Some 25 years ago, one of the country's most respected public opinion researchers, Daniel Yankelovich, put forth the notion that Americans often require a seven-step journey to reach consensus on difficult public policies. The process begins with awareness of an issue, gains urgency and ultimately finds resolution when the public sorts through options and takes an intellectual stand on a preferred action.
A significant hurdle comes about midway through the process when people get waylaid by wishful thinking. Americans pin their hopes on silver bullets and false fixes. Sometimes we are quick to move on to real solutions. Other times, we get stuck on the delusion that change can be accomplished without trade-offs.
That seems to be where things stand today — and, in fact, for most of the past three decades — on health reform. We are stuck on wishful thinking.
That reality was underscored by an opinion survey recently released by HealthBasics, a collaboration of leaders from Medica, TwinWest Chamber of Commerce, Minneapolis Regional Chamber of Commerce, Minnesota Building and Construction Trades Council and North Memorial Health Care. Members of this diverse group bring different perspectives to interpreting the HealthBasics issues, a collaboration not often found in health policy discussions.
Politics shapes issue
The research found that more than two-thirds of Minnesotans see the health system challenges and solutions through the perspective of their political ideologies.
Conservatives place cost and quality above coverage, believe these goals are best reached through marketplace competition and want the government largely to stay out of health care.
In contrast, political moderates and liberals are more inclined to put affordable universal coverage at the top of their priorities, and believe government is best able to deliver on these goals. Consistent with their views, they favor government action to control the cost of some health treatments and to limit the compensation paid to executives.
Meanwhile, the research shows that a strong majority of Minnesotans rejects solutions that would change how we interact with the health care system. For example, a majority of Minnesotans believe that doctors often order tests and treatments that don't really improve a patient's health. But rather than find ways to identify the most effective treatments, 67 percent of us say that insurers should pay for every treatment or service a doctor prescribes.
In other words, Minnesotans want whatever treatment is prescribed by a physician; we want to see specialists without referrals; and we want our health insurance to pay the full cost of care. And we want all of this regardless of cost or effectiveness.
The goal of HealthBasics is not to chide the public for its wishful thinking. The HealthBasics research provides insight into the most important values and priorities Minnesotans bring to health reform. This baseline of understanding is being used by HealthBasics to host conversations in different forums around the state. These conversations, we believe, can move Minnesotans along Yankelovich's continuum, helping the public identify and sort through different policy options.
The initial forums hosted by HealthBasics already have revealed consistent themes. For example, Minnesotans place a high value on the quality of health care available throughout the state. But what if Minnesotans defined "quality of care" not just in terms of treatments provided by medical professionals and institutions, but the actions each of us took to promote personal health? A broader range of policy options promoting health improvement — for example, ways to encourage better nutrition or more physical activity — might emerge that would be more effective and less costly than treating health problems after they occur.
Another message from forum participants is their frustration with the complexity of the health care system, including insurance. People aren't certain what is or isn't covered or why their premiums go up or down.
Solutions to this challenge might come from more private sector cooperation, not more government. For example, insurers could use more plain-language documents, health providers could be more transparent in what procedures cost and employers and unions could do more to educate their employees and members on how to be better consumers of health care.
HealthBasics is a process to help Minnesotans move from wishful thinking to sorting out the real choices available to them and the trade-offs that will be required. The involvement of business, labor, insurance and health providers in HealthBasics helps assure that facts prevail over politics.
HealthBasics doesn't know the destination; we do believe, though, that we are drafting a map that will help Minnesotans on their journey to good health reform choices.