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Monday, April 18, 2005

Health care satisfaction

Posted by: Hammer / 8:15 AM

Kevin Drum continues his review of the state of health care in the United States:
This paper includes some survey data about how satisfied people are with their country's healthcare system (see Exhibit 1). The United States rates pretty low on this scale (14th out of 17 countries), but it turns out the survey includes something even more interesting: separate satisfaction ratings for the poor and the elderly (see Exhibit 3). It takes a bit of interpolation to extract all the numbers, but that's not hard to do. So with that in mind, here are the percentages of Americans who say they are "fairly or very satisfied" with their own health system:

* Poor: 45%

* Elderly: 61%

* Everyone else: 34%

I suspect that the difference in satisfaction reported by the poor and the middle class lies mainly in expectations. I'm a member of the wide middle. Every year my health care coverage gets worse -- premiums go up, copays go up, but coverages are rolled back. Of course I'm not satisfied. My health care coverage was measurably better 5 years ago than it is today. It was pretty good then, but continues to trend worse each year. I have no expectation that my coverage will ever improve.

What about the poor? The thousands of people removed from Medicaid lists will clearly be dissatisfied with the change. But the vast majority of workers who earn just enough to be poor, which is too much to qualify for Medicaid, didn't have health insurance last year, don't have insurance this year, and don't expect to have insurance next year. How can they be satisfied?

Satisfaction is a measure of expectation. If you expect each day to be full of chocolate cake and light massage, you might be dissatisfied if the frosting is too sweet. On the other hand, if you expect each day to be a kick in the jimmy, suddenly a glancing blow becomes a reason to celebrate. If you were worried about not having health insurance all year, but little Billy got to see the doctor when he was sick anyway, you can be satisfied that at least he got the treatment he needed.

This is probably patronizing to the nth degree, which I regret. But I don't think that the poor are so much satisfied with the health care they receive as they are relieved that disaster has yet to strike.


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