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Medicare News
Medicare Solvency Ranked Third in Health Care
Priorities by Opinion Leaders
Most want Congress to cover uninsured, reduce
health care costs
 January 8, 2007 – The top health care priority over
the next five years for Congress should be expanding coverage for the
uninsured, says a new survey. Reforming Medicare to ensure it's
long-term solvency came in third, just below the priority of moderating
rising health care costs. The Commonwealth Fund released the survey
today of what it says are "leading health care experts."
Expanding coverage for the uninsured was identified
as "absolutely essential" or "very important" by 88% of respondents to
this TCF Health Care Opinion Leaders survey.
The percentage for the other top priorities are
moderating rising health care costs (81%), reforming Medicare to ensure
long-term solvency (80%), and increasing the use of information
technology to improve the quality and safety of patient care (80%).
"Opinion leaders also say that reducing the
proportion of the uninsured under-65 population from 18 percent to 5
percent is an achievable and desirable goal for policy action within the
next 10 years," according to the Commonwealth report.
The survey of leading health care experts with a
diverse range of professional and ideological perspectives is the ninth
in a series by The Commonwealth Fund, and the first conducted in
partnership with the publication Modern Healthcare.
The opinion leaders' online survey included 289
experts "with a diverse range of professional and ideological
perspectives" from four broad health care sectors: academia and research
organizations; health care delivery; business, insurance, and other
health industry; and government and advocacy groups, according to TCF.
Elected officials and media representatives were excluded. The survey
was conducted by Harris Interactive on behalf of TCF and focused on
Congressional priorities.
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Top Priorities for Congress in Next 5
Years--Ranking Summary |
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(Percent responding "absolutely essential" or "very important")
1. Expand coverage for the uninsured - (88%)
2. Enact reforms to moderate rising health care
costs - (81%)
3. * Reform Medicare to ensure its long-run
solvency -* (80%)
3. * Increase use of IT to improve quality and
safety of medical care - (80%)
5. Expand SCHIP to reach all uninsured children -
(76%)
6. Ensure families don't pay excessive
out-of-pocket costs relative to income - (75%)
7. Address shortage of trained health care
professionals - (70%)
8. Control rising cost of prescription drugs -
(66%)
9. * Reform Medicare payment to reward performance
on quality and efficiency - (64%)
9. * Reduce racial/ethnic disparities in care -
(64*)
Rank based on proportion of respondents responding
"absolutely essential" or "very important"; statistical significance of
differences cannot be precisely determined.
*When percents were equal, options were assigned the same rank.
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"When this many of our nation's health care
experts, who don't always agree about priorities, name the same few
critical issues, we have an excellent starting point for action on the
health care agenda for the next few years," said TCF President Karen
Davis.
"Covering the uninsured is a key component of a
high performance health care system for the United States, and the
experts' opinions reflect this great need."
Reducing Uninsured and Cost Burdens, Improving Care
Seen As Attainable Goals
Opinion leaders feel that substantial changes are
achievable and desirable in several health care policy areas, according
to the analysis by TCF.
"In addition to saying that the proportion of
uninsured could and should be significantly reduced over the next 10
years, respondents said (on average) that the proportion of households
spending more than 10 percent of income (and 5 percent for those with
low incomes) on health care costs could be reduced from 17 percent
currently to 10 percent. Respondents also said that the total cost of
health care as a percentage of gross domestic product (GDP) should and
could be held to the current level of 16 percent over the next 10 years.
Current projections by the Centers for Medicare and Medicaid Services
are that health spending will grow to 20 percent of GDP by the year
2015," reported TCF.
Respondents also said that the proportion of
recommended care received by adults could be increased from 55 percent
to 75 percent, and the proportion of recommended care received by
children could be increased from 44 percent to 80 percent.
Leaders Indicate Approaches That Would Be Effective
to Expand Coverage
Opinion leaders agree on the importance of expanding health coverage for
the uninsured and, in large part, on the approaches that would be
effective in expanding coverage. Majorities say that effective
strategies include:
● mandating that all individuals buy coverage,
combined with subsidies and an insurance pooling mechanism for the
uninsured to purchase affordable coverage (57%);
● providing states with matching funds for expanded Medicaid/SCHIP
coverage for low-income children and adults (57%);
● creating a single-payer insurance system (54%); or
● covering everyone under Medicare (53%).
Half of all respondents say that requiring
employers who don't provide coverage to contribute to a fund would be an
effective way to improve coverage, and 62 percent of respondents from
government and advocacy groups believe that would be effective. Half of
all respondents also say that allowing individuals and small businesses
to buy into the Federal Employees Health Benefits program or similar
group option would be an effective way to expand coverage.
Experts were less confident that the following
options would be effective: providing tax credits or subsidies to
low-wage workers (25%); promoting tax-free health saving accounts (14%);
or allowing association health plans to provide coverage without state
licensing restrictions (13%).
Respondents differed about which reforms would be
extremely or very effective strategies to expand coverage for the
uninsured. Respondents from academia and research organizations believe
that a single-payer insurance system would be effective (66%); whereas,
most respondents from the health care delivery sector (62%) and
business, insurance and other health industry leaders (57%) believe that
an individual mandate to buy coverage would be effective.
Reducing Inappropriate Care, Increased Use of
Evidence-Based Guidelines, Improving IT Use Considered Top Ways to
Control Costs
When asked about approaches to control the rising cost of health care,
three of four health care leaders said that reducing inappropriate care
would be effective, with the greatest support coming from
business/insurance/other health industry leaders (83%). Other approaches
health care leaders think would be effective in reducing costs are: use
of evidence-based guidelines to determine whether a test or procedure
should be done (70%), increased and more effective use of information
technology (66%) and increasing the use of disease and care management
strategies for the chronically ill (65%).
Effectiveness of Reforms to Expand Coverage for the
Uninsured
According to Sector--Top Five Ranking Summary by Sectors
(Percent responding reform would be extremely or very effective)
Academic/Research = AR
Health Care Delivery = HCD
Business/Insurance/ Other Industry = BI
Government/Labor/Consumer Advocacy = GLC
Mandate that all individuals buy coverage, with
subsidies and pooled insurance to increase affordability
AR #4 (59%); HCD #1 (62%);
BI #1 (57%)
Provide federal matching funds for Medicaid/SCHIP
coverage for low-income adults
AR #3 (61%);
HCD #2 (58%); BI #2 (53%);
GLC #5* (51%)
Establish a single-payer insurance system run by
the government
AR #1 (66%);
HCD #5 (52%); GLC #2* (54%)
Cover everyone under Medicare
AR #2 (63%);
GLC #2* (54%)
Require employers who don't provide coverage to
contribute to a fund to pay for such coverage
HCD #4 (54%);
BI #3 (46%); GLC #1 (62%)
Allow buy-in to the FEHPB program or similar
federal group option
HCD #3 (55%);
BI #5 (44%); GLC #5* (51%)
Open up Medicare to everyone not covered by an
employer plan
AR #5 (56%);
GLC #2* (54%)
Provide incentives or requirements to expand
employer-based health insurance
BI #4 (45%)
Let near-elderly adults buy into Medicare
GLC #5* (51%)
Rank based on proportion of respondents indicating
reform would be "extremely effective" or "very effective"; statistical
significance of differences cannot be precisely determined.
*When percents were equal, options were assigned
the same rank.
Editor's Notes:
The survey findings are posted on the Web sites
of The Commonwealth Fund and Modern Healthcare, along with commentaries
from Congressman Pete Stark (D-CA) and Senator Mike Enzi (R-WY). A data
brief from the Commonwealth Fund Commission on a High Performance Health
System with additional analysis of survey findings is also posted on the
Fund's Web site.
About Source: The Commonwealth Fund is a
private foundation supporting independent research on health and social
issues.
Methodology: The online survey was
conducted within the United States by Harris Interactive between
November 14, 2006 and December 8, 2006. The survey was delivered via
e-mail to a panel of 1,246 opinion leaders in health policy and
innovators in health care delivery and finance; 289 responded. The
sample was derived from a panel developed by The Commonwealth Fund,
Modern Healthcare and Harris Interactive. Data from this survey were not
weighted. With a pure probability sample of 289, one could typically say
with a ninety-five percent probability that the overall results would
have a sampling error of +/-6 percentage points. Sampling error for data
based on sub-samples would be higher and may vary. However, that does
not take other sources of error into account. This online survey is not
based on a probability sample and therefore no theoretical sampling
error can be calculated.
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