Last week, the New England Journal of Medicine ran a piece on the effects of economic crisis on health care. Data beyond what happens when you lose your job and your insurance is sparse, but the author, Ralph Catalano, noted:
At the onset of bad economic times, the demand for psychiatric services declines, with fewer visits for "maintenance" but eventually more for acute episodes. "Coerced" treatment increases as society's tolerance for people with behavioral problems drops. Generalizing from psychiatry, I expect that medical care providers will first see a small decrease in demand as copayments become more onerous, more patients lose their insurance, and some people take fewer risks and perhaps become healthier. People who seek care will be more likely to have insurance and may feel that their employment status and social standing are threatened by society's lower tolerance for their physical or behavioral deviance. As time passes, however, I would expect to see increased demand for services from people who "deferred maintenance" because of costs and therefore become ill.
These predictions raise questions that are worth considering. How can we reduce the suffering of job-losers and their family members who will become ill but not seek help at the onset of illness? How can we encourage them to seek care? How can we finance their care if they seek it? Surely, we can devise a plan for those made sick, directly or indirectly, by the failure to regulate our economy. After all, we seem to be at no loss for the cleverness and resources to rescue those who capitalized on that negligence.
With that (and this) background in mind, Kaiser.org released a poll yesterday of what is happening to American families. we are seeing those "deferrals of care" Catalano referred to.
As economic conditions continue to worsen, the public is increasingly worried about the affordability and availability of care, with many postponing or skipping treatments due to cost in the past year and a notable minority forced into serious financial straits due to medical bills, according to the Kaiser Family Foundation’s first health care tracking poll of 2009.
In the face of the country’s current economic challenges, the public’s support for health reform remains strong and their trust in President Obama to do the right thing in health care reform is high.
Slightly more than half (53%) of Americans say their household cut back on health care due to cost concerns in the past 12 months. The most common actions reported are relying on home remedies and over-the-counter drugs rather than visiting a doctor (35%) or skipping dental care (34%). Roughly one in four report putting off health care they needed (27%), one in five say they have not filled a prescription (21%), and one in six (15%) say they cut pills in half or skipped doses to make their prescription last longer (see chart).
As usual, independents power the partisan gap by leaning Dem:
The share of Americans who say that the country’s economic problems make it more important than ever to take on health care reform has remained remarkably stable over the past five months at roughly six in 10 (62%). However, the partisan divide also remains large with Democrats overwhelmingly (79%) saying reform is more important than ever and most Republicans (58%) saying the nation cannot afford to tackle health care reform at this point. Independents tilt the balance by being in favor of reform now (57%).
Health care continues to rank as one of the top issues on the nation’s policy agenda. The economy dominates (71%) the public’s priorities for the president and Congress, followed by making Medicare and Social Security more financially sound (49%)—a new issue added to the list this month. Terrorism (42%) and health care (39%) rank third and fourth.
And, as far as Obama's standing on the health issue as we get started with the process, for right now, Obama has his mandate:
Seven in 10 Americans (72%) have a “great deal” or “fair amount” of trust in President Obama “to do or recommend the right thing for health care reform,” giving him a 12 percentage point lead over the next most trusted actor in health care reform. Following Obama on the list of trusted players are doctors’ organizations (60%), Democratic leaders in Congress (57%) and AARP (57%).
Congressional R's come in at 38% (hello, House Republicans?).
Ezra has more on the politics of reform here. Here's an important graph to go with it.
It's important because most people have insurance, and those are the voters who will decide whether reform goes forward with support. Note the 59% of the country who think we'd be better off with reform, even if not themselves.
Finally, keep in mind the definition of "health reform'
When Americans hear policymakers talk about health care reform, they predominantly are thinking about cost and coverage. When asked what “health care reform” means to them, 40 percent of the public respond with a cost concern – people paying less for care, care being more affordable, or lowering the prices of medical goods such as prescription drugs. Just as many (39%) describe reform as providing insurance to more people or helping the uninsured. Quality or delivery system reform did not leap to the minds of Americans with only nine percent mentioning it in their responses.
But it does include quality (which might contribute to savings), and even if the public just assumes quality, planners can't do that.
More to come, but this will at least set us up as to where we are at now. Americans are worried about health care costs as much as access (and vice versa) , trust Obama more than anyone else to fix it, and Republicans continue to be odd man out. So it goes.
Full polling data available here.