Obama's Hurdle: Selling The Satisfied On Health Care
How do you sell something to someone who doesn't know they need it? That, in a nutshell, is the biggest hurdle President Obama and Congressional leaders face in trying to push a health care overhaul to the roughly 180 million Americans who have private health insurance coverage.
The president previewed some of the themes he's likely to use in his address to a joint session of Congress Wednesday at a Labor Day picnic in Cincinnati. "I see reform where we bring stability and security to folks who have insurance today," he said, "where you never again have to worry about going without coverage if you lose your job or you change your job or you get sick."
But the sagging poll numbers, both for Obama and his top domestic priority, show that so far, the public isn't buy what he's selling. Robert Blendon, a public opinion expert at the Harvard School of Public Health, says he's not that surprised. "This recession... has not left Main Street people's lives," he said.
"And for them to really sign onto these bills they have to feel that their insurance premiums will be lower in the future and their out-of-pocket costs. And they just don't see that."
Karen Pollitz, an insurance expert at Georgetown University, says the problem is actually even bigger: Most people who have insurance don't realize that they might not have as much protection as they think.
The reason most people say they're satisfied with their health insurance? They don't use it very much. "The majority of Americans who are healthy account for only about 3 percent of total medical spending," Pollitz said. "It's kind of like hearing that most people are satisfied with their new car before they drive it off the dealer's lot."
On the other hand, those who do run up big bills often experience problems. One survey, Pollitz said, "found...that more than one in five cancer patients who had health insurance the whole time they were in treatment, nonetheless, ended up using up all or most of their savings on medical bills."
Pollitz says that because most people are healthy, insurance companies have tried to attract their business by holding down premiums. But what many people don't realize is that those lower premiums often mean less coverage when you really need it.
For example, she says, "you might be paying a lower premium because the drug benefit in your policy only covers generic drugs."
That's no problem if you have a common ailment like high blood pressure or only require the occasional antibiotic. But if you're diagnosed with a serious illness for which there are no generic medications, like multiple sclerosis, "you need very very expensive name brand drugs that cost thousands of dollars every month," Pollitz said.
Harvard's Robert Blendon says the Obama administration, like the Clinton administration 16 years ago, may have misstepped in trying mount a campaign for changes to the health care system that's too similar to the one it mounted to get its candidate elected president.
"People's investing in a president is different from having their health care changed," Blendon said. In getting people to vote for a candidate, he says, "they don't have a lot to lose. They like the candidate; they want something called change. And so you may get audiences excited for Obama or Clinton when they're running for office, that don't get excited at all about their health care getting changed."
Instead, Blendon says, what backers of health care overhaul should be doing is running a campaign like people do for local school bond referenda, where voters must raise their own taxes for the greater good. In those cases and this one, he says, "You really have to convince people that if their taxes go up their schools will be better; it won't be a waste of money."
That convincing starts with the president's speech Wednesday night.
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President Obama hopes to regain the momentum for overhauling health care when he addresses lawmakers and the nation tomorrow night. Public support for major change has fallen off in recent weeks. Those who have insurance may be skeptical of big changes.
But as NPR's Julie Rovner reports, many people may not know exactly what their insurance covers until they actually need it.
JULIE ROVNER: President Obama previewed his speech at a picnic for organized labor in Ohio yesterday, complete with a new slogan.
President BARACK OBAMA: I see reform where we bring stability and security to folks who have insurance today, where you never again have to worry about going without coverage if you lose your job or you change your job or you get sick.
ROVNER: The president makes a point of reaching out to those who already have insurance for an important reason, according to Harvard's Robert Blendon, a public opinion expert. Blendon says it's because those health insurance haves aren't yet sold on the idea of big changes to the health care system, particularly if it might mean higher taxes.
Dr. ROBERT BLENDON (Public Opinion Expert, Harvard School of Public Health): Given the difficult economic times people have, there is a caution about putting themselves at risk for financial situations if they're not sure they're going to be better off.
ROVNER: And most polls show vast majorities of people who have health insurance are currently satisfied with their coverage.
Karen Pollitz of Georgetown University says that's primarily because most people with health insurance rarely use it.
Professor KAREN POLLITZ (Insurance Expert, Georgetown University): The majority of Americans who are healthy account for only about 3 percent of total medical spending. So I'm not all that surprised to hear that most people are happy with their health insurance if most people make few or no claims. It's kind of like hearing that most people are satisfied with a new car before they drive it off the dealer's lot.
ROVNER: But what happens when people get sick and need a lot of care? Pollitz cites one survey that looked at the financial consequences of cancer.
Prof. POLLITZ: And what that survey found was that more than one in five cancer patients who had health insurance the whole time that they were in treatment nonetheless ended up using up all or most of their savings on medical bills.
ROVNER: Because most people are healthy, insurance companies have tried to attract their business by holding down premiums. But what many people don't realize, says Pollitz, is that those lower premiums mean less coverage when you really need it.
Prof. POLLITZ: You might be paying a lower premium because the drug benefit in your policy only covers generic drugs.
ROVNER: Which is fine if you have high blood pressure or you need an antibiotic for the occasional strep throat. But if you're diagnosed with a serious chronic disease, like multiple sclerosis for which there are no generics…
Prof. POLLITZ: You need very, very expensive name brand drugs that cost thousands of dollars every month.
ROVNER: And that you find out too late your low premium health insurance doesn't cover.
Harvard's Robert Blendon says that like the Clintons did in the 1990s, where the Obama administration may have foundered is by trying to run its health care campaign the way it ran its campaign for president, with something like health care, he says…
Dr. BLENDON: You're not running on a personality. You're asking people to do something that'll change where they are.
ROVNER: Rather, Blendon says, convincing people that changing the health care system is a good thing is more like getting them to vote for a new school tax. He says voters will often say the education system is broken, but they like their children's school.
Dr. BLENDON: And so they're cautious. And that's what we see here in health care. They have something to lose and they need to know how things are going to be better before they vote for something. At the moment, they think it gets them a tax increase.
ROVNER: So far, administration officials haven't tipped their hands much about what the president might say in his big speech tomorrow night. What is clear is that if Mr. Obama wants to sign a health bill this year, he needs to convince those with coverage that there's something in this for them.
Julie Rovner, NPR News, Washington. Transcript provided by NPR, Copyright National Public Radio.
