health care

Could an Economic Downturn Be the Ticket to Health Care Reform?

Jenny Choi — Tue, 18 Nov 2008 16:25:53 -0500

An analysis in the Los Angeles Times today posits what could prove to be a tipping point for the health care crisis: the current economic slump. Senate Finance Committee Chairman Max Baucus (D-Mont.) announced his proposal last week for a universal health care package, and Senator Ted Kennedy (D-Mass.), a long-time proponent of expanded coverage, says he plans to advance his own universal health care plan next week. But how can we possibly be talking about expanding coverage at the same time that the government has a ballooning deficit?

Health care costs in the current economic climate have no doubt placed an enormous added strain on the uninsured and the newly unemployed, not to mention employers, health care providers and the government. But many believe that health care and the economy are inextricably linked -- that, in essence, health care is an economic problem. Last week, the New America Foundation released a report, "The Cost of Doing Nothing," which argues that waiting to reform the system, while costs continue to skyrocket, comes with a price. By their calculations, the "economic cost of failure," the billions of dollars in lost productivity for those without coverage, is actually less cost-effective than covering every American.

Americans, on the whole, agree that our current health care system has major flaws and is in need of change, but the degree of reform is less unanimous. Public support for a universal health care plan varies based on survey question wording. Two-thirds believe it is the federal government's responsibility to ensure that all American have health coverage, but they are less galvanized about requiring it by law. Still, the consensus is that lowering the cost of health care and extending it to more people are the most important issues for the president and Congress to deal with.

More on public attitudes about various health care issues can be found in our red flags section, and be sure to visit the health care guide in our Citizen's Survival Kit for the bigger picture: key facts and statistics, plus a discussion guide that offers three approaches to the problem, with pros, cons and specific strategies for each.

Health Care Reform In The Next Administration

Francie Grace — Mon, 27 Oct 2008 12:18:14 -0400

No matter who wins on November 4th, one thing we know for sure: neither the health care reform plan advocated by Barack Obama, which builds on employer-provided insurance, nor that favored by John McCain, who argues for a free market system with tax credits to help some on affordability, is going to be enacted as is. So says health care policy expert Drew Altman, speaking at the Maxwell School/Public Agenda Policy Breakfast series. "My view," says Altman, is "it will be a centrist deal, or no deal at all." For more on this and other key issues, see our Voter's Survival Kit.

Health Care Reform In The Next Administration

Meagan Murray — Fri, 24 Oct 2008 17:10:16 -0400

By Meagan Murray

Oct. 23, 2008 - - No matter who wins on November 4th, there's one thing for sure: neither the health care reform plan advocated by Barack Obama, nor that favored by John McCain, is going to be enacted as is. So says Drew Altman, a frequent and highly-regarded commentator on health care who is president and CEO of the Henry J. Kaiser Family Foundation, one of the nation's largest foundations devoted to health care issues.

"My view," said Altman, whose long resumé includes heading up New Jersey's Department of Human Services and a senior role in the Health Care Financing Administration during the Carter Administration, is "it will be a centrist deal, or no deal at all."

Altman shared his thoughts in New York Thursday as the speaker of the latest installment of the Maxwell School/Public Agenda Policy Breakfast series, which regularly brings together policymakers, academic and business leaders to discuss current issues.

Altman pointed to the health care insurance system now in place in Massachusetts as an example of what will need to happen if any kind of wide-ranging reform is to be approved. The Massachusetts plan, he explained, is an example of consensus-building – in which a coalition was put together and the final law had elements from both ends of the ideological spectrum.

Drew Altman (right), president and CEO of the Henry J. Kaiser Family Foundation, talking about the possibilities for health care reform, with Robert Siegel of National Public Radio, at the Maxwell School/Public Agenda Policy Breakfast.

"We are at one of these moments of opportunity when there is at least a possibility for bigger health reform," said Altman. "The new president has to make health reform - bigger health reform - an early and top priority. The question is whether you go after something smaller that would be easier to agree on, or you seize this moment and try and go after something big."

Altman acknowledged that the recent downturn of the economy in the housing and banking sectors has overshadowed rather than highlighted the need for individual security in areas such as health care. The overshadowing, he observed, relates directly to a disconnect between legislators and citizens regarding the timeliness of restructuring the health industry.

"Our polls and surveys find that many American people are truly struggling – postponing care and skipping medications because they can't pay their health care bills," he said. "So, in the public's mind, it is about economic security and their health care bills, as much as anything else."

Altman suggested that policymakers reframe their vision of health care as a major component of the present economic strain.

"Health care is being defined now by affordability," he said. "It's been defined by the American people not as a health care problem but as a pocketbook issue. And the train that is leaving the station in the Congress is the 'economy train' and legislation related to that, so unless the issue is reframed as an economic issue… I think it will get pushed aside over the next several years."

Even with the hyped attention of other economic aspects constantly in focus, health care has played a major role in the 2008 presidential race.

Senators Barack Obama and John McCain have offered health care plans with starkly different approaches. You can find out more about health care policy options in Public Agenda's Voter's Survival Kit on Health Care. Senator Obama's health plan is designed to expand coverage by building on the current system of government programs and private insurance.

McCain's plan instead focuses on a free-market approach, with tax-free medical savings accounts and tax credits for some to address affordability issues.

"I've been really frustrated with the way the health reform debate has evolved so far," he said. "At best they [the candidates' health care reform plans] represent a statement of direction and a device of a political campaign, that will then morph hugely as others get into the act, like Congress and interest groups."

Altman argues that instead of focusing on the details of the candidates' plans, Americans should instead focus on the fundamental differences between the candidates' visions for health care. The Kaiser Foundation, said Altman, has created a website, Health08.org, which allows Americans to do just that – keep track of how health care is addressed in the 2008 election.

"It is a national shame that we have so many people without health insurance coverage," Altman said toward the conclusion of the discussion. "I know there are more or less efficient ways to cover 47 million people, but I've almost reached a point where I don't care how we do it, just as long as we do it."

Meagan Murray is an intern at Public Agenda.

Voter's Survival Kit: Ten Things You Need to Know about Health Care

Scott Bittle — Thu, 23 Oct 2008 13:27:23 -0400

Too often, trying to follow the presidential campaign debate is like coming in on the middle of a movie. You can get the gist of what's going on, maybe, but you know that major plot points slipped past you – you know you could figure out who the murderer is, if you'd just been able to catch the first 15 minutes.

The basic reason is that the candidates, even when they talk about the issues, assume you already know the basics. The candidates figure they don't have time to explain the background to you, and they figure it might bore you anyway, so they jump right into what their plan would do. That's particularly unfair because the politicians themselves often are working off cheat sheets or talking points that give them the key points to make. Their staff has done the digging; the politician gets the bullet-point version.

Take health care, for example. The plans put forth by Sen. Barack Obama and Sen. John McCain are miles apart in ideological terms, and wickedly complicated in their details. But do the campaigns or the media spend much time stepping back and looking at what's going on with the health care system, or why it needs fixing in the first place? Not really.

So here's ten things you need to know about the state of the U.S. health care system. This is where we stand as a nation on this issue, and with these key facts in hand you can start to get your mind around the very complicated options the presidential candidates are putting out there. For a start:

Some 47 million Americans, 15.8% of the population, don’t have health insurance.

These are mainly people in jobs that don’t offer benefits: people between jobs, part-timers, the self-employed and lots of folks who work for small businesses. The number of uninsured may well go up over the next year because of the bad economy, as businesses lay off workers or cut back benefits.

The U.S. government spends nearly $700 billion each year on health care, mainly for Medicare (which covers nearly all older Americans), Medicaid (which helps cover those who are very poor) and care for veterans.

Meanwhile private health costs amount to about $1.1 trillion every year. About six in ten Americans get health insurance from their employer.

And just in case you hadn’t noticed, individuals shell out for health care too. It’s usually for deductibles, co-pays, premiums and drugs that aren’t covered by insurance. For an unfortunate group of Americans, it’s what they have to pay when they have a very serious illness or injury and basically their insurance basically runs out.

The U.S. health care system is incredibly complicated. Essentially, it’s not a ‘system’ at all – it’s a patchwork of private insurance and government programs like Medicare. There are holes in the system – and there’s duplication as well.

Health care costs have been rising faster than inflation for decades (they went up 6.7 percent in 2006). This will probably get worse. Government experts project health spending could double in 10 years

This presents a huge burden for business and it’s a budget-buster for the government, but frankly you’ll be on the line too. Business faced with spiraling health care costs sometimes cut benefits or raises or may even cut back their work force. Government needs to get the money from someone to cover health care costs. Guess who?

Most experts say expensive new treatments, procedures and drugs, along with an aging population are the major reason health care costs are shooting upward, but everyone also agrees that there’s a lot of inefficiency in the system too.

The plans of both presidential candidates are going to cost a lot of money. And give the staggering projections for the federal deficit over the next few years, money is going to be tight. So the government's going to have to find a way to pay any reform plan.

How do we know this? Here are our sources:

Census Bureau, Health Insurance 2006; Center for Medicare and Medicaid Services, National Health Expenditures Data; Government Accountability Office, The Nation's Long-Term Fiscal Outlook April 2008; Kaiser Family Foundation, Trends and Indicators in the Changing Health Care Marketplace; Tax Policy Center, Analysis of the Presidential Candidates' Tax Plans,

Want to think over the options for actually fixing this problem? Have a look at Public Agenda's Voter Survival Kit on health care, Your Money or Your Life, where we lay out different options, with potential costs and tradeoffs. And to check out the candidate plans in detail, visit the McCain and Obama web sites.

Hawaii Ends Universal Health Coverage for Children

Jenny Choi — Fri, 17 Oct 2008 15:52:47 -0400

State officials in Hawaii announced today that they will eliminate funding for its universal health care program for children. The law, implemented just seven months ago, is the only state program of its kind in the country and was intended to provide care to low-income children who could not afford it but weren't eligible for Medicaid. The Hawaii Medical Service Association, the state's largest private health care provider, has promised to extend coverage to children through the end of the year. State administration officials say many families had left their private plan to enroll their children in the state program and cited a major state budget shortfall in 2011.

Seven in 10 Americans show support for more federal funding for the State Children's Health Insurance program. But overall, the American public tends to show ambivalence when it comes to the government’s involvement in regulating health care. Nearly two-thirds of the public say the federal government should guarantee health insurance for all Americans—but half say they would not be willing to pay higher premiums or higher taxes. Public attitudes about a universal health care system also vary depending on survey question wording.

The Third Debate: What Would Joe the Plumber Do?

Scott Bittle — Thu, 16 Oct 2008 13:12:13 -0400

This morning most of the pundits are saying the last presidential debate was sharper in tone but just highlighted the well-established differences between Sen. McCain and Sen. Obama in substance. When it comes to the issues, the main innovation was the laser-like focus on an Ohio plumber as the stand-in for the electorate. But this debate did get into important questions that have been underexamined so far, like education and abortion.

So, with full knowledge of the irony involved, I'm going to repeat my defense of repetition: all of the talking points from Sen. McCain and Sen. Obama are old news to those who've been following this long, long campaign. But for the large number of voters who are only paying casual attention, repeating the basic points is important. These fundamental arguments about policy often get buried under a pile of media coverage of tactical decisions. By the time a campaign reaches the final weeks, everyone in the media assumes the public has actually been reading and remembering all the stories they've filed on this stuff over the past year and a half. And that's a bad assumption.

There are some things the candidates didn't say (click here for video of the debate along with our frame-by-frame comments) in their final appearance together and there are some key facts that voters need to know. The election's less than three weeks away, and if you're looking to get up to speed on the problems facing the country, have a look at our Voter's Survival Kit.

Some key points:

On the economy, both candidates continue to do something that is quite frustrating, which is mixing up the short-term problem – how we deal with the current financial crisis and looming recession – with how we deal with creating a sound economy in the long run.

In all three debates, the moderators have done their best to pin the two men down on fiscal responsibility, but none have succeeded. The fact is that the next president will be facing an extremely constrained budget, and will have to govern accordingly. Money’s going to be tight.

Here’s something Obama and McCain agree on: that the United States can eliminate some sources of foreign oil in 10 years. Note that neither one endorses complete energy independence, and most experts would agree that can’t be done, at least not anytime soon. Even eliminating imports from the Middle East and Venezuela, which both candidates endorse, would be a challenge. Those regions supply about one-quarter of U.S. oil imports.

The candidates had quite a lot to say about trade, which is one of the classic cases where leaders have very different views than the public. Most economists say global trade is a good thing, but the American public isn’t so sure. In Public Agenda’s Confidence in U.S. Foreign Policy Index, we found huge numbers of Americans (41 percent) aren’t sure whether the U.S. or foreign countries benefit more from trade. About as many (42 percent) say other countries benefit more, and only 14 percent think the U.S. benefits more.

We heard a little about education in this debate, including math and science education, which hasn't gotten much attention in this campaign. Education and business leaders are deeply worried about math and science education, but our research shows the public hasn’t caught up with them yet. Most parents think the amount of math and science their child gets is about right, which is the last thing most business leaders would say.

UPDATE: Here's our video commentary on the debate:

U.S. Infant Mortality Rate Drops, But Still High

Scott Bittle — Thu, 16 Oct 2008 12:43:23 -0400

The United States continues to sink in global rankings on infant mortality, with American infants dying at a much higher rate than babies in other developed countries. The Centers for Disease Control and Prevention reports the infant mortality rate was 6.78 infant deaths per 1,000 births in 2004, leaving the U.S. in 29th place worldwide, tied with Poland and Slovakia. All told, more than 28,000 infants under age one die each year in the U.S. There is some good news in the report, with the mortality rate taking a significant 2 percent drop in 2006, based on preliminary data.

The report just adds new fuel to the debate over the U.S health care system, where costs are increasing dramatically and some 47 million Americans remain without insurance. Health care has been one of the major issues debated in the presidential campaign, with both Democrat Barack Obama and Republican John McCain proposing significant – and expensive – changes to the system.

Your Money or Your Life, the health care guide in our Voter's Survival Kit, offers key facts and several alternatives for reforming the system, including the pros and cons of each choice. You can get this and the other survival kit guides here.

Digging Deeper For Health Care Bills, Even When Insured

Jenny Choi — Thu, 25 Sep 2008 11:25:27 -0400

A new survey of employers indicates that employees are beginning to bear a much larger burden in health care costs, in the form of rapidly rising deductibles. The findings, released yesterday by the Kaiser Family Foundation, showed that deductibles rose this year by an average of 29 percent, or $1,344, for families and 21 percent, or $560, for single workers.

Many employers said they increased deductibles in order to shoulder some of the costs of rising monthly premiums. In an interview with USA Today, Kaiser Family Foundation President Drew Altman suggests the numbers could, in fact, be "the tip of the iceberg toward less comprehensive, skimpier coverage."

Skyrocketing health care costs have left their mark on public attitudes about health care issues. Surveys show that cost and access to health care are considered to be the most "urgent" health problems, compared to a decade ago. Yet while there is some consensus among Americans that our health care system has major problems, responses tend to vary and waiver when it comes to potential tradeoffs and solutions.

For more on this subject, including the pros and cons of different approaches to health care reform, check out our Voter's Survival Kit.

Health Care Reform and the Federal Budget Deficit

Francie Grace — Tue, 16 Sep 2008 16:26:24 -0400

Health care reform was the topic as Public Agenda's Scott Bittle – author, with Jean Johnson, of "Where Does the Money Go? Your Guided Tour to the Federal Budget Crisis" – dropped by Health Care Week in Review, at the Corporate Research Group, for a discussion of some of the challenges ahead if a serious attempt is to be made to tackle this national problem.

Both presidential candidates have very different ideas about health care reform, but according to the Tax Policy Center, there's one similarity: the cost of the proposals each man has made each exceed a trillion dollars.

How can the federal government take on that added load, with the federal budget already surging to a deficit that's expected to top $400 billion this year?

Click here to see the video of the Sept. 12, 2008 interview with Bittle's observations on that subject, including the potential for solutions and public opinion research on the options for health care reform.

To learn more about these issues, check out our Voter's Survival Kit guides to Health Care and Taxes, Spending & Debt. And for further resources on the federal budget crisis, why it matters, and what can be done about it, go to FacingUp.org.

Voter's Survival Kit: Health Care, So What's the Plan

David White — Tue, 09 Sep 2008 13:52:46 -0400

DOWNLOAD PRINT-FRIENDLY VERSION OF THIS GUIDE

There are many ideas about how to improve the American health care system – and frankly it’s going to take a while to really make sense of the situation and fix all the problems Americans complain about. But here are three different directions a lot of politicians talk about, directions the country might move in.

CHOICES IN BRIEF

Use Competition to Make the System More Efficient

Expand the Current System to Cover More People

Create a National Health Care System

The main problem with the health care system is that costs keep going up. All the other problems in the health care system stem from this and won't be solved until we give everyone real choices and the ability to take responsibility for what they spend on care. That means reducing regulation and using free market competition to allow insurers to offer a wider range of plans. We should also embrace managed care, which watches expenses carefully and has already slowed down the rise in health care costs. By moving further in the direction of managed care and adopting medical savings accounts, which encourage individuals to save and shop around for health care, we’ll be able to bring down costs and cover more people.

We don’t need to rip up the existing health care system and start over. We already have the best, hightech medical centers in the world and insurance programs in place that cover 85 percent of Americans. We can just extend those proven programs, public and private, to cover more people. We can require employers and individuals to have health insurance and offer them financial incentives to make it affordable. The federal government already has effective health programs for the elderly (Medicare), the poor (Medicaid), low-income children (CHIP) and its own employees. If we expand the eligibility for those plans and require employers to offer coverage, we’ll be able to cover more uninsured people with the least disruption to those who already have insurance. Gradually expanding the current system is the most practical way to cover more people without breaking the budget.

Decent health care ought to be a basic right, not something that depends on the job you hold. Our patchwork health care system of private insurance and government programs simply isn’t working. It’s time to try what Canada and most European countries already have: a national, government- run health care system. The system would work much like Medicare, except that everyone would be entitled to coverage, regardless of age, income or job status. Like Medicare, you’d still pick your own doctor, but the government would get the bill. We’ve debated what to do about health care for years, but nothing else has solved the problem. This is the only way to solve the problem of the uninsured, once and for all.

CLICK HERE TO SEE THE CHOICES IN DETAIL

Use Competition to Make the System More Efficient

Expand the Current System to Cover More People

Create a National Health Care System

What should be done?

Offer tax credits and tax-free medical savings accounts to make it easier for people to buy individual coverage.

Make your insurance “portable” so people can keep the same policy if they change jobs and not be totally dependent on what their employer provides

Encourage more employers to provide coverage through HMOs and other forms of managed care to ensure competition.

Encourage small businesses to join together in insurance pools to negotiate for better rates.

Encourage the use of lower-cost generic drugs and allow people to buy approved drugs from Canada and Europe. Charge patients more if they insist on brand-name drugs.

Allow private insurers to create basic policies that would cover the most common problems and make coverage affordable for small businesses and individuals.

Require employers to offer health coverage to all their workers, even low-wage or part-timers. Offer tax incentives to business to cover the cost.

Lower the Medicare eligibility age to 55.

Extend the Children’s Health Insurance Program cutoff age to 25.

Increase Medicaid funding and raise the income cutoff to cover the working poor.

Open up the federal employee health insurance program to allow individuals without insurance to buy coverage at favorable rates.

Create a Medicare-style "single payer" system, where the government provides health insurance for everyone.

Allow patients to get a standard list of covered health services from any doctor or hospital in the program.

Raise taxes or repeal existing tax cuts to fund the program.

Tie the new health insurance system into existing government programs to promote good nutrition, mental health awareness and exercise.

Arguments For This Approach

If the health care system becomes more efficient, we can provide more services for more
people, without spending more money.

The constant rise in health care costs hurts everybody – it burdens business and government and makes insurance too expensive for lowincome people.

The only way to control costs is for insurers, health care professionals and patients to make decisions about what they really want and need. That means empowering patients to set aside money tax-free for medical care and allowing them to seek out cheaper alternatives, like drugs from other countries.

HMOs and other forms of managed care control costs by relying on competition, rather than heavy-handed government programs.

By expanding existing programs and employer- provided insurance we can cover most of
the uninsured.

This is the least disruptive way of attacking the problem – it won’t require massive changes in how the health care system operates or how people get their insurance.

People will still be able to pick their own doctors and health plans and get the same quality of care.

Health care should be a right, not a privilege for those lucky enough to have a good job, or to be over a certain age. This approach is the only way to guarantee that everyone gets medical care.

ICountries with national health care systems often have good health care at a lower cost because the government can make bulk purchases of drugs and control costs.

This will actually reduce paperwork. Doctors and hospitals will only have to deal with one set of forms and one government agency, rather than dozens of private companies and government agencies, all with different rules.

Any new taxes will be offset by the savings earned when employers and workers no longer
have to pay insurance premiums.

Arguments Against This Approach

This approach will do little to expand health care to the millions of Americans who don’t have insurance.

This will mean patients will have to face a lot more red tape and may even be turned down for treatment an insurance company decides is too expensive.

Under managed care, decisions about treatment are often made based on what’s cheapest, not necessarily the best.

The real reason health care costs are going up is new, expensive treatments and the aging population.

This will be an expensive expansion at a time when the federal government already has a budget deficit, and we still may end up with some people uninsured.

The Medicare program is already at risk and will likely go broke as it deals with aging baby boomers. Adding more people to Medicare will just cause the program to collapse more quickly.

This will do nothing to control health care costs, which are rising at an outrageous rate.

Requiring employers to provide coverage will be expensive, and even if the government helps with the cost, we’ll still impose a huge paperwork burden on business.

Under this plan, a government bureaucracy tells you what health care you can have.

In Canada and other countries it’s common to wait months for elective treatments or surgery.

This will require steep tax increases. All the health care costs now paid by private industry
would be taken on by taxpayers.

The Canadian and European health care systems are expensive and those nations struggle to cover their costs without breaking the budget.

Health costs will still be a burden to businesses, which will trade a health insurance plan they can control for a health care tax they can’t.

CHOICES PLUS & RISKS

Use Competition to Make the System More Efficient

Expand the Current System to Cover More People

Create a National Health Care System

The big plus is that people would have many more choices for the kinds of insurance
they want and competition among insurers for your business would make the policies more affordable.

The big risks are that insurers would take advantage of the situation and that most people really need help deciding which policies will be best.

The big plus is that this builds on our current system and keeps most of the healthcare system in the private sector – not in the hands of government.

The big risks is that this expands a system that is astronomically expensive and confusing – it does very little to squeeze the duplication and excess out of the system.

The big plus is that everyone would have insurance and the money now going to insurance companies and their profits could actually be spent on health care.

The big risk is that this would be monumentally expensive and give a big government agency the power to say what kind of care will be covered and what won’t.

Medicare's Self-Inflicted Wounds

Scott Bittle — Thu, 21 Aug 2008 11:50:31 -0400

Today's New York Times story on Medicare fraud raises an interesting question: Who pays the medical bills when a government bureaucracy shoots itself in the foot?

The Times reports that a yet-to-be-released inspector general's report will say Medicare officials overstated their efforts to cut fraud, and in fact instructed their auditors to skip certain procedures that might have spotted bad claims. The report hasn't been released yet, and some of the reported findings may get pulled back. But the Times says the report found more than one-third of Medicare spending for medical equipment in 2006 was improper, This was at the same time that Medicare officials were boasting their new anti-fraud effort blocked $700 million in bad claims.

If it's true, the worst part is that Medicare is wasting a lot more than money.

Medicare is by far the most frightening element of the long-term fiscal problems facing the federal government. The combination of out-of-control health care costs and the retirement of 78 million baby boomers will push Medicare spending into the stratosphere. In fact, Medicare will need to dip into its "trust fund" to cover expenses for the first time this year, and the first baby boomers aren't even eligible yet.

Most budget experts will tell you that getting rid of waste and fraud won't be enough to cure Medicare's problems. We'll have to look at things like controlling health care costs, cutting benefits, or raising premiums – and probably some combination of all three.

But that's going to be a very tough sell to anyone who's read the Times story. When Public Agenda conducted focus groups on the nation's fiscal problems, we found people were at least willing to consider all kinds of solutions, including painful ones. But the biggest barrier was trust, in the form of a deep skepticism about the government. People care about Medicare, and they might consider making sacrifices to save it – but only if they thought the government would spend the money wisely. Why should they give the government more money if the government can't hang on to the money it's already got?

The potential cost in public trust here is going to be a lot more expensive than the cost of fraudulently-billed wheelchairs and oxygen tanks. Without trust, we can't solve Medicare or any of the other long-term fiscal problems we face. And failing to solve these problems would be very expensive indeed, for all of us.

Anecdotes, Facts, Marriage and Health Care

Scott Bittle — Thu, 14 Aug 2008 12:49:32 -0400

Storytelling is a powerful tool – and never more so than in public policy.

What got me thinking about this was a story in the New York Times, Health Benefits Inspire Rush to Marry, or Divorce." According to the Times, "it is not uncommon" for couples to get married or break up at least partly in order to have health insurance.

Except, as the Times candidly admits, "there is no way to know how often it happens." The story has compelling anecdotes and quotes from lawyers and advocacy groups saying they believe it happens "regularly."

But the only actual data point is a Kaiser Family Foundation survey that shows 5 percent of those surveyed saying that in the past year they or someone in their household decided to get married "mainly" to have access to health care benefits. (It's question 12, if you want to have a look). And poll results in the single digits are notoriously unreliable – the margin of error really kicks in. This poll had a margin of error of plus or minus 3 percent, which means this number could really be 8 percent, or only 2 percent. In cases like this, just a few respondents in a sample of 1,500 people can make a huge difference.

The much more accurate way of looking at the results is that 92 percent, a huge majority, don't marry "mainly" for health benefits. Even if there were problems with the poll and the results move a few points, we're still talking about overwhelming numbers. And it fits more closely with what other research tells us about attitudes on marriage .

That said, I'm sure the people quoted in the story are telling the truth about what they've seen and experienced. People do factor in economics and health benefits when they get married. Surveys show lower-income people, in fact, are more likely to cite economic considerations as important factors in a successful marriage . We just don’t know how many marry because of health insurance, how big a factor it is, or whether this is increasing or decreasing.

There's a reason why this matters, and it has to do with how people process ideas. When Public Agenda brings people together in focus groups or community forums to talk about public issues, they don’t usually quote statistics. They tell stories – anecdotes about things that have happened to them or people they know, or just stories they've heard. Human beings are storytellers by nature and we use anecdotes and narratives to make sense of the world. Reporters know this; that's why they're trained to find the "human angle." Politicians know this too, which is why nearly every president brings some exemplary person to the State of the Union to stand up, take a bow and buttress a point.

I'm not saying the policy world should give up on storytelling. On the contrary, we should roll with it. Statistics without stories just lie there, lifeless. But not every anecdote illustrates a larger trend. Worse, anecdotes without facts can actually lead us in the wrong direction. That's why we conduct surveys and compile statistics.

If you look at the survey data again, you'll see much more solid indications of how our troubled health insurance system changes people’s behavior. Half say they've put off going to the doctor, and even more say they save medical visits for only the most serious conditions . Nearly three in 10 say they've skipped doses on their medication because of the cost. In the Kaiser survey, some 18 percent say they've decided to stay in a job rather than leave in order to keep better health benefits, and roughly the same number say they've "used up all or most of their savings" because of medical bills. One in five say they've had difficulty paying other bills.

These are much more statistically solid and disturbing numbers. Maybe we've heard those stories before; maybe we're tired of those anecdotes. But the best stories aren't always the best indicator of what's really going on – and what needs to be fixed.

Washington Ready to Tackle Health Care Reform?

Jenny Choi — Tue, 17 Jun 2008 10:53:27 -0400

The Washington Post reports that a renewed emphasis on health care reform is being felt in Washington, with two bipartisan Senate proposals in the works, a near doubling of health care experts on the staff of the Congressional Budget Office this past year, and Monday's health care summit, organized by the Senate Finance Committee, at the Library of Congress. Fed Chairman Ben Bernanke issued cautionary words about the financial challenges facing our health care system, saying that rising costs have been compounded by an aging population and the retiring baby boomers -- all of which will put an unprecedented strain on both personal and government budgets if nothing is done.

In fact, a new study from the Health Research Institute at PriceWaterhouseCoopers reports that employer health costs are projected to rise 9.9 percent this year.

Though many inside the beltway seem geared to tackle these issues, the public is still working through the possible solutions and has yet to come to terms with the various tradeoffs involved in health care reform. Cost and access are seen by the public as the most urgent health problems today, and most are in agreement that the system currently needs either fundamental changes or to be rebuilt entirely. But support for a universal health care plan varies based on survey question wording -- especially when paying more in taxes or premiums is mentioned. And yet two-thirds say it is the responsibility of the federal government to guarantee health insurance for all Americans.

It's also critical to point out the perception gap between experts and the public as to what might be driving these costs. Whereas experts consistently make reference to new medical technologies and treatments and a longer life expectancy, when asked to name the single biggest factors of rising costs, the public names company profits, malpractice suits and fraud and waste in the system.

Life Expectancy Surpasses 78 Years

Jenny Choi — Thu, 12 Jun 2008 10:38:56 -0400

Americans' life expectancy was 78.1 years in 2006, a record level, according to new data released by the National Center for Health Statistics. Death rates from heart disease, cancer, diabetes, influenza and pneumonia were all down from the previous year.

Polls show Americans don't quite connect the nation's aging population to the problem of swelling health care costs -- one of the most urgent issues in the eyes of the public. When asked to name the biggest reasons for escalating costs, most pointed to profits by insurance companies and malpractice lawsuits.

Most Americans say they would rather increase government spending on domestic programs than...

Nora Benavidez — Thu, 05 Jun 2008 12:50:00 -0400

A majority of voters are willing to pay more in taxes for education and health care, but...

Nora Benavidez — Thu, 05 Jun 2008 12:41:19 -0400

Mandatory Health Insurance, Put To The Test

Francie Grace — Tue, 03 Jun 2008 15:50:30 -0400

The first major study of Massachusetts' new law making health insurance coverage mandatory (pdf) found big changes in the first year it took effect. The number of uninsured adults dropped from 13 percent in 2006 to 7 percent in 2007. Some $9.7 million in fines levied on residents who did not buy health insurance will help pay for the program. The New York Times reports state lawmakers are also considering increasing the tobacco tax.

With health care reform among the issues on the presidential campaign trail, a series of CBS News/New York Times polls shows many Americans worry about health care costs, want major changes in the health care system, but are divided on what kind of changes to make. Eighty-eight percent of participants in a 2007 poll said the health care system needs either fundamental changes or should be completely rebuilt.

Americans clearly support expanding health care to cover more Americans, but support for such proposals varies according to the wording of questions on the issue – an indication that opinion on this subject is still evolving. Sixty percent in another CBS News/New York Times poll (pdf) last year said they'd be willing to pay higher taxes so that all Americans could have health insurance they could not lose; 34 percent said they would not be willing. Asked if it would be fair to require all Americans to participate in a taxpayer-funded national health care plan, 48 percent said "unfair" and 43 percent said "fair."

In March and April of this year (pdf), 42 percent told pollsters they were "very concerned" about not having enough money to pay for their current health care costs, 29 percent said they were "somewhat concerned" and 28 percent said "not at all concerned." Even so, in another April survey, health care did not lead the list of topics survey participants said they'd most like to hear discussed by the presidential candidates. Forty-three percent said the economy and jobs, 17 percent said the war in Iraq, 9 percent said health care/Medicare/Medicaid, and 7 percent said gas prices.

Americans are divided on whether medical malpractice lawsuits should be...

Nora Benavidez — Tue, 03 Jun 2008 11:26:58 -0400

Overwhelming majorities of Americans rate their own health insurance as...

Nora Benavidez — Tue, 03 Jun 2008 10:54:00 -0400

State-by-state health insurance coverage rates

Nora Benavidez — Thu, 29 May 2008 17:36:38 -0400