Monday, April 28, 2008

A Word From the Prairie

At a recent meeting representatives from the Kansas Hospital Association (KHA) presented information from a recent public opinion survey. The 2007 Kansas Resident Survey contacted 611 households, and at least 100 in each district of KHA. (You can link to an executive summary at the KHA site. My comments today are based on a more detailed report.)

I found some of the results quite interesting, especially coming from Kansas. First and foremost, Kansas is prominent as a "red state." That's not so much about one political party, as it is about the values that lead folks to lean toward one political party. Conservative and "traditional" values are the norm here.

Most striking to me was the response to the question, "Do you think the government should offer an insurance program, like Medicare, to all Americans?" 59% said "yes," a result much higher than I would expect. When asked how to pay for it, the largest response, at 39%, was "Have government spend less on other programs." With that and other tax-oriented choices (tobacco, gaming, or payroll), 87% of respondents preferred a tax-based solution. So, a significant majority would prefer some form of government-supported universal health insurance; and a significant majority of them would prefer supporting the program through taxes. Moreover, when asked, “When voting for a political candidate, how important is the candidate’s position on health care to the way you vote?” a combined total of 87% responded Important, Very Important, or Extremely Important.

Some other results were also interesting. When asked, “Do you think all hospitals and health care facilities where surgeries are performed should be required to treat patients regardless of their ability to pay?” some 86% said Yes. For those of us whose community hospitals face competition from “boutique” specialized surgery centers, this was very interesting. The smaller specialty centers tend to “cherry pick” patients with insurance, so their reimbursement is more secure. In addition, they don’t have the additional overhead expense of Emergency Departments, full staffing for 24-hours, etc. On the other hand, the reimbursement they receive is the same as “full-service” hospitals. Community support for a position that the smaller specialized centers should take on a greater share of the economic risks is, understandably, of great interest here.

Some results seem to indicate interesting trends. The survey asked, “Do you think the amount HOSPITALS are reimbursed by insurance providers (like Blue Cross, Preferred Health, etc.) is too high, about right, or too low?” They compared the results in this survey with the results of a similar survey in 2006. The numbers of those who thought reimbursement was Too High didn’t change significantly (19% in 2006, and 16% in 2007). However, numbers changed significantly for About Right (46% in 2006 vs. 38% in 2007) and for Too Low (14% in 2006 vs. 24% in 2007). The same trend was visible with the question, “Do you think the amount HOSPITALS are reimbursed by government programs like Medicare and Medicaid is too high, about right, or too low?” (About Right: 38% in 2006 vs. 34% in 2007; and Too Low: 21% in 2006 vs. 32% in 2007) These numbers suggest that more of our patients are aware of the reimbursement difficulties for hospitals.

Respondents were also asked which health care issues “were the biggest problems in Kansas,” and asked to choose three. Of those chosen, the top three were health care costs, the number of uninsured, and, interestingly enough, “Insurance company “red tape.” When asked what factors contributed most to the high cost of health care (and, again, asked to choose three), the top three choices were insurance companies, lawsuits and legal costs, and drug costs. In this conservative, and in some ways libertarian state, it was interesting to me that all three of those exceeded “Unnecessary excessive use of health services,” even though that is a concern expressed often by more conservative legislators.

In one sense, these results are small. Kansas is a relatively small state, with a large rural constituency, and so not necessarily typical for the wider American society. At the same time, it is often held up as typical of political conservatism in the United States. If that is meaningful, than these results are very interesting. If in this conservative state there is strong support for a government-provided, tax-supported health insurance plan, then there may well be stronger support for it nation wide than some conservative officials appreciate. If there is rising concern about adequacy of reimbursement by insurance programs and by Medicare and Medicaid, then these are not simply “liberal” issues. Perhaps Kansas is too “red state” to be entirely typical. That, however, would make the point more clearly: if there is support for and concern about these issues in Kansas, then it’s quite likely there is support and concern in the larger conservative community. And for those of us who were already concerned about these things, perhaps this supports hope that we can get broad support in this country for making some important changes.


Malcolm+ said...

Kansas is held up in a recent political book, "What's the Matter with Kansas," by Thomas Frank. Using Kansas as sort of a case study, the book explores the issue of why so many "red state" voters actually vote against their own economic and class interests.

It also points out (as is so often missing in most US political coverage) that there is actually along history of progressive populism in many of those "red states." I'm not sure if the book goes here, but as a Canadian, I draw obvious parallels to the fact that it was the Canadian prairie that saw the election of North America's first socialist government and the introduction of a universal health insureance program which has since been expanded nationally.

A bit of trivia for you. The Premier of that government was Tommy Douglas - a Baptist clergyman and the grandfather of actor Kiefer Sutherland.

Malcolm+ said...

Marshall Scott said...


I'm aware of the book, although I haven't read it. There have been, I think, a number of responses written to it, as well (references, anyone?).

While I haven't read the book, I see the issues worked out on the evening news and in the local paper. I live in Missouri and work in Kansas, and so have some sense of life on both sides of the line. Some things (like ongoing struggles over abortion, and over teaching evolution in the public schools) aren't pretty, but they're pretty common.

I am aware of the populism of the Plains, seen in the United States in the Grange Movement of the late 19th and early 20th centuries. I think the last real organized remnant of that is in Minnesota, where the state Democratic party isn't exactly the same as the national Democratic party.

And, thanks for the trivia.

Malcolm+ said...

The Democratic Party in Minnesota is officially known as the Democratic - Farmer - Labour Party. I believe that is also the case in the Dakotas.

Anonymous said...

Marshall, I think these results are dynamite! (In a good way.) I just hope the leading Presidential candidates are listening. If even Kansas wants it, we are surely ready as a nation for government run, tax-supported, single-payer health care coverage.