7 Surveys That Say A Lot About U.S. Healthcare

How would you grade American healthcare based on the criteria of cost, quality, access and technology?

When seeking answers to burning questions like these, informal surveys provide an easy way to tap into the “wisdom of the crowd.” And in medicine – where everyone is a patient, a healthcare professional or both – there’s plenty of wisdom to go around.

Since November 2017, I’ve relied on a simple polling mechanism to better understand the concerns, opinions and hopes of my newsletter subscribers. These are doctors, healthcare leaders, medical students, researchers, policy wonks and some of the nation’s savviest patients. As such, nearly all who receive “Monthly Musings On American Healthcare” are disproportionately knowledgeable about medical politics, economics and care delivery.

Therefore, a word of caution: If you’re a survey purist seeking a random or representative sample of Americans, these poll results are not for you. However, if you’re curious what healthcare experts and well-informed participants think, these results should interest you very much.

1. How would you grade American healthcare? (November 2017)

Approximately 75% of all American patients report feeling satisfied with the care they personally receive, according to the latest Gallop poll. And yet, almost the same percentage of patients (73%) say the healthcare system is in trouble.

Now, according to the first Monthly Musings poll, most of my readers agree the system is far from perfect. Combined, survey participants awarded American healthcare a “C –” based on a scoring rubric of cost, quality, access and technology.

In addition to these anonymous survey results, I received many comments from readers who described what it would take for American healthcare to earn an “A” grade. On the whole, three major improvements stood out:

  1. Medical care and insurance needs to be affordable for more individuals and families.
  2. Care should be more convenient (aided by modern technologies like video visits, online appointment scheduling and secure emailing with physicians and staff).
  3. When multiple doctors treat a single patient, they must establish a higher degree of coordination.

I would add to this list of improvements: (a) greater focus on prevention, (b) elimination of avoidable medical errors and (c) better management of chronic disease to prevent future complications.

2. What were the year’s top healthcare stories? (December 2017)

This Twitter survey tied into a Forbes article from early 2018 on the previous year’s top healthcare stories. By a large margin, respondents pointed to the opioid crisis over the senate’s failed attempt to “repeal and replace” Obamacare and the spree of healthcare mega-mergers that dominated business news pages late in 2017. Of note, the tragic case of Charlie Gard, the infant who was taken off life support after being at the center of a vicious and highly publicized debate over parents’ rights, received no votes.

Since this survey concluded, we learned that American life expectancy has declined for the second year in a row, and that the opioid crisis played a major part. In the first half of 2018, our nation’s opioid addiction continues to be a hot topic among the media and elected officials. I would not be surprised if opioid abuse remained on the list of top stories for 2018, as well.

3. Who’s responsible for 42,000 opioid deaths? (January 2018)

Taking a cue from readers, the first survey of 2018 centered on the opioid crisis and whether those responsible for it should be held legally accountable.

Drug manufacturers were identified as the biggest villains and, interestingly, 60% of respondents felt those responsible should be held legally accountable.

But what about the 28% who felt opioid users were most responsible for the crisis? This finding stirred up quite the debate on social media. Some took exception to the conclusion, pointing out that addicts are victims. In contrast, others noted that the majority of patients who are prescribed opioids never become addicted. And then there were others, like this LinkedIn commenter who felt, “I think the problem is multi-factorial and the blame game is not appropriate.”

I agree the problem has many components. However, I do find the “blame game” appropriate and important.

Around the time of this survey, Michael Bloomberg wrote this about fight against opioid addiction: “Real success requires much bolder leadership – and a far greater sense of urgency – from both elected officials and industry leaders.”

Indeed, leadership is about recognizing when you have made an error and doing the right thing. In recent testimony to Congress, several drug company executives (whose companies promoted the drugs and provided false information to doctors) continued to eschew any accountability for their actions.

We need a way to hold these companies legally responsible – not just to satisfy our punitive desires but to ensure this kind of avoidable epidemic never happens again. Elected officials should muster the courage to pass legislation, similar to the Sarbanes-Oxley requirements that holds executives accountable when they deceive the public and fail to present accurate statements, whether in the financial or medical arenas.

Looking Ahead

At a macro level, American healthcare gets (and deserves) a poor grade from my newsletter readers. Based on the survey results so far, the current state of American healthcare looks bleak. But as you’ll see in part two of this series on June 19, respondents maintain a sense of cautious optimism about the future.

The next four survey results will focus on the more personal aspects of people’s healthcare experiences and will include their hopes and expectations for a better tomorrow. Please check back two weeks from today to learn more.

Dr. Robert Pearl is the bestselling author of “Mistreated: Why We Think We’re Getting Good Health Care–And Why We’re Usually Wrong” and a Stanford University professor. Follow him @RobertPearlMD

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