Asking the Wrong Questions

For the past few weeks, I've been getting calls from a number in Philadelphia asking if I could answer a few questions for the Harvard School of Medicine/National Public Radio Healcare Survey.  The first dozen calls always caught me at work, driving, eating dinner or already in bed (who calls for a survey at 8:58 pm?).  But finally on Friday afternoon they reached me at a time when I had no real excuse to blow them off--so I agreed to answer the questions.

The focus of the survey is to determine the "effectiveness of the Affordable Care Act".  With NPR and Harvard being the sponsors, I was expecting the options for the answers to be skewed in such a way as to make the ACA look as "effective" as possible.  And the survey did not disappoint.

There were a number of questions about the cost of my health insurance plan over the past couple of years--yet I was not asked what type of insurance I actually have.  Having a High Deductible-Health Savings Account policy, my premiums were never going to be as volatile as someone with a traditional low deductible plan--who tends to use their benefits far more often--at a greater costs to the insurer.  But that will not be factored into the equation when the results show "A majority of Americans have seen no increase in the cost of their health insurance plans!"

There were also several questions about my out-of-pocket costs for health care over the past couple of years--but not once was I asked for any specific numbers (and I could have provided them if they wanted them).  I truthfully answered that I had seen little increase in my out-of-pocket costs--because they went from next-to-nothing to still-next-to-nothing--mainly because I don't get sick or injured.  But again, by not asking for specifics, the survey will find "A majority of Americans have seen no increase in their out-of-pocket costs for health care!"

At the end of the survey I was asked what I felt were the main driving factors of rising health care costs.  Finally, I thought,  a chance to provide some real feedback!  We then went through a list of factors like "large malpractice settlements"--a small factor--"doctors doing too many tests and procedures that may not be necessary"--a moderate factor--and patients not asking the price of procedures and treatments--a HUGE factor.  But when we got to the end of the list, several of the factors I think are most pertinent weren't even in there.

Take for instance, we have a large older population in the US.  Consider the number of nursing home beds we have in our cities compared to the number of hospital beds--yet that is not considered to be a factor?  And where was a question about the average Americans' refusal to stay in shape and practice good health habits?  You don't think obesity and lack of substantial exercise is any kind of factor in the growing number of health issues in this country?  Also not on the list is our demand to take a pill to solve any and all discomforts we may encounter.  Can't go to the bathroom?  Take a pill.  Can't stop going to the bathroom?  Take a pill.  No energy?  Take a pill.  Too much energy? Take a pill.  That explains why when I go in for my annual physical, everyone seems so surprised that I am not on any prescription medications--since that is the "norm" nowadays.  And yet, our pollsters didn't see fit to include all of the money spent on medications to be a factor in rising costs.  Instead we will hear about how "Americans believe Hospitals and Doctors are still charging too much."

So when Harvard and NPR release their survey results--and supporters of the Affordable Care Act trumpet them as being "proof" it's working--just remember, they weren't asking the right questions.