New Health Care Poll Looks At Swing Districts

November 24, 2009 - Businessweek
By Cathy Arnst

Opinion polls on health care reform keep piling up, and most of them show the public’s deep ambivalence, if not rejection, of the House and Senate bills on the table. But a new survey of residents in key battleground congressional districts found that support for reform can go way up if people are asked their opinion of specific proposals that might either save money or improve care.

The poll, sponsored by a pro-reform coalition of business and labor unions called America’s Agenda, sought out likely voters in Congressional districts where represenatives are could face tough opposition in the next election, as well as those represented by conservative Democrats, often called “Blue Dog” Democrats. It found that only 36% of these moderate-to-conservative voters favor current reform proposals (28% strongly), with 38% opposed (30% strongly) and 26% undecided.

But then the pollsters asked voters if they would support a reform bill that required that teams of doctors and nurses work together to coordinate all of patient’s health care needs, particularly for those with chronic diseases. Under that scenario, 57% of voters in Blue Dog
districts and 70% of voters in swing Republican districts would be in favor of a health care reform.

It’s a bit of a trick question, since neither the House and Senate bills include any meaningful incentives to encourage such coordinated care, often referred to as the patient centered medical home. Though the concept holds great favor among health care experts, the current fee-for-service payment structure, which rewards doctors for the quantity of services rendered, works against the medical home. There is also the lack of widespread implementation of electronic health records that are almost a necessity for coordinated care. Add in the fact that 83% of primary care practitioners are not tied into a network of care givers—in fact, half are in single-doctor practices—and coordinated care appears a long way off.

Still, the survey does show that people might show greater support for a reform bill that focused on improving care and making the system more cost-efficient, rather than just figuring out how to cover the uninsured. While such proposals as mandating that citizens buy insurance without providing a public financed option, or taxing high-coverage “Cadillac” plans, typically poll very low, reform proposals that improve care, even if it means dramatic changes in the existing delivery system, are usually quite popular. “People are saying I can support reform. They really do want the reform agenda to focus on care improvement and chronic care and team care,” says George Halvorson, CEO of managed care provider Kaiser Permanente. Kaiser is one of the nation’s largest practitioners of coordinated care, and a member of America’s Agenda.

Congress doesn’t seem to be listening, however, since the current bills do little to reduce costs and nothing to change the delivery system, other than fund a few pilot projects. A Rasmussen Reports poll released this week found that just 38% of American voters favor the Democratic health care plan against 56% who are opposed. A Robert Wood Johnson poll was more positive, but did point out that Americans are pretty conflicted over what health care reform would mean for them:

Asked how the health care overhaul would affect their own access to medical care, 57 percent said it would stay the same. Similarly, 61 percent said their personal financial situation would stay about the same. Among those who do expect a change, 28 percent said they thought their access to care would get worse, while 15 percent said they thought it would improve. On finances, 27 percent said they thought the health care bill would make them worse off financially, while 12 percent expected an improvement.

Meanwhile, here are the results of five other polls on health care reform released in the last week:

• Fox - Favor 35% Oppose 51% 
• Quinnipiac - Favor 35% Oppose 51%
• CBS News - Favor 40% Oppose 45%
• CNN - Favor 46% Oppose 49%
• PPP - Favor 40% Oppose 52%
(Source: Polls taken November 13 to 18)

Congress might want to take another look at the medical home model if it wants to win support.



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