What Americans want from health care

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Asthma medication versus acne medication; MRIs versus birth control; surgery versus rehab. These are some of the decisions policy makers need to consider when deciding what’s covered and what’s not in healthcare.

But are Americans willing to make those hard choices? The non-partisan Center for Healthcare Decisions conducted a series of phone surveys and group discussions and asked people: What matters most in healthcare?

On "Here and Now," the group’s executive director, Marge Ginsburg explained the survey and shared findings.

"What we did with this phone survey is, everyone received nine vignettes — short, two-sentence descriptions of a medical problem or a treatment — and there were a number of things that more than 90 percent of the people agreed yes, it should be covered," said Ginsburg.

"The types of situations that almost everyone agreed on were things that saved lives, that enables productive functioning, that prevents new illness, that controls pain, and that produces good results."

There were a few vignettes that caused controversy — one such vignette was about breast reconstruction surgery. Ginsburg says this example raised a lot of questions in people’s minds about the essence of health insurance, "What was interesting about this is on the phone survey, 81 percent approved it for coverage — which is fairly high, not among the highest.

"We brought this one to the discussion groups and we got far more controversy on this than we were expecting. Some folks who really didn’t think that this should be part of a basic health plan would say things like, it’s basically cosmetic surgery; that if she’s been cured [of] cancer we don’t really need to go the extra step and make her feel whole again; an artificial breast really has no function. In fact, someone made an interesting statement which I’ll quote: ‘We’re not talking self-esteem insurance, we’re talking health insurance.’"

Coverage for mental health problems garnered strong support from the people surveyed; however, most didn’t feel marriage counseling was important enough to be covered.

When it came to overweight children and whether insurance should pay for medically supervised nutrition and exercise, people responded from two different angles.

"On the one hand is this strong feeling most people have that it is the responsibility of the parent to make sure that it’s the responsibility of the parents to make sure that their child is eating well, is exercising well; it’s not the responsibility of society to step in and make those changes that they can make on their own," said Ginsburg.

"But the people who thought it really should be covered, were looking at it from the angle of, first of all this is a young boy, 12-year-old, and they were very worried that if he’s at this pattern now, at this age, there’s no telling what his health is going to be like ten years from now. So they really thought, the parents can’t handle it clearly, and there’s a point at which we have to step in and offer some help to mitigate these problems before they turn into serious health problems."

Another vignette involving an expensive and seemingly unnecessary medical test also garnered surprising results — while support was low, 55 percent of the people surveyed approved it. Ginsburg says this was probably due to the fact that people weren’t told they had a limited amount of money to spend.  

Ginsburg says most of the time the public is not aware that a lot of what’s being done lacks any evidence of effectiveness, "They assume that anything that their doctor prescribes is being prescribed because it has been proven to work.

"When you ask people to come together as a group and figure out what is fair and what is reasonable, what are the rules by which we can all live and feel good about it, they’re much more willing to say no, we need to wait and make sure something really works well before we invest hundreds of thousands, if not millions of dollars, down a road that leads nowhere."

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