An Issue Map

What Should We Do To Combat Rising Medical Costs That Would Not Compromise Good Health Care?

This example of an issue map for a deliberation on the rising costs of health care lays out some of the major concerns people have when they encounter the increasing costs of drugs, doctor fees, hospital visits, and insurance premiums. The options that are formulated in response to the title question are derived from a brainstorming session on "What concerns Americans." Once participants in the naming and framing process have brainstormed their concerns on the issue, they are asked "What might be done?" As they consider possible action steps, they are asked to consider the advantages and disadvantages of these proposed steps. Questions to develop an issue map are:

  1. What Concerns Americans
  2. What Might Be Done
  3. What are the Advantages of These Steps
  4. What Are Possible Disadvantages
 

The responses that are received are grouped into three approaches (with the help of a facilitator trained in the naming and framing process)

Three Possible Approaches

 

Option 1:

The costs of catastrophic illness or accidents make people feel extremely vulnerable and with no personal control. People recall stories of Americans who have lost all their savings to pay for their medical bills. They worry about the same thing happening to them. Require everyone to carry private or government insurance to protect against extreme loss but with higher deductibles (just as we do with home and auto insurance). Communities could establish more wellness centers that would give people the information to take more responsibility for their own health using preventative measures. Higher deductibles may discourage people from getting the early diagnosis that can result in effective treatment. So the quality of care could be compromised for those who couldn’t pay the higher deductibles

Option 2:

Prices are so high that they seem unreasonable. At the gas pump, people suspect, rightly or wrongly, that someone is ripping them off, and they have the same reaction to the prices of drugs and medical services. They say that the prices aren’t fair, that it isn’t right to profit from the misfortune of others. Put limits on what can be charged or at least regulate what can be charged. And if excessive jury awards are driving up costs, put limits on the amounts that can be awarded for damages. Encourage citizens to use more generic drugs. Communities could require hospitals to make prices available. Cost controls, while holding down price increases, could dry up funds for research and limit the use of expensive but life saving medical technologies. And caps on awards for damages could result in uncompensated losses, not to mention infringing on basic rights. Furthermore, government controls would negate market competition and its potential to control costs through informed consumer behavior.

Option 3:

We aren’t recognizing that we are all in this together and that by joining forces we could both reduce costs and protect the most vulnerable. High costs mean that some Americans have to choose between eating and taking their medicine. They put off needed surgery because they can’t afford it. This inequity is troubling. Costs also make our industries less competitive globally. Give every American insurance by any one of several plans. We could have a single plan and payer for everyone as governments offer in other countries. Or we could expand the existing government programs—Medicare and Medicaid. Or communities, churches, and fraternal groups could pool risks and self-insure. Universal coverage would likely require some kind of restrictions on coverage, and those limits could adversely affect the availability of care for those who do not qualify for treatment.