News with clear eyes. (AP Photo/Khin Maung Win)

Americans tend to have purple views about the U.S. health care system.

Republican lawmakers tend to want to promote programs that do more to cut coverage costs for the healthy than programs that help sick people and low-income people buy coverage, and Republicans also talk about the need to reduce government spending on health care.

Many Democratic lawmakers tend to discuss the need for guaranteed-issue underwriting, subsidies for the poor, and reasons to maintain the current level of benefits offered by Medicare and Medicaid, even if that increases costs.

Researchers at the Robert Wood Johnson Foundation, Princeton, N.J., and the Harvard School of Public Health have published survey data that could make everyone happy and everyone miserable.

The researchers collected the data by commissioning telephone surveys of 1,598 U.S. residents ages 18 and older.

When pollsters asked, “What do you think is the most important problem with the nation’s medical care system?”, 51% cited health care costs, and only 18% mentioned the plight of the uninsured or access to health care.

Just 7% named the “government role in health care,” and only 5% named “insurance companies.”

But, when the pollsters asked, “If you had to choose, would you rather have a smaller government providing fewer services in health, or a bigger government providing more services in health?”, only 37% answered “smaller government,” and 52% answered “bigger government.”

In response to another question, 45% of the participants said providing subsidies to help the uninsured buy health insurance or get health care services should be a top government health care priority.

The only answers that drew more positive responses were improving Medicaid, which struck 56% of the participants as being a top priority, and improving Medicare, which impressed 63% of the participants as being a top priority.

Participants said the government is doing the best job at preventing the spread of infectious diseases and the worst at shoring up Medicare and Medicaid.

The pollsters also asked about difficult life events, such as whether participants had suffered personal or housing damage resulting from a natural or man-made disaster in the past 12 months. This year, 10% of the participants said they had.

ACO MAN

Blue Shield of California, San Franciso, has hired Dr. John Hirshleifer to be medical director of accountable care organizations (ACO).

Hirshleifer will help the network management team develop an ACO program.

An ACO is supposed to be an organization that pays for care at least partly on a whole-patient basis, rather than purely on a fee-for-service basis, in an effort to increase the incentives for doctors and hospitals to treat patients more efficiently.

Hirshleifer previously was the medical director at Alta Bates Medical Group, Berkeley, Calif. He also has been a medical director at Health Net Inc., Woodland Hills, Calif. (NYSE:HNT), and Centinela IPA, San Dimas, Calif.

Hirshleifer has a bachelor’s degree in philosophy from Yale University and a medical degree from the University of California, San Diego. He has a master’s degree in public health from the University of California, Los Angeles. He is board certified in emergency medicine, preventative medicine and internal medicine.

THE FUTURE

The American Enterprise Institute, Washington, will hold a panel discussion on “Dismantling the Federal Employees Health Benefits Program” at 9:15 a.m. Wednesday in its offices.

The institute is asking whether recent Obama administration moves to let the government directly buy all prescription drugs sold through the Federal Employees Health Benefits Program (FEHBP) and a proposal to let the U.S. Postal Service drop out of the program count as the first steps in efforts to dismantle as an effective market-based health insurance program.