A new JAMA Forum article, “Doing Health Reform Better: Listening to the Public” highlights the importance of engaging the public around health care issues and solutions, and provides key learnings from a recent experiment.
At the end of 2018, United States of Care’s Board Chair, Andy Slavitt, put out a call on Twitter for people to share the health concerns that are most common among their friends and family, and that they most want solutions to.
More than 200 people responded, and while we recognize that Twitter feeds are far from a scientifically representative sample of the population, the results provide valuable insight on how people with different experiences and priorities can still find common ground in conversations about health care.
Unsurprisingly, costs emerged as a major concern, with more than a third of respondents mentioning some form of difficulty paying for health care. Two specific issues rose to the top – paying for prescription drugs and dental care – but otherwise, comments about cost covered a wide range of scenarios, from emergency care to high deductibles to out of network costs.
This variation shows the many drivers of health care costs, and how addressing this issue requires a multi-pronged approach. It also indicates that we can unite around the need to lower health care costs, even if we differ on which costs need to be addressed first.
Our daughter’s insulin! As a type one diabetic, her costs out of pocket are hundreds a month! It’s not only crushing, it’s crushing.Lightman Gibson (@frigibson)
The costs! Insurance premiums, deductibles, prescriptions, hospital stays and all that goes with that and on and on and on. It is scary. One serious illness and most of us will go bankrupt! It should not be this way in America!Terry B. (@terrybarnett55)
The cost of dental care without insurance is prohibitive for many, but so too is the cost of dental insurance, with the result that many (most?) go without either. Dental care should be rolled into overall healthcare. Dental care IS healthcare.Lisa S. (@LisaSarro)
Another common thread that emerged from these comments is that people are more concerned about general issues than specific ones. For example, while many individuals expressed concerns about affording and navigating their insurance, only a few mentioned specific programs, such as Medicare, Medicaid, or ACA Marketplace coverage.
What we take from this is that Americans are more concerned about the impact that policies have on themselves and their loved ones, as opposed to ideological motivations or getting into the weeds on the policy details needed to achieve their desired outcome. We believe that this could indicate a disconnect between the way policymakers and voters talk about health care – and a need for strategies to bridge that gap.
The amount of time and energy needed to navigate, advocate within and too often fight against the system(s) that are supposed to be grounded in caring for us.@brioharder
Wider networks. I just can’t hold on to my full complement of doctors from year to year now. It sucks having to decide which doctor to give up.Anna G. (@anotherAKGorman)
Finally, these responses show that health care does not exist in a vacuum. Many responses mentioned education, child care, nutrition, employment, and the environment as key issues related to health care. It is imperative that any health care solutions also address the broader social context in which they occur.
Worrying about health insurance when losing/changing jobs – gaps in coverage, high cost of COBRA, difficulty finding out ahead of time if your existing doctors will be covered under new plan, etc.Vanessa M., PhD (@vlmerker)
United States of Care is committed to putting people over politics, and harnessing public opinion to shape policies that reflect the hopes and concerns of the majority of Americans. To stay updated on our work, be sure to subscribe to our news updates and follow us on Twitter.