Wednesday, September 23, 2009

Who You Gonna Ask?

A new survey tells us that Americans are really quite pleased with their health insurance coverage (I guess only those were asked who have insurance?):

The findings underscore the challenges facing Obama and Congress as they try to reduce costs in the unwieldy health care system and provide coverage to millions of Americans without insurance.

Although there is widespread agreement that changes must be made in the USA, a strong majority say they are satisfied with what they have and don't want it upended.

• Eight in 10 say they are satisfied or very satisfied with the quality of the medical care available to them and their families.

• Six in 10 say they are satisfied or very satisfied with the cost of the medical care for themselves and their families.

• More than half say rising health care costs such as insurance premiums and out-of-pocket expenses are either no problem or a minor problem for them.

• Nearly two-thirds say reductions in what their insurance plan covers is either no problem or a minor problem.

"All people have heard are negative stories about the health care industry," says Robert Zirkelback of America's Health Insurance Plans. But "the vast majority of Americans are very satisfied with their health care coverage."

Here's the problem with surveys like that: The answers depend very much on whether you have actually needed to use your coverage a lot or not. Those whose families have been healthy will only judge the coverage in terms of the premia they themselves pay and any out-of-pocket costs.

It's only when you really need to claim expenses that you find how good the system is. So, strictly speaking, the survey should have had a separate section for that group. It is their answers which are most meaningful.

To think of a comparison, suppose that you get a warranty for your new car. As long as nothing happens to the car, you are probably pleased with the warranty. It's only when the car breaks down that you find if the warranty covers what it said.

The findings also reflect two other things. First, it's commonly the case that surveyed individuals rate their own situation as not so bad, even while agreeing that some wider social or economic problem is worrisome. For instance, a recession might be seen as a problem but not the respondent's own economic situation. This could be partly because even large calamities only affect some individuals.

Second, those who oppose any real health insurance change have been very good at their job of increasing fear about the impact of any changes. Thus:

Only two in 10 Americans say their health insurance coverage and the quality of the health care they receive will improve if a bill passes Congress this year, despite President Obama's promises to improve the system for those with and without insurance.

I must admit that I'm not even following what's happening to the reform proposal. It's beginning to look like those monsters from horror movies: made up of little square patches and nobody knows if there's a skeleton somewhere inside. Reminds me of the very complicated reform proposal of the early Clinton era. Which actually had some very good aspects in it, by the way.