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The Kaiser Family Foundation has issued a new series of tracking polls to measure the salience of health care as an issue in the presidential campaign. While Iraq continues to top the list of public issues (44%), health care is now second on the list (29%) as one of the important problems government needs to address.

And health care may be increasing in importance as it starts to rise from its former tied position with the economy (13%) in the public mind. Half those polled (52%) want to see the candidates proposing major new health reform in their campaigns. Despite this public call for more action, many people (45%) can’t name a candidate, or say there is no candidate (21%), who is placing placing a big emphasis on health care. One in five do name Hillary Clinton. So the American public wants a reform plan — at least for now — but none seems to have hit the radar screen yet.

Remember this poll was taken before March 13th, so we have yet to see if an “Elizabeth Effect” will stimulate more public awareness of health care issues.

In New York magazine, David Amsden chronicles the plight of New York’s young uninsured (The Young Invincibles). Conducting over 50 interviews with friends, and friends of friends, he tries to get at how being uninsured has affected their lives. He writes, that “If there was a dominant theme to these conversations, it was that being uninsured has a distinct way of tweaking one’s perception of the city: New York becomes a kind of phobia-forming obstacle course, one navigated with the goal of keeping doctors at bay.” Many follow elaborately obsessive routines to avoid even minor risks of injury or illness.

But the writer comes to find out that keeping the doctors at bay is not an easy job. He learns that “even the youngest, healthiest, most resilient bodies can malfunction in mysterious ways. One morning you wake up with a minor stomachache, and before you know it, you’re in the hospital, delirious with pain, waiting to see the doctor. “

Amsden discovers something else about being uninsured. It’s not only the cost of care that’s worrisome; you are also afraid that the care you do get will be substandard because you don’t have insurance.

So some friends resort to unusual ruses. One admits, for example, to carrying an expired Blue Cross card in his wallet. “You never know, maybe they’ll think I have insurance and I’ll get better care.”

But being uninsured in New York is not without its ironies. One friend said “I would never live without my cell phone, but I won’t consider buying health insurance. It sounds ridiculous to say that out loud, but the fact is insurance is just too expensive. If it was the same price as my phone I’d buy it in a second.”

Salon’s Walter Shapiro writes:

“Presidential races are often about more than control of the levers of power and the policy direction of the nation. Prior campaigns forced the nation to confront questions about religion, divorce and career-minded first ladies. This time around, especially for the Democrats, everything is on the table: race (Barack Obama), gender (Hillary Clinton), Hispanic heritage (Bill Richardson) and now cancer (the Edwardses).”

For John and Elizabeth Edwards, cancer (and by extension, health care) is much more than an “issue” to be twisted and spun for political convenience. They are now in the clutches of something deep and extremely personal. And how could it be otherwise? As I’ve said before, serious illness can sometimes be a transforming experience. And from what we’ve seen, I suspect they’ve already crossed an important emotional bridge in their decision to open up their private struggle to the rest of us.

So what of the campaign? Their affliction may well impact every aspect of their presidential bid. We are now hearing about the profound “Elizabeth Effect” on Edwards’ campaign and how he it being perceived. Will the campaign attempt to “manage” that perception? In presidential politics–how could it be otherwise? Campaigns are often about the skillful manipulation of people’s attachments to images and stories. Even if the Edwardses are not complicit in this image-manipulation, their surrogates and others will be on their behalf.

It will be a serious challenge to see the truth of their battle with cancer through the distorted lens of a presidential race. But this truth will do more to advance health care reform in America than any speech or policy platform ever could.

A poll was released on the feelings of consumers about the privacy of their health care information. The headline on the AHIP Smartbrief (Free Subscription) warned “Poll: Many concerned about health record privacy”. A click on that headline took you to a Health Data Management website — “Survey: Medical Data Privacy a Concern”. The Health Data Management article referenced the originating Harris poll. Yet when you looked at that report you wondered whether you were reading the same story. That head read — “Many Adults are Satisfied with the Use of Their Personal Health Information.” The same poll was the subject of all three mentions.

So the media comes to a news source with their own narrative in mind, and builds the story off of that. As the saying goes, “show me the assumptions on which you base your facts.”

But shouldn’t we have a slightly higher expectations when it comes to specialized health news in what we euphemistically call the “professional press”? While you should expect some hawking of special interests or products, these articles were just too misleading to go without mention. That’s because many readers will only digest the headlines to form an opinion (or simply reinforce their bias) and quickly move on.

So I quote from the Harris poll report itself and you make the judgment which headline reflects the real content.

• Seven in 10 (70%) U.S. adults agree that they are generally satisfied with the way doctors and hospitals handle personal health information in terms of protecting its confidentiality and security. One in five (20%) strongly agree with this, 50 percent somewhat agree and another 19 percent disagree. The remaining 11 percent are not sure;
• By 63 to 25 percent, a majority agrees that increased use of computers to record and share patient medical records can be accomplished without jeopardizing proper patient privacy rights. One quarter (23%) strongly agrees with this;
• A majority (60% to 27%) feels that existing federal and state health privacy protection laws provide a reasonable level of privacy for their health information;
• A similar 63 to 27 percent of U.S. adults also agrees that they would consent to have their medical records used for medical research as long as there were guarantees that no personally-identifying information would be released.

Based on these attitudes, it would seem that about six to seven in 10 adults seem to be fairly comfortable with the use of their personal health information today. However, about one quarter of adults do have significant concerns.

Reports are out indicating that, for the past 12 years, the numbers of uninsured coming from the U.S. Census Bureau have been wrong. Not by much, mind you, but still wrong. Revised estimates reported 44.8 million people were uninsured in 2005 rather than 46.6.

The Bureau says the impact is small and historical trends remain unchanged. Yet Representative Carolyn Maloney, who serves on the House subcommittee that oversees the Census Bureau, says, “For an agency that specializes in statistics, 1.8 million is not a minor error. It’s a major error.” But why the surprise? The U.S. Government Accountability Office warned about the quality of Bureau data back in 2004.

Sure, it was a computer glitch. A “minor hitch or technical problem.” And it was a relatively small glitch at that. But as this incident shows, small glitches can make for big problems. With health care being front and center in Washington this year — especially on the plight of the uninsured — trust in the numbers becomes a critical factor in combating the “politics of denial” that often hinder real debate. It will be important that the Bureau repair its image through an open dialogue on its problems. More important, however, Congress must take its head out of the sand and restore public confidence in the Bureau through more effective oversight.

Washington, D.C. — The AHIP National Policy Forum ended today with some heavy-weight policy folks pushing more talk on “transparency” and “value” — two words that come up in almost every conversation on health care these days. And that’s another word that seems to be making the rounds. We appear to be having “conversations” on everything in health care lately. Not arguments, fights, or debates, but “conversations.” I think its the new code for “let’s stay calm and civil.” Of course at times it does drip with a little sarcasm.

That said, one gets the sense of strange bedfellows coming together to take advantage of the public and congressional mood for action on health care reform. Many stakeholders have found a common language in the value/transparency oeuvre and are hooking their wish lists to it. All feel strongly that the time is now to get the political wheels in motion. For example,

• Take Congressional action on SCHIP to cover more uninsured kids
• Support the emerging universal coverage experiments in states like Massachusetts and California
• Make health care a priority focus of the upcoming presidential election
• Build consensus for the big decisions to come in 2009 with a new president and congress

Now a few sound bytes from today’s sessions:

“Some states spend more SCHIP money on adults while children go uncovered!”

(Orrin G. Hatch, Second Ranking Minority Member, Finance Committee, The United States Senate on the debate on who’s being covered with SCHIP monies.)

“There is not a consensus in Congress on how to do this.”

(Hatch on how to help the working poor pay for health insurance.)

“We have to make sure we get it right– the right care, at the right time, for the right patient.”

(Carolyn M. Clancy, Director, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services)

“Good (health care) information has to be impossible to avoid.”

(Clancy on the need for consumers to have good information on quality care.)

“‘Technology is rarely always effective or never effective.”

(Gail R. Wilensky, Senior Fellow, Project HOPE on the difficulty of assessing new medical technology.)

“Medicare –20 years of getting it exactly wrong. Same reimbursement for best in class and worst in class.”

(Wilensky on how Medicare reimbursements to physicians do not promote quality.)

“That’s pin-the-tail on the donkey financing.”

(Uwe E. Reinhardt, Professor of Economics and Public Affairs, Princeton University on government imposing unfunded health care mandates on hospitals.)

Washington,. D.C. — Thought I would share some sound bytes from today’s speakers at the AHIP (America’s Health Insurance Plans) National Policy Forum

“I believe we are on the verge of better health and lower costs for all Americans.”

(Michael O. Leavitt, Secretary, U.S. Department of Health and Human Service, in praise of Bush’s value-driven health care initiative.)

“I don’t know.”

(Leavitt when asked how the implementation of the National Provider Identifier was going.)

“What can you do? You got to find the sweet spot as an agent of change without turning off the status quo. “

(Amy Walter, Senior Editor of The Cook Political Report, on how Republican candidates are approaching the upcoming elections.)

“McCain an outsider? Can’t shake that Washington smell after eight years in the Senate.”

(Walter on McCain’s presidential campaign)

“The ideologues want to see it fail.”

(Jon M. Kingsdale, Executive Director, The Commonwealth of Massachusetts Health Connector Authority on Massachusetts’ plan for universal coverage.)

“Pimp my ride health care reform”

(Cindy Inez, Director California’s Department of Managed Heath Care referring to reform that has no substance)

“Arnold’s ‘leave no ox un-gored’ approach”

(Inez on everyone having to contribute to funding health care)

“Why these programs? If you’re looking to reduce costs, you should look at where the costs are.”

(Peter R. Orszag, Director, Congressional Budget Office when asked why he is eying cost reductions in Medicare and Medicaid)

“We don’t know yet what will bend that curve.”

(Orszag, on containing future increasing costs of Medicare and Medicaid)

“Costs are unsustainable and have reached a tipping point.”

(John J. Castellani, President, Business Roundtable on health care costs)

“A Republican and a Democrat walk into a bar to talk about health care. This should not sound like a joke.”

(William D. Novelli, Chief Executive Officer, AARP on working with all political stakeholders for health care reform)

“Each group brings its top priority (on health care) to the table .. everybody’s second favorite choice is the status quo.”

(Ron Pollack, Executive Director, Families USA paraphrasing Stuart Altman on why health care reform typically goes nowhere.)

“There’s probably an inverse relationship between being a front runner (in the presidential campaign) and the specificity of their plans (for health care).”

(Pollack on the political risks for presidential candidates being too specific before stakeholders buy in)