VOICES OF REFORM: Consumers Union Jim Guest on the Push For Change

We had a little e-mail chat with James Guest, president of Consumers Union, the other day about the organization's activities in educating (or empowering) health care consumers, and its role in the efforts for comprehensive national health reform. We liked that he mentioned the underinsured, a topic that's been getting a lot of deserved attention in the last few days (for instance, see today's New York Times editorial) since the recent Commonwealth Report which we wrote about earlier this week. Here's what Guest had to say:

A lot of people think of Consumers Union as a place you turn for help buying a car or a household appliance. Can you explain why national health reform is a consumer issue?

Since its founding in 1936, Consumers Union's mission has been to advocate for a fair, just, and safe marketplace for all consumers. Today, there is probably no marketplace that consumes the attention—or the pocketbooks—of the American public more than the health care system. We spend 16 percent of the gross national product on healthcare, yet 47 million Americans remain uninsured. At Consumer Reports, we're seeing through our surveys a growing new class of health-care consumers— the underinsured—-those who have insurance but not enough to cover their basic needs. In our survey, nearly one-third of people who had health insurance were underinsured with coverage so meager they often postponed medical care because of costs. Twenty-two percent of respondents who were underinsured lived in households making more than $100,000 per year.

As a result, our research also shows that more than 1-in-3 consumers have taken steps, at the risk of their welfare, to control cost by doing things like putting off a doctor's visit, declining a medical test, skipping filling a prescription, skipping a scheduled dose of a medication or cutting prescribed pills in half. These are staggering statistics that make it quite clear why this issue has become such a primary focus for a group like ours who regularly speaks to—and hears from—millions of consumers.

In the early 1990s, CU leaders advocated a single-payer health care system, and some were quite critical of President Clinton's reform efforts. But in the last few years, CU has cited several ways of achieving coverage for all Americans—single payer, employer mandate, individual mandate all among the options. Have you chosen one of these paths as the organization's main focus? And why have you broadened your approach from the early 90s?

Right now, Consumers Union is focused on the outcomes we know from our in-depth surveys, our research, our participation on various quality committees, and our activism that consumers would like to see in the health-care system rather than on the various approaches to getting there. Namely, we have three primary objectives. They are to:

1. Lower Health Care Costs. Contain costs for individuals and families and in the overall health care system without compromising quality of care.
2. Improve Quality of Care. Ensure that medical care is appropriate, high-quality, and safe.
3. Guarantee Coverage for Life. Ensure that every individual and family automatically has healthcare coverage for life regardless of their medical problems and at a price they can afford.

We've learned in the last 15 years that our work to improve Americans' health care involves more than just lobbying for federal reform legislation. It involves fighting for marketplace change such as getting more health care data disclosed so consumers have meaningful comparative information, pushing for doctors to exercise greater accountability and evidence-based decision making, pushing players in health care to address the misplaced incentives, providing public education, and much more.

We've all seen your Best Buy Drugs and now your new hospital ratings. How much can we really "shop" for our health care, given that plans may limit our choices, or we may be facing emergencies? And how do these consumer tools link to the broader questions of national health reform?

There's no question that rating health care providers such as insurance companies, hospitals, and doctors is not the same as rating toasters, but what we know first-hand from our 70-plus years of experience is the value publicly available comparative data has in improving the safety and performance of products and services. In the case of health care providers, we know from our focus groups that most consumers are unable to make an informed decision about a private health insurance policy that meets their needs. On the one hand, they are unaware of some valuable information resources (e.g., from state insurance departments), and on the other, information from insurance companies often is impenetrable. One participant summed it up by saying: "It's scary we are paying so much and don't understand what we are getting." In the case of doctors, we had one tirelessly crusading activist (she lost her son to a medical error) say it best when she said, "You can call up the Better Business Bureau to check on complaints with your roofer or your plumber, but right now, you have no easy way of checking on the background of your doctor." This is why our efforts at Consumers Union aren't just focusing on transforming the healthcare system, but also on helping consumers navigate it. It's not just about educating consumers about the problems but making it easier for consumers to make more informed choices—through transparent, credible (free from conflict of interest), fully disclosed (performance outcomes should be available to the public) and standardized information. Consumers are—right now— almost completely in the dark. If we help them see the light, they'll be far better advocates for change.

There are many lessons from the failures of 1993-94 health reform efforts, but what do you see as the most pertinent one for Consumers Union? How do you make sure we don't miss another opportunity?

The biggest lesson we learned from the health care reform effort in the 1990s is that while Americans were certainly united on the problem, they were not united on the solutions. And back in 1994, there was no powerful enough countervailing force to the "consumer" faces of "Harry and Louise" to convince the American public that reform wouldn't mean giving up choice or quality. Now we know that we can't develop messages on solutions until people really understand the depth of the problems. Now we know that in order to speak for consumers, we need to speak directly with them. We need this effort to come from the ground up—-not from the top down. That's why five years ago we launched a grassroots activism program at Consumers Union that, in its short tenure, has helped us pass landmark federal drug safety legislation and laws in more than 20 states to reduce hospital-acquired infections. It's also why we're spending the summer driving an RV around the country (www.coveramericatour.org) collecting compelling stories of people's troubles with the healthcare system—everyone from small business owners who can't afford to give their staff raises and continue to pay their healthcare to consumers who are waiting until they are eligible for Medicare to get the treatment they actually need now. As part of this effort, we're posting videos online, writing a blog, and holding events, and eventually some of these people will make their way with us to Capitol Hill. In order to be successful in passing meaningful health care legislation, we need to broaden consumers' understanding of the issues so that they're educated advocates for reform. And then we need to ensure that the consumer voice is heard. We intend to use everything in our arsenal to amplify that voice—through lobbying, activism, surveys, focus groups, strategic partnerships and alliances, and investigative research and journalism to name a few. For every dollar the health care industry spends lobbying, we intend to match it with consumer stories pushing for change.