Experts versus the public on health care: Reconciling the gaps

Drew Altman, who heads the Kaiser Family Foundation, writes an excellent series on health care policy called Pulling it Together... But I don't think his latest column, The Experts vs. The Public on Health Reform is on the money. According to Altman:

In repeated Kaiser polls, we see a divide between what experts believe and what the public believes about some of the key issues in health reform. They don’t disagree on everything; far from it. But there is a wide gulf on basic beliefs about what is behind the problems in the health care system and key elements of reform, especially delivery reform...These differences between experts and the public matter because key elements of health reform which elected officials expect to resonate with the public could get a decidedly less enthusiastic reception than expected if more is not done to close the gap in basic premises and beliefs between experts and the public. Most fundamentally, the challenge is to educate the public about why health costs are rising as fast as they are in the U.S. As long as people think we can solve the problem of rising health care costs simply by eliminating waste, fraud and profiteering, the hard choices they hear experts and leaders talking about will not make much sense to them.

There's a certain logic to this argument, but I don't find the examples in his table particularly compelling:I'll examine his points one by one:

• Unnecessary care: Experts would probably agree that there are a lot of people who don't get the tests and treatment they need. (However, it is probably true that people don't realize they receive unneeded care.)
• Why costs are so high: Drug and insurance companies certainly have made a lot of money --and that is a part of the reason costs are high. Even when insurance companies don't make a lot of profit they do contribute to administrative costs for providers, themselves and ultimately purchasers. People really are paying too much now, considering our health care costs are so much higher than anywhere else in the world.
• Quality: The public isn't right that there's no big difference in quality among doctors in their area. However, this is probably attributable to lack of good quality information rather than a rigid view that everyone is the same.
• Health IT: The public might be right about this one, especially over the first few years of reform.
• Comparative effectiveness research: Experts probably feel the same way as the public when they are patients themselves.
• Ratings: I'm with the public on this one. Patient experience is an important part of the quality equation. I'd prefer a doctor I have a good relationship with to someone who happens to have a high rating --especially since the rating may be unreliable, outdated, or unrelated to the procedure I'm receiving. Also, a doctor I know may pay more attention when working on me, thereby improving quality.
• Prudent purchasing: Consumers are just learning to deal with cost information. One reason they don't ask is no one seems to have good answers when they do.
• The health cost problem: It's certainly reasonable for individuals to look at this issue on a personal level while experts view it on a macro level. But the two are linked: if individuals pay too much then the nation is paying too much. I think there actually is another issue here, that this table doesn't bring out. It's that many people think the country should spend more on health care --by expanding Medicaid and Medicare and placing restrictions on managed care practices-- rather than less.