Americans Want More Control Over Their Own Health Care

ObamaCare's popular provisions lose their appeal once Americans are confronted with the consequences.

With the three-day ObamaCare circus at the Supreme Court behind us, let’s fast-forward to June. Suppose that five justices find their constitutional bearings and do what a majority of Americans want them to do: Scrap the individual mandate, the key provision without which the law will collapse. What then?

Will that mean that our current system can just lumber along as is? No. America’s health care system is wasteful, inefficient and way too expensive: The U.S. retail price for an MRI, excluding professional fees, exceeds $4,000—about 20 times more than in Japan and France. This makes it extremely hard for Americans without coverage to spring for their own care, creating a system of medical haves and have-nots. It is not surprising, therefore, that a Kaiser Family Foundation tracking poll earlier this month found that six out of 10 Americans want lawmakers to keep searching for workable reforms even if the Supreme Court eventually kills the president’s reform law.

But any reform has to be based on the correct diagnosis of the problem. The administration's main argument for ObamaCare's mandate—that unless every freeloader is forced to buy coverage, we won’t be able to control spiraling health care costs—is a total red herring. The cost of uncompensated emergency care in America adds up to only about $40.7 billion annually, less than 3 percent of the country’s total health care spending. Arguably, even if hospitals were not legally required to treat uninsured patients, they would provide that amount of care pro bono—just as they do in India, a far poorer country. Many private, for-profit hospitals I queried during a previous visit reported treating up to 10 percent of their patients for free. American law firms, by comparison, aim to offer 3 to 5 percent of their billable hours in pro bono services.

But the question remains: What kind of reforms do Americans want? The Obama administration completely misread the public mood when it based its decision to craft a 2,700-page, Rube Goldberg-style makeover of literally one-sixth of our economy on polls suggesting that Americans would be willing to pay higher taxes for universal coverage. Worse, a joint Reason-Rupe poll released last week found that the misnamed Affordable Care Act—a.k.a. ObamaCare—imposed trade-offs that Americans were simply unwilling to accept. The act’s supporters insist that even though a majority of Americans view the overall law unfavorably, many of its specific provisions are quite popular. But the problem is that most polls pose questions in a vacuum, without actually confronting Americans with the consequences of their choices. The Reason-Rupe poll was among the few to do so systematically, and it found that although Americans do want equity and coverage for all, they want control, choice and quality for themselves even more.

Like other polls, it found that Americans don’t want the government forcing them to buy coverage, although they were more amenable to employers being forced to provide coverage to employees, even if that means job losses and pay cuts. Indeed, 56 percent of respondents said they were fine with an employer mandate, compared to the 39 percent who said they were not.

Americans like the idea of giving everyone the same access to health care, regardless of medical status—except if it means sacrificing affordability or quality. Fifty-two percent approved of the community rating provision in the law, which would ban insurance companies from charging higher premiums based on medical history, compared to 39 percent who opposed it. But this support drops precipitously if the provision’s side effects include longer wait times for doctors (41 percent) or higher premiums (38 percent) or higher taxes (37 percent) or lower-quality care (15 percent).

But what was truly revealing was how eager Americans are to control their own health care dollars. Forty-eight percent said they’d prefer it if their employers gave them the money to purchase their own coverage, compared to 41 percent who would not. Even more remarkably, 65 percent of Americans want Medicare payouts in the form of a credit for use toward a private health plan, compared to 24 percent who don’t. This is good news for Rep. Paul Ryan’s “premium support” proposal for Medicare reform.

All of this makes perfect sense in light of another finding. When asked to rate how much they trust various entities in “addressing their health care needs,” 61 percent said they have a “great deal of trust” in themselves—but only 15 percent said that of their employers, and 5 percent of the government.

What’s more, Americans want to make their own coverage decisions. Almost 70 percent said they want the same ability to shop around for “a less expensive or better [health] insurance policy” as they have for their auto insurance.

So what are the implications of all this for health care reform? Americans are not dogmatically opposed to government intervention in health care markets. But their intuitions are more in line with advocates of consumer-based medicine who believe that the best way to control spiraling costs—the key to improving access—is to give patients more control over their medical dollars and inject a modicum of price sensitivity into our health care system.

If the Supreme Court relegates ObamaCare to the dustbin of history, Congress ought to bear that in mind when it crafts a revised bill. The last thing the country needs is another failed reform effort.

Reason Foundation Senior Analyst Shikha Dalmia is a columnist at The Daily, where this column originally appeared.

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  • Fist of Etiquette||

    But the problem is that most polls pose questions in a vacuum, without actually confronting Americans with the consequences of their choices.

    Unintended consequences or unconsidered consequences, our leaders and their constituency don't like to think about consequences.

    And I think PPACA was their one shot at big change. I don't know if the dust will settle enough for a second try. If Obamacare goes tits up from the Justices' cruel hands, so many will have lost their seats for nothing. Will the idealogues be able to corral their less firmly entrenched colleagues to give it another go any time soon?

  • Rev. Blue Moon ||

    Hell no. They'll never be able to do this again.

  • ||

    Rev., I'm not totally convinced of that. From a provider perspective, the notion of single payer is very strong: it's the PAYING for it that is what ultimately causes even its supporters to balk.

    I really do think, with increasing patient dissatisfaction with insurers (purposefully induced by this legislation), and with the most popular aspects of this law being the most expensive (mandatory acceptance of pre-exists being the most onerous and treatment mandates) they will take another bite at the apple nationally. I also think single-payer with a defined tax could easily survive judicial review.

    Unless we end up with the equivalent of fifty RomneyCares.

  • Live Free or Diet||

    From a provider perspective, the notion of single payer is very strong

    One client is dangerous stuff. Where are your alternatives? What happens when that one client wants a bigger discount than you can give? Or free stuff? What keeps you from being his slave?

  • ||

    One client is dangerous stuff. Where are your alternatives?

    I am investigating medical expatriation to Donetsk, UKR. I only have one possible limiting factor that should be resolved by the end of the month. I hope to be out of here before the end of the year.

    What keeps you from being his slave?

    In a word, nothing. Tony, MNG, and their ilk see no problem with this. "Greater good" and other such drivel.

  • Lord Humungus||

    Wow, talk the talk and walk the walk!

  • ||

    Spent 10 days there in Donetsk during the month of FEB. It's actually quite beautiful and more politically stable than I was lead to believe and went to the local places where tourists don't go and it was alright.

    Ukrainians aren't too fond of Russks, however.

  • Heroic Mulatto||

    The Ukraine? There are a million tropical medical tourism paradises that would be glad to accept you and you chose the Ukraine?

  • ||

    I have my reasons, HM.

  • WTF||

    Would the surplus of hot Ukrainian women have anything to do with it?

  • Lord Humungus||

    and WTF wins the prize.

  • ||

    Christ Heroic, have you seen the women there? Screw palm trees, I will take Ukrainian beauties any day over sand and coconuts.

  • Drax the Destroyer||

    Ideally we end up with 5-10 RomneyCares (hopefully not in a state I am anywhere near) of various flavors, and they fail spectacularly, thus giving clear statistical evidence of the unviability of such rape-happy schemes. If you can't get them to work on millions of people, how in the fuck will they work on hundreds of millions of people?

  • Pound. Head. On. Desk.||

    "But they just weren't done right! We need more control! We have to force people to do what they want!"

  • Zombie Jimbo||

    Sure we take a loss on every patient, but we'll make it up on volume!

  • ||

    I also think single-payer with a defined tax could easily survive judicial review.

    Yeah, but where do the votes come from? Dems balking at that sort of straightforward, defined tax is exactly why they had to pass it in the constitutionally dubious form they did. And they had their chance to run wild after two completely mismanaged wars.

    I'm not super-optimistic on health care -- I mean, the status quo sucks, too -- but I don't know when the Dems will get a chance to do this again.

  • MoreFreedom||

    With single payer, you also get a single solution, including death panels who decide whether a procedure is cost justified. And you get no choice on your coverage. Thus, your statement is contrary to Dalmia's article that we want control of our health care, not government control of it.

  • unreasonableman||

    I already have a death panel. It's called my insurance company. they limit what doctors I can see, forcing me to use treatments that are known to not work and likely to cause greater deterioration later. Can I change insurance companies? No because my employer doesn't offer any other insurance companies. oh wait, changing to another insurance company wouldn't help because they would just be another death panel.

    employer managed, government managed, or private managed. As long as we are spending $.40 out of every premium dollar to some executive compensation package, we are going to have problems. We need to remove the profit motive from medical field.

    What's that? No profit would mean no medical advances? Well, the profit motive has given us questionable medications such as ssri's, atypical antipsychotics, treatment plans that "manage" diseases like herpes and diabetes by keeping up the drug company revenue stream. Yea, some advances come out of the free-market but most of them come out of universities and are improperly tested and developed before exploiting the marketplace.

    all futures suck

  • GreatLandGal||

    Rev. Blue Moon....make that a double Hell no, will you?
    Sorry Author....I am one of those Americans who are dogmatically, ethically, emphatically, financially, Constitutionally, and irrevocably opposed to any Federal government involvement in, 'tweaking' of, or re-proposing of some adulterated version of healthcare which STILL places government exactly where it has no business being....in control of Americans healthcare options and insurance choices.
    Quite frankly, I am stunned that a Reason reporter would not come down with an iron fist against any further federal involvement in what should be a free market situation.
    All insurance Companies being able to compete for business equally in all 50 States is only the first step toward true reform...Tort reform ( the capping of malpractice lawsuit damages and more), plus a serious look at Insurance Industry practices regarding denials of claims upon the flimsiest of excuses, pre-existing illness prohibitions and a blue-million more stone-walling practices resulting in loss of coverage for legitimate medical expenses.
    I don't believe that anyone posting here would deny that ObamaCare, (or any other federally contrived medical coverage plans), would benefit MOST....in this order....the insurance industry, The Federal government, Big Pharma, and the States. The least of the benefits will befall the unfortunate 'insureds'.

  • Fluffy||

    So no avatars?

    I was promised avatars.

  • SIV||

    I want Smilies

  • WTF||

    Meanwhile, Obama must expect to lose, because he is pre-emptively attacking the Supreme Court.

  • Suki||

    How could the constitutional scholar expect to lose? Whilst flinging poo at the SCOTUS, he said bills that become law have never been overturned by them before.

  • MoreFreedom||

    As a supposed constitutional scholar (has any journalist found anyone who attended one of his classes?), we know he can't believe this. Even I learned in high school the SCOTUS often throws out unconstitutional laws.

    Has Obama lost it? Or is his MO to say what he wants us to believe regardless of the truth?

    Obama: I'm sure this duly constituted law (whatever that means) will be upheld by the unelected justices of the SCOTUS.
    Pelosi: Are you serious?

  • Ted S.||

    I was flipping through the channels last night, and caught that on the evening news. Thankfully I was only about to start making dinner, so there wasn't anything to throw up.

    Somebody needs to tell everybody in Washington that you can't care about the children if you don't want to preserve the rule of law for them.

  • WTF||

    I'm pretty sure Obama thinks he is the law.

  • Randian ||

    AWWWW YEAH.

    Guess who's back? Back and more Registration-y than ever?

  • Jimbo||

    Not sure if they did this because of all the trolls flooding the comments? It was getting to be a big turn-off for me when reading the responses.

  • Suki||

    Obama says Obamacare is incredibly popular. The only people who don't like it need to be institutionalized.

  • Suki||

    One more time.

  • NAR||

    Hooey. When people are polled on the individual aspects they support ObamaCare. And when the GO and their media appeasers are screaming about DEATH PANELS and RATIONING all the time you're going to have a lot of people who oppose it out of ignorance.

    But why are we discussing what polls well? When people are asked they support Medicare for all, but the GOP would never let that happen.

  • WTF||

    C'mon, 'Nathan' - you're really Nancy Pelosi, aren't you?

  • Red Rocks Rockin||

    Hooey. When people are polled on the individual aspects they support ObamaCare. And when the GO and their media appeasers are screaming about DEATH PANELS and RATIONING all the time you're going to have a lot of people who oppose it out of ignorance.

    The "death panels" might be hyperbole; the "rationing" is not. For your edification, since I have to keep repeating it to every progressive that enters here:

    Federal spending on healthcare, 1980: $55 billion

    Federal spending on healthcare, 2011: $800 billion

    At the 9% annual increase that represents, federal spending on healthcare will reach $1.6 trillion in eight years, and $3.2 trillion in 16 years. If you think that, short of massive inflation, the government is going to be able to spend nearly its entire 2011 budget on healthcare, you're nuts.

    You cannot support "cost-shifted healthcare" for all and argue in the same breath that everyone will get all the treatment they want, regardless of how expensive it is. The money simply won't exist, and rationing will HAVE to take place, regardless of any mewling from progressives about Granny not getting her arthritis medication.

  • GreatLandGal||

    Red Rocks Rockin: You are soooooh correct to point out that this massive spending simply is NOT sustainable without rationing...Keep pointing it out to all the trolls who will still lie and cheat to get into this website to spread their delusions of Utopia and obamanomics.

  • anon||

    When people are polled on the individual aspects they support ObamaCare.

    Of course. When you ask people if they want free shit they're going to say "Yeah, sure."

    Then when you tell them what they have to pay for it, they say "Oh wait, fuck that."

    It's a sales gimmick, and nothing more.

  • AnnieO||

    ^This.^ What people really want is unlimited prepaid (by somebody else) healthcare for themselves and their loved ones. But for other people, not so much.

  • JohnR22||

    Oh c'mon NAR. When people are polled about having ice cream on their birthday, they're all in favor of it too.

    But, once you start to talk about cost and how they'll be taxed, the support evaporates.

    The biggest advantage the Left has always had is people's inability to understand that entitlements are not "free" and that the middle class pays out far more than it gets back.

  • l0b0t||

    Sorta OT - RI Law Enforcement To Get $230M From $500M Google forfeiture.

    "I am extremely pleased that of that $500 million dollars forfeited by Google, $230 million will be distributed to five state and local agencies that contributed investigators to the legal team headed by my office," Neronha said. "It is truly my hope and my expectation that these monies will be used for the benefit of all Rhode Islanders, by enhancing our overall ability to fight crime and keeping all Rhode Islanders safe."

    http://abcnews.go.com/Technolo.....e-16055911

  • John Galt||

    Seeing the four white lab coats has changed my mind.

  • Finite||

    Yeah, they don't look anything like the four horsemen I was told about.

  • ||

    Kinda makes you wonder who comes up with all that stuff.

    www.Surf-Tools.tk

  • ||

    So much for registration cutting down on the spam and bullshit...

  • Invisible Finger||

    Looks like the people in the white coats are coming to take him away.

  • tcolgan001||

    What an absurd question.

    (paraphrased): “Would you oppose ObamaCare if it is going to cost you more and you are going to get less?”

    And the answer is … duh?

    What needs to be addressed is what approach is going to both:
    1) reduce costs.
    2) improve results.

    The consensus among people who analyze the available data is that universal coverage will do that (aiming to reduce the 15% insurance share that private insurers take toward the 6% that medicare has as overhead). Instead of having private insurers spending significant resources to single out and disqualify pre-existing conditions those resources go to medical care.

  • Red Rocks Rockin||

    The consensus among people who analyze the available data is that universal coverage will do that (aiming to reduce the 15% insurance share that private insurers take toward the 6% that medicare has as overhead).

    Nope, sorry.

    The government will not be able to ramp back a 9% annual increase in the cost of healthcare and still provide universal, on-demand health services, regardless of condition. The infrastructure is not in place, nor does the math support, such a goal.

  • anon||

    (aiming to reduce the 15% insurance share that private insurers take toward the 6% that medicare has as overhead).

    The health insurance industry has a profit margin of 2%.

    Even if you somehow believe they're "taking" that 2% from the consumer, it's merely 2%. And this doesn't account for the negotiation the company does on your behalf, nor the ease with which you receive health services.

    I'm very willing to pay that 2%.

  • JohnR22||

    tcolgan001: Name me one big govt program...hell, name me ANY govt program...where their cost projections have come anywhere close, or where the promised services ever materialized.

    The govt's track record is ZERO. If you actually think our Rube Goldberg bureaucratic contraption can do what you claim, I've got some land in florida to sell you.

  • Registration At Last!||

    Praise the Lord! The great bastion of Libertopia do-what-thou-will-ism decides that comments need a registration system!

    I predict sevo and Epi will last about ten days, tops. Griefers beware, and handle-jackers, good-bye!

    Regarding the post, you can make these polls come out any way you want with loaded follow-up questions. To wit...

    Q: Do you want people to be able to get insurance regardless of pre-existing conditions?

    A: Of course!

    Q: What if it means higher insurance premiums for you?

    A: Then no, in that case.

    Q: But what if that means that your daughter would not be able to get medical insurance if she was born with a pre-existing medical condition?

    A: Uh, then back to "yes", I guess.

    Q: But what if it means a decline in "quality of care?"

    A: Then ... um ... "no" again? I think?

    And so on and so on.

  • SusanM||

    Bravo on the registration! Woot! Now griefers and troll will have to spend an extra five minutes one time ;)

  • anon||

    Meh, at least it will force trolls to be at least somewhat clever, rather than copy & paste.

    Spammers generally avoid sites that require registration after a few tries. It's just too tedious.

  • Claudio Ibarra||

    Does anyone have a source for the mentioned cost of uncompensated emergency care? I'd like to read more on that.

  • Contrarian P||

    Emergency care, compensated and not, represents a very small portion of the total amount spent for health care. It's a myth that a bunch of the uninsured coming to the ED are responsible for the dramatic increases we've seen in health care costs.

  • JohnR22||

    Obama didn't misread anything. He knows full well that once an entitlement is in place, people "love" it; that's to say they become addicted to it, become terrified of losing it, and view it as "free".

    The Left's game plan is to expand entitlements as fast as possible. If they can fund it through massive tax hikes that's fine; if they can't, they'll just deficit fund to the moon.

    Their bet is that once the economy collapses through massive debt, voters will opt for tax hikes (always sold as tax hikes on the rich) instead of cutting entitlements.

    The sad part is that the Left will likely win. The game was up with the New Deal. It's always just been a matter of time until we have a full blown socialist tyranny.

  • Perrin Clemenceau||

    Eliminate the tax incentives for employers to compensate employees with health care benefits and you'll solve most of cost issues. Or better yet give a more attractive tax incentive (i.e. theft prevention tool) to individuals than that of businesses.

    We are over-insured in this country. A routine doctor visit being "paid for" with a $15 co-pay is horseshit. Yet garbage like this is covered by employer insurance policies because employers are better off spending money on heath care than they are w-2 income for their ee's.

    Insurance is to limit risk for costly, catastrophic events, not silliness such as taking little Johnny to the family doc because he has the sniffles.

    Pay for the cost of healthcare directly and suddenly, magically you'd see a price collapse like no other.

  • ||

    BUT! BUT! TEH CHILDRENZ!

  • ||

    "...although Americans do want equity and coverage for all, they want control, choice and quality for themselves even more."

    In other words, they want contradictory outcomes, and the fact that they show no consciousness of the irony of their statements nor appear to be plagued by the cognitive dissonance that should accompany such a proposition is proof positive that any future health care reform legislation will be just as shitty as this one.

  • HTuttle||

    Here's one: $6 a pair for disposable latex gloves. My last operation rang up about 30 pair. How's that for BS charges. That's like a BBQ restaurant charging for each napkin you use. WhyTF is that not wrapped into the basic hospital cost? BS.

  • itrain||

    To have any credibility on any healthcare reform the Feds must first address Medicare costs. They need to go to a capitation system of payment for Medicare. They need to take the 800 billion dollars they spend on Medicare annually and divide it up among hospitals in proportion to the number of seniors that register with them. In other words a hospital group that cares for 10,000 seniors gets a monthly block grant that is twice the size of one that cares for 5,000. This gives providers the incentive to control costs instead of the current ridiculous 9% compounded annual cost increase. Secondly they need to peg the growth of Medicare to the growth of GDP. Until the budget is balanced Medicare disbursements must not increase at greater than 50% of the past year's GDP growth rate. Under this rule ( until the budget is balanced) if this year's GDP growth is 2% then Medicare disbursement next year will increase by 1%

  • concetta adams||

    roomate's aunt earned $18544 the previous month. she is working on the computer and bought a $367500 home. All she did was get lucky and put to use the clues uncovered on this web site Nuttyrichdotcom

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