Problems with a health care myths survey

Volokh Conspiracy's Jim Lindgren thinks the University of Indiana's survey on health care myths may have ... well... mythed a few points.

If you look at the survey, you see that most of the supposed knowledge questions do not turn completely on known facts, which can have true or false answers. The myth questions are mostly subjective — expectations or predictions about the future — which by nature have no right or wrong answers. This distinction is axiomatic in the field of survey research.

Of course, most of these predictions could at some future time be determined to be true or false by most fair-minded observers, but not now. A few of the predictions about the future strike me as being extremely likely to turn out to be correct (if Obama's plans were enacted) and a few strike me as strike me as being extremely likely to turn out to be incorrect predictions. If Obama's plans are ever enacted, time will tell. But they are not now “myths.”
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In other words, most of the myth questions in the Indiana survey are questions about subjective views (expectations, opinions, attitudes, and beliefs), not currently knowable facts. For a social scientist reporting a survey to call them “myths” violates general principles of opinion polling.

OBAMA’S PROMISE TO MAKE COMPANIES CHANGE INSURANCE PLANS

Before getting into the survey questions themselves, people should remember what President Obama said in his first August town hall meeting on health care in New Hampshire:

Under the reform we're proposing, insurance companies will be prohibited from denying coverage because of a person's medical history. Period. . . .

Now, when we pass health insurance reform, insurance companies will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. And we will place a limit on how much you can be charged for out-of-pocket expenses, because no one in America should go broke because they get sick. (Applause.)

And finally — this is important — we will require insurance companies to cover routine checkups and preventive care, like mammograms and colonoscopies — (applause) — because there's no reason we shouldn't be catching diseases like breast cancer and prostate cancer on the front end. . . .

So this is what reform is about.

I quote this to remind skeptics that President Obama is promising to prohibit insurance companies from offering lower cost plans with high deductibles, which some younger people in good health currently prefer. In other words, some of you who like your current health plans will not be allowed to keep them.

And in part 2

Here are the relevant myth questions on the survey and my own comments about what is likely to occur if President Obama's reforms were to be enacted:

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1. Millions of Americans will lose their current health insurance.

COMMENT: This strikes me as extraordinarily likely to occur, especially given Obama’s promises quoted in the last post. Given that Obama is proposing to change coverage, plans, and incentives, enough will change that it is either naïve or dishonest (or both) for a survey researcher to call this statement a “myth.”

2. Wait times for health care services like surgery will increase.

COMMENT: This strikes me as extraordinarily likely to occur. Increasing the scope of coverage without appreciably increasing the number of doctors should lead to longer wait times. Again, it is either naïve or dishonest (or both) to call this a “myth.” Further, the Massachusetts experience is not encouraging.

3. Health care services such as treatments, physicians, and care will be rationed.

COMMENT: Given that the White House admits that rationing is already happening by private insurance carriers, I don’t understand why they think that rationing in some form is unlikely under their proposed reforms. I suspect, however, that the government will find it difficult to make many of the tough decisions, so that most "rationing" will occur not by the government denying care but by doctors being unable or unwilling to treat many of the patients covered under government or private insurance plans. Time will tell.

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7. The Federal Government will become directly involved in making personal health care decisions for you.

COMMENT: Whether this is likely to turn out to be TRUE depends on what is meant by “directly involved in making personal health care decisions for you.” By creating panels that will mandate some coverage and refuse to reimburse other coverage, this assertion will probably be TRUE for many people. But if the question means that government officials will decide on your treatment on a case-by-case basis, this is likely to be FALSE. Participants in the public option, however, may have case-by-case decisions made on which sorts of coverage will be reimbursed, given their diagnosis and condition.

8. The Federal Government will make decisions about whether you will be treated or not.

COMMENT: Again, whether this is likely to turn out to be TRUE depends on what is meant by making “decisions about whether you will be treated or not.” By creating panels that will mandate some coverage and refuse to reimburse other coverage, this assertion will probably be TRUE for many people. But if the statement means that government officials will decide on your treatment on a case-by-case basis, this is likely to be FALSE. Participants in the public option, however, may have case-by-case decisions made on which sorts of coverage will be reimbursed.

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