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Survey Finds 72 Percent of Americans think Healthcare System Needs Overhaul


The Commonwealth Fund has released a survey which found 7 of 10 adults think the U.S. health care system needs to be fundamentally changed or completely rebuilt. The concerns of those surveyed reflect widespread experiences with access barriers, poorly coordinated care and growing costs.

The survey was conducted by Harris Interactive, Inc. by telephone, with a representative sample of 1,011 adults ages 18 and older between February 7 and February 11, 2011.

The new survey found that a majority have concerns about access, with 71 percent reporting problems gaining access to needed health care. These concerns included the inability to get timely doctors' appointments or advice from their doctor on the phone, or to obtain after-hours care without going to the emergency room.

The survey also noted nearly half experienced poorly coordinated care (47%), and more than half reported wasteful (54%) care.

When asked about the future, three quarters of people surveyed (74 %) are worried they won't get high quality care when they need it, or that they won't be able to afford their medical bills if they become seriously ill.

"It's not surprising that people worry about the future, given the problems they are currently experiencing in the health care system," said report co-author and Commonwealth Fund Senior Vice President Cathy Schoen. "Health care is too often unaffordable, hard to get when needed, and wasteful or poorly coordinated."

The survey found nearly all adults (85% or more) support policies that would make care better coordinated and would provide more transparent information about health care costs and quality. There was strong support for medical homes and a team approach to care, with 93% of people saying it was important or very important to have one place or doctor responsible for primary care and coordinating care.

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This survey comes on the heels of U.S. Congressman Paul Ryan’s unveiled budget proposal for 2012 with cuts of $5.8 trillion. Included in the proposal are major changes in Medicare and Medicaid.

The Congressional Budget Office (CBO) highlighted key features of the proposal, based on information from Ryan’s staff and its own analysis, including:

  1. Starting in 2022, the eligibility age for Medicare would increase by two months per year until it reached 67 in 2033.
  2. The so-called “doughnut hole” in the Medicare prescription drug benefit – in which beneficiaries pay 100 percent of drug costs – would continue under the Ryan plan. The health law passed last year calls for the coverage gap to be ended by 2020.
  3. The private plans offered to Medicare enrollees starting in 2022 would have to comply with a standard for benefits set by the Office of Personnel Management, and would have to charge the same premiums for all enrollees of the same age.
  4. The premium support payments would vary depending on the health status and the incomes of the beneficiaries.

The CBO report also said that in 2022 the average government payment for a 65 year old in Medicare would be $8,000. In each successive year, it would increase to reflect inflation and the enrollee’s age. Patients’ share would rise sharply. Higher-income beneficiaries would get a lower premium support payment.

Besides overhauling Medicare, Ryan’s 10-year budget proposal also would give states more control over Medicaid, the state-federal program for the poor, but cut the amount states would receive for the program from federal coffers by hundreds of billions of dollars over a decade.

Commonwealth Fund President Karen Davis feels, "The message from this survey is clear: people want an accessible, better functioning health care system that delivers care they can afford. One recent step in the right direction is the support for the formation of patient-centered medical homes and accountable care organizations included in the Affordable Care Act. If optimally designed and implemented, these new health care delivery models supported by modern health information systems have the potential to address many of the concerns the survey highlights."

How would the formation of patient-centered medical homes and accountable care organizations included in the Affordable Care Act and championed by the Commonwealth Fund fit into these budget changes proposed by Congressman Ryan?

A Call for Change: The 2011 Commonwealth Fund Survey of Public Views of the U.S. Health System; Kristof Stremikis, M.P.P., Cathy Schoen, M.S., and Ashley-Kay Fryer; April 2011

CBO: Seniors Would Pay Much More For Medicare Under Ryan Plan; Julie Appleby, Mary Agnes Carey and Laurie McGinley; Kaiser Health News, April 5, 2011

U.S. Congressman Paul Ryan (Wisconsin)