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Originally posted in the Star Tribune on Oct. 16, 2014. View the article here.
HealthBasics survey clarifies differences and need for straight talk.

In an age where surveys and late-night comics’ man-on-the-street interviews regularly find Americans’ knowledge of current events lacking, a recent assessment of Minnesotans’ understanding of a complex issue — health care — provided reassurance.

Asked to identify the main drivers of health care cost increases, Minnesotans correctly spread the blame, rather than simplistically singling out one factor — a finding that offers welcome reason for optimism as the bitter debate over health care reform continues. An aging population, expensive new treatments and technologies, unnecessary tests and services, malpractice lawsuits, as well as profits made by insurers, drug companies and providers were all accurately identified in a recent survey as contributing to medical care’s rising expense.

The survey, taken in late summer, was conducted by Minnesota HealthBasics, a farsighted collaboration of state business, labor and health insurance interests. The group’s admirable goal: to better understand Minnesotans’ health care values, priorities and knowledge. And then, to move beyond the ideological talking points to a nuts-and-bolts discussion of what’s needed to curb health care costs, ensure access and maintain quality.

The HealthBasics group released its results on Wednesday. In reporting their findings, researchers highlighted the deep division found between Minnesotans who see a limited role for government in achieving health care goals (about 34 percent of those surveyed) and a similarly sized group that supports the government playing a significant role to achieve universal coverage, through such measures as government cost controls.

The ideology-fueled divide is reflective of the angry debate over health care and underscores the urgency in forging common ground. But another insight yielded by the survey may prove most valuable in moving the debate forward, because it points to the surprising but critical ingredient needed to do so: honesty.

That quality often has been sorely missing from the messages delivered by politicians, policymakers and industry representatives as health care reform discussions have played out. Consumers understandably want more and better health care, but they also want to pay less. What neither free-marketers nor advocates for a bigger government role in health care have admitted often enough is that trade-offs will have to be made.

The unrealistic, more-for-less expectation can be seen clearly in the HealthBasics findings. Even as Minnesotans correctly identified the factors driving health care costs, those surveyed resisted changes to root out inefficiencies.

“A strong majority of Minnesotans say when it’s all said and done, we don’t want limits placed on our own interactions with the health care system. Minnesotans want whatever treatment is prescribed by a physician; we want to see specialists without referrals; and we want our health insurance to pay the full cost of care. And never mind the contradictions,’’ HealthBasics researchers concluded.

The numbers bear out those contradictions. Of those surveyed, 82 percent said that unnecessary tests and treatments were a key driver of rising health care costs. Eighty-six percent of those surveyed said there is too much waste and fraud in the system. Yet “67 percent of us say that insurers should pay for every treatment or service a doctor prescribes,’’ HealthBasics researchers said.

In addition, only 41 percent of those surveyed agreed that insurers should work with providers to identify the most effective treatments or services, and then pay only for those that meet this standard. Somehow, the remainder of those surveyed apparently missed the point that “waste” in the system includes unnecessary or ineffective treatments.

It’s hard to blame consumers for the disconnect. Politicians have pandered to voters for years on this issue, talking vaguely about painless efficiencies and eliminating waste and fraud somewhere else. The hard truth is that compromises will have to be made whether you’re a fan of less or more government involvement in health care.

The HealthBasics survey will be followed up by a “variety of forums” later this year and in 2015. Its findings are a timely reminder of the hard work that still lies ahead on health reform and the need to be clear about the changes needed. The sooner the straight talk begins, the better. HealthBasics’ work will give the process a much-needed kick-start.