U.S. Health Care Expenditures: Costs, Lessons, and Opportunities Proceedings of a Workshop (2023) / Chapter Skim
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4 Framing and Shifting the Health Narrative in the United States
4 Framing and Shifting the Health Narrative in the United States
Pages 37-50
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From page 37... ...
• Loss aversion affects perspectives on initiatives that would decrease health spending; concern is seen among people with good coverage through private insurance or Medicare and even among those without insurance who may fear having to pay more. (Schneider)
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From page 38... ...
PERSPECTIVES ON HEALTH CARE CHALLENGES Gollust opened the discussion by listing some priority concerns submitted by workshop webcast participants: underinvestment in the social determinants of health and social services, high health care expenditures, underfunding of the public health system, disparities related to the COVID-19 response, and racial health inequities. She asked the panelists to identify major themes from their research on the perceptions of health care challenges held by the public and by policy makers and to relate these themes to the priority concerns posted by workshop participants.
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From page 39... ...
In the context of the majority of Americans expressing satisfaction with the status quo on access and quality and being more concerned about personal health care costs than aggregate spending, it is difficult to advance meaningful legislative change. Sweetland said that FrameWorks Institute social scientists systematically investigate the communication-related difficulties and opportunities in discussing or advancing specific social issues.
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From page 40... ...
The most dominant model of health is individualism, which characterizes health as a personal concern shaped by personal lifestyle choices, Sweetland explained. Most Americans are able to list two or three determinants of health, with the most prevalent responses being diet, exercise, smoking, and alcohol and substance abuse.
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From page 41... ...
Regarding high health care expenditures, the social analysis of the problem is that this is a matter of high costs, but that language may not shift public thinking. For instance, when the FrameWorks Institute held discussions on the overall economic costs of health issues, such as tobacco use or poor oral health, participants placed blame on the people experiencing the problem for the associated increased costs.
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From page 42... ...
THE POTENTIAL IMPACT OF COVID-19 AND THE RACIAL EQUITY MOVEMENT ON HEALTH POLICY The COVID-19 pandemic brought attention to racial health inequities and the interconnected nature of human well-being, while widespread protests for racial equity have highlighted the importance of racial justice, Gollust said. She asked whether this context could potentially accelerate or facilitate a public shift toward a systemic understanding of health care cost issues.
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From page 43... ...
In contrast, data indicate that views regarding racial inequality are shifting, creating potential openings for highlighting the need for health care system reform. Haynes responded that USofCare public opinion polling indicated that 68 percent of respondents identified the presence of inequities in the health system.
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From page 44... ...
Schneider added that one of the largest social spending increases for reducing childhood poverty, which was recently passed into law, was offered in the context of COVID-19 pandemic relief rather than associated with reduced medical spending (American Rescue Plan Act of 2021, Public Law 117-2, 117th Cong. [March 11, 2021]
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From page 45... ...
He suggested that local efforts can be more pragmatic and garner bipartisan support more easily than federal programs. Highlighting the difficulty of reaching consensus on health care reform at the federal level, he said that his polling research indicates that approximately three-quarters of Democrats prefer a government-run health insurance system while the same
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From page 46... ...
PERSPECTIVES OF MEDICARE RECIPIENTS Gollust asked whether research suggests that people in the Medicare program have different perspectives on health costs than the general population. Schneider replied that it is difficult to distinguish the age cohort effect from Medicare insurance status.
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From page 47... ...
Sweetland expressed concern regarding a consumer frame for health care that contains terminology such as "low value," "high value," and "saving people money." While Frameworks Institute has not tested terminology regarding health care costs specifically, research in communication about child care costs may apply. The researchers found the most compelling approach in communicating with the public was to frame the issue in terms of benefits and effectiveness.
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From page 48... ...
Gollust noted that public opinion is influenced by the broader messaging ecosystem -- including industry marketing, politicians, and the news media. Geographic Contexts and Comparisons Gollust asked how geographical comparisons of health spending and outcomes can shape the dialogue about health care in the United States.
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From page 49... ...
Disassociating Social Service and Health Care Spending Given that the American Rescue Plan (ARP) included an extensive package of upstream investments, Gollust asked whether advocating directly for investment in social services and a social safety net might be more effective than pushing for a reallocation of health care spending.
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From page 50... ...
Schneider stated that in a time of heightened partisanship and political polarization, the window of opportunity seems to be opening for equity and social justice issues; this could potentially be taken advantage of to address health spending and the health dividend. Haynes added that a holistic approach can be used to frame health equity as a benefit for everyone.
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