Wednesday, September 18, 2013

Fwd: qotd: Gaps in public understanding of Medicare

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Subject: qotd: Gaps in public understanding of Medicare
Date: Wed, 18 Sep 2013 12:22:15 -0700
From: Don McCanne <>
To: Quote-of-the-Day <>

The New England Journal of Medicine
September 12, 2013
The Public and the Conflict over Future Medicare Spending
By Robert J. Blendon, Sc.D., and John M. Benson, M.A.

Our thesis is that there exists today a wide gap in beliefs between
experts on the financial state of Medicare and the public at large.
Because of the potential electoral consequences, these differences in
perception are likely to have ramifications for policymakers addressing
this issue.

There are concerns about Medicare today and current cost-containment
efforts. Most respondents see Medicare in some cases already withholding
treatments and prescription drugs to save money, including 63% who
believe this happens very often or somewhat often. Also, the public sees
the bigger problem for Medicare beneficiaries as not getting the health
care they need (61%) rather than as receiving unnecessary care (21%).
Medicare pays about half the total personal health care expenditures for
beneficiaries, but many people are confused about what proportion is
paid by Medicare, whether it pays for most of recipients' bills or
substantially less.

When given a dozen possible causes for rising Medicare costs that have
been suggested either by experts or in the media, the majority do not
identify any one of them as the most important. However, the three most
often cited reasons relate to poor management of Medicare by government,
fraud and abuse in the health sector, and excessive charges by
hospitals. The lowest ranked reason was the cost of new drugs and
treatments being offered to seniors.

Although Medicare is popular, it is not seen as better run than private
insurance plans, nor is it seen as particularly different from private
coverage with respect to quality of care or access to physician care.

The one area of clear support for the future is the growing preference
for Medicare Advantage–type private health coverage among persons less
than 65 years of age.

In conclusion, two points are important. It would aid the long-term
resolution of these issues if there were a nonpartisan, broad-based
public education campaign launched focusing on how Medicare works
financially. Second, it would be advantageous if discussions of the
financial sustainability of Medicare could be separated from public
debates over reducing budget deficits or enacting tax cuts. Until these
concerns are better addressed, the gaps in perception are likely to remain.

MedPage Today
September 11, 20133
Public Often Clueless About Medicare
By David Pittman

Because of a high level of misunderstanding about Medicare's financing,
lawmakers in Congress are hesitant to enact changes to the program
fearing voter backlash, Bob Blendon, ScD, and John Benson, MA, both of
Harvard University, wrote in a special report in Wednesday's New England
Journal of Medicine.

Ted Marmor, PhD, professor emeritus of public policy at Yale University,
said it's misleading to imply public opinion is a shaper of public
policy. He called it more of a protector than a promoter.

"The public is almost never well informed about details," Marmor told
MedPage Today in a video interview. "What's important about public
opinion is what its values are and what it would be threatened by, not
what it means in terms of shaping public policy in terms of direction on

Harvard School of Public Health
Poll - May 13-26, 2013
Public Attitudes about Medicare

10. Which do you think is better run, (the federal Medicare program) or
(private health insurance plans that people get through their jobs), or
do you think they are about equally well run?

15% - The federal Medicare program
41% - Private health insurance plans
39% - About equally well run
5% - Don't know/ Refused

19. (When you retire,) If you had a choice, would you prefer to get your
Medicare health insurance benefits from the current government Medicare
program, or from a private health plan, such as a PPO or HMO, offered
through Medicare?

34% - From the current government Medicare program
56% - From a private health plan, such as a PPO or HMO, offered through
10% - Don't know/ Refused

Comment: The public is not well informed on the details of Medicare. A
plurality believe that private insurance plans are better run than
Medicare, and a majority would prefer private plans when they retire.,

We should think about the political implications of this. Is "Medicare
for All" really a good slogan for single payer? Medicare has some very
serious defects, like it pays only about half of beneficiaries' health
expenditures. Yet we certainly don't want a slogan that would suggest
that single payer would be like private insurance for everyone.

We shouldn't change course based on the results of a single poll, but we
should continue to think about how we can improve our messaging so that
people do understand that single payer is what they really want. That's
true when the facts are presented, but too many still don't understand
that. As Ted Marmor implies, perhaps we should be placing more emphasis
on values.

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