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    What America Thinks
    Close to a Fever Pitch Over Health Care

    By Richard Morin
    Washington Post Polling Director
    Monday, Sept. 21, 1998

    While political Washington wallows in the Lewinksy scandal, public concerns over managed care are beginning to boil over – not that anybody inside the Beltway seems to notice or care.

    They should. And they eventually will. They'll have to: More people than ever before are worried about their health care. Moreover, those concerns are fueling a heightened call for government action to control a health care system that many fear puts profits ahead of patient care, according to a new national survey conducted by The Henry J. Kaiser Family Foundation and Harvard University. In the past year, the percentage of Americans who say health maintenance organizations (HMOs) were doing a good job serving consumers declined from 36 percent to 30 percent, according to the poll. More ominously, the proportion saying they were doing a bad job increased from 25 percent to 42 percent. Likewise, the proportion saying managed care companies were doing a good job dropped modestly from 34 percent to 30 percent, while the proportion saying these firms were doing a bad job grew by 15 percentage points to 36 percent in the past year.

    The poll also revealed a disquieting increase in the proportion of Americans concerned that the quality of health care provided by managed care health plans. Last year, fewer than half – 45 percent – said managed care has "decreased the quality of health care for patients." Today, a 56 percent majority expresses that view.

    The poll also found small increases in specific complaints: Nearly two in three – 64 percent – say HMOs have "decreased the amount of time doctors spend with patients," up from 61 percent last year. Nearly as many – 62 percent – say today that managed care has made it harder for sick people to see medical specialists," up from 59 percent one year ago.

    While more people see problems with managed care, fewer people agree that HMOs have significantly reduced health care costs. Overall, nearly six in 10 say managed care has "not made much difference to health care costs," up slightly from one year ago.

    These worries have increased dramatically in the past year. Today, 33 percent of those in health care plans said they're "very worried" health plan would be "more concerned about saving money than about what is the best treatment," up from 18 percent last year. The proportion in plans with many rules and restrictions are the most concerned: More than four in 10 – 43 percent – of this group said they were "very worried" that their plan would put profits before patient care.

    Some of these fears likely are misplaced. Media coverage of HMOs and other forms of managed care has been relentlessly negative, despite surveys that consistently show that people generally are satisfied with the quality of health care they receive from their own HMOs or care plan.

    But there are signs that growing concerns are also fueled by direct personal experience. The survey found that 57 percent of those in managed care plans say they or someone they knew has experienced a problem with their plan in recent years, up from 48 percent last year.

    Three in 10 – 30 percent – said they or someone they knew has had difficulty getting a health plan to pay for an emergency room bill, up from 19 percent last year. Twenty-six percent said they or someone they knew has had problems "getting permission from a health plan or regular doctor to see a medical specialist," up from 18 percent. The proportion who report having difficulty getting permission to see a gynecologist more than doubled, from 6 percent to 15 percent.

    Little surprise, then, that the proportion who favor a law that would allow patients to sue a health plan for malpractice have increased from 64 percent in December of last year to 73 percent today. And the proportion who said they or someone they knew wanted to sue a health plan for malpractice grew from 9 percent in December to 13 percent in the latest poll.

    It's also no surprise that the proportion of Americans who want the government to protect health care consumers has surged over the past year. According to the survey, two in three Americans – 65 percent – now agree that "the government needs to protect consumers from being treated unfairly and not getting the care they should from HMOs and managed care plans." One year ago, barely half – 52 percent – of those interviewed wanted the government to intervene.

    But few things in the health care debate are simple. When potential consequences are mentioned, support for various reforms drops.

    Consider what happens when people are asked whether they would support a law requiring HMOs, managed health care plans and insurance companies to provide more information to consumers, make it easier to see specialists, allow independent reviews and give people the right to sue their health plans.

    Nearly eight in 10 – 78 percent – support would support such a law, sometimes called the health care "Bill of Rights." But when supporters were asked if they would still favor such legislation if it would increase the cost of health insurance premiums by $200, the proportion supporting the law drops to 40 percent. Raise the cost to $1,000, and barely a third of the original supporters say they'd still favor the law.

    A total of 1,200 randomly selected adults were interviewed Aug. 6-20 for this survey. Margin of sampling error for the overall results is plus or minus 3 percentage points.

    Richard Morin is director of polling for The Washington Post. "What Americans Think" appears Mondays in The Washington Post National Weekly Edition. Morin can be reached at .

    © Copyright 1998 The Washington Post Company

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