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Friday, March 19, 2010

Who Benefits if a New Healthcare Plan is Passed Into Law?

Assuming the new healthcare reform bill does in fact become law over the next several days, cui bono? Who will reap real-world, tangible benefits from the new legislation?

Americans appear to have an answer to this question: The pending healthcare legislation is the functional equivalent of a Medicaid bill. The legislation will help the poor and those who currently don’t have health insurance, but at the cost of a net negative impact for most other groups affected.

This conclusion comes from the remarkable findings of Wednesday Gallup polling. The survey question asked Americans if the “bill now being considered in Congress” would make things better or worse for a list of 10 different entities.

Results: Only two entities would gain more than they lose if the healthcare legislation now being considered in Congress is passed into law. These are:
  • Americans who do not have health insurance
  • Lower income families
All other entities tested are perceived by John and Jane Doe out there across America as being net losers from the passage of the new bill.
Americans say they themselves (“you and your family”) will be worse off rather than better off by a 37% to 28% margin if the bill passes. The United States as a whole will be worse off rather than better off by a 44% to 39% margin. Middle-income families will be worse off rather than better off by a 44% to 34% margin.

The fact that Americans believe the poor and those without insurance would benefit probably is not particularly surprising to those pushing for passage of the bill.

President Obama has made some efforts to convince Americans who already have health insurance that they too will benefit from the bill. But he has focused of late directly on those who are out of the system.

Case in point.  Obama’s recent speech in Ohio focused on the emotional plight of a woman named Natoma, who has cancer, is self-employed and can no longer afford health insurance. According to the account on the White House Web site, Notama recently collapsed with a recurrence of cancer and “Natoma and her family are struggling to determine how they will afford Natoma’s medical treatment now that she no longer has insurance, which she dropped in January 2010 because of rate hikes that simply made insurance unaffordable.” Obama was introduced by Natoma’s sister at the speech.

Other supporters of the bill similarly focus mainly on the centrality of the eleemosynary mission of the bill. Politico quotes Congresswoman Barbara Lee of California as saying “. . . there’s no argument [for the healthcare bill] beyond the moral imperative,” and that “This is about the 47 million people who don’t have health insurance.”

The data suggest that the majority of Americans would agree with Lee’s orientation. In addition to this week’s poll results, we have also found that the top explanations given by those who support the bill are along these lines: it will help the unfortunate who have been left adrift health insurance wise.

These data are relevant to the next stage of the healthcare drama.  Obama and the Democrats, assuming that the bill passes into law, will now shift to a position of reinforcing the virtues of this major legislative action.

If they want to build off of existing perceptions, they should primarily focus on the fact that the new law will help the less fortunate. To argue that the bill is good for all would run to a degree against existing attitudes. About 83% of Americans have health insurance and most Americans do not consider themselves to be lower income.  As a result, as noted, most Americans do not currently believe that they would benefit from the bill. (Obama and the Democrats could argue, of course, that "there but for the grace of God, go I"; i.e., that any of us who do have health insurance could suddenly confront a life-changing event and become one of those without).

There is also the issue of the unpopular health insurance companies.

President Obama has explicitly cast the bill as a pushback against health insurance companies. In the process, he has apparently helped convince Americans that health insurers would be significant net losers if the bill passes. Over half of Americans say that health insurance companies will be worse off if the bill passes. This is the biggest "worse off" percentage of any of the ten entities tested.
What actually will happen on the insurance company front is not clear. Pushing tens of millions of Americans onto the health insurance rolls who were not previously insured certainly will increase the number of healthcare customers. This could, in theory, be a net plus for the healthcare system -- including insurance companies.

The proposed legislation has many elements in it designed to curb the amount of money that healthcare companies can make off of patients. Still, Rep. Stephen Lynch, Democrat of Massachusetts has, according to a report in The Washington Post, called the bill “a great bill if you’re an insurance company” because it does not have a public option to compete with private insurers. Another observer states: "Briefly, the most significant outcome of this legislation is the windfall gain for insurance companies -- who will be able to tap the wages of the huge pool of nearly 50 million Americans who currently do not purchase health insurance."
I’m not sure what to make out of the perception of the part of Americans that doctors and hospitals will worse off -- rather than better off -- if the bill passes. Again, increasing the ranks of the insured, in theory, could mean more patients for everybody in the system.  But if the net result of the bill is to cut the amount of money insurance pays out to doctors and hospitals, it could mean higher volume but with lower/non-existent profits.

DoAmericans want their doctors and hospitals to make less money?  That's not clear.  Americans have much more positive views of these two entities than they do of health insurance companies. Creating a more negative financial situation for doctors and hospitals could trickle down to worse care for patients. Or push more doctors to the point where they begin requiring that patients pay extra fees outside the system in order to be seen.

Update:  Remy recent post on basic ballot questions about the healthcare plan.

I pointed out that the two most recent polls at the time of my writing showed the public slightly tilting away from support for the plan. Now, two new polls show somewhat stronger opposition to the plan. Here are the wordings of the questions involved and the responses:

Pew Research Center (March 10-14): “As of right now, do you generally favor or generally oppose the health care bills being discussed in Congress?” Results: 38% generally favor, 48% generally oppose.

Fox News/Opinion Dynamics (March 16-17): "Based on what you know about the health care reform legislation being considered right now, do you favor or oppose the plan?" Results: 35% favor, 55% oppose.

One note: These questions don’t ask directly if the plan should be passed, but rather if it is favored. When The Wall Street Journal/NBC News poll recently asked two separate questions about healthcare legislation, one right after the other, it found more support when Americans were asked if they wanted the plan passed than when they were asked if they favored the plan.

5 comments:

sgoldreich said...
March 20, 2010 at 7:38 AM  

One reason for the poor opinion of the bill is the amount of disinformation passed along as fact, where deliberately or by simple sloppy commentary or reporting. Case in point is today's Christian Science Monitor story on your poll quoting you saying "The bottom line is that Americans perceive this to be a Medicare-type
bill – a welfare bill mainly aimed at helping poor people and those without insurance,” says Frank Newport, editor in chief of Gallup. “They
think everyone else will be a net loser.”
There is no follow up graph noting that Medicare is a universal entitlement helping all seniors who have paid for the benefit, quite the opposite of a Medicaid-type welfare.
I assume this was a misquote, given your comment above that Americans consider "The pending healthcare legislation is the functional equivalent of a Medicaid bill," NOT A MEDICARE BILL.

Anonymous said...
March 20, 2010 at 9:39 AM  

What I do not find and do not hear is how much competition exists in the insurance industry. I have found CBO and GAO reports to members of Congress that indicate that the health insurance market is dominated by only a few companies. Further, looking at growth in market share over the last 10 years there seems to be a concentration of market share in an ever smaller portion of the market.
So, the question becomes one of Who will be able to issue the 30 million new policies? Will that be spread across all existing companies or will it be proportional to current market share or will it go to the larger, more rapidly growing companies? Answers to these questions will make a significant difference in who the biggest winners will be.

Anonymous said...
March 21, 2010 at 11:36 AM  

I favor President Obama and the Democrats Health Care Reform Plan because there are many working people who are not poor that have made their payments to their insurance companies only to find that they can not use their insurance due to some pre-existing condition or inadequate insurance coverage not being able to cover a deadly illness. The poor are covered by Medicaid so they are not the ones who are in question. This is a matter of fixing a broken system along with the economy. I can not fathom anyone who would vote against Health Care Reform because if they are then they are voting for America to not succeed as a country.

ray : ( said...
March 23, 2010 at 8:41 PM  

Who benefits from this bill? politicians! I am unemployed not insured i would rather work than have this trashy healthcare bill passed!I noticed obama had to pull every bit of underhanded ,backroom deals to pass this misreable bill! Not to menton it is against the constitution to demand we buy health insurance ,its just another power grab for our already socialist country !Has the goverment ever run any medicare social sucurity well .NO both will be bust by 2016 i geuss the republicans will have to fix this mess HA unlikely also! FIRE everyone in congress senate and president start all over with new rules 75% must agree to pass a bill and no more parties!!!!!!!!

Anonymous said...
March 24, 2010 at 7:28 AM  

It's such a great thing...but the politicians have excluded themselves from being a part of it. That worries me. It also worries me that if you choose to not have health insurance now you are being forced to purchase something against your will. I know many families that refuse to pay the insurance game. As they work and earn a living, they set aside funds for future medical bills. They go to doctor's who don't play the insurance game. But now that way of life is being forced out. That is not how a democracy works. When we not longer have a choice to have insurance or not and be fined if we don't...that IS socialism. Exactly why our forefathers left England to start a new life without the tyranny. Obama has made his bed and I hear it is full of fleas.

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