Governments and politicians are loath to use
the dreaded “R” word. They, and almost all who debate health care policy, talk
as if there are solutions to our problems that would make rationing
unnecessary. Increasing productivity, reducing errors, lowering costs,
improving lifestyles and prevention, and cutting waste, fraud and abuse are all
admirable goals which would make the money go further—but never far enough to
avoid the need to ration care.
Taylor concludes, “Because
we ration care now, and will always have to ration care, you would think there
would be a big national debate about how to ration care, on what criteria
to use, and on what mechanism to use in making rationing decisions.
Without such a debate we cannot hope to close the gap between expectations and
reality. We need to manage expectations.”
About Harris Interactive®
Harris Interactive (www.harrisinteractive.com) is a worldwide market
research and consulting firm best known for The Harris Poll®,and
for pioneering the Internet method to conduct scientifically accurate market
research. Headquartered in Rochester, New York, U.S.A., Harris Interactive
combines proprietary methodologies and technology with expertise in predictive,
custom and strategic research. The Company conducts international research
through wholly owned subsidiaries—London-based HI Europe (www.hieurope.com)
and Tokyo-based Harris Interactive Japan—as well as through the Harris
Interactive Global Network of local market- and opinion-research firms, and
various U.S. offices. EOE M/F/D/V
To become a member of the Harris Poll OnlineSM and be invited to
participate in future online surveys, visit www.harrispollonline.com.
Press Contacts:
Nancy Wong
Harris Interactive
585-214-7316
nwong@harrisinteractive.com
|
