Dr. Mollyann Brodie, Executive Director of Public Opinion Research, Kaiser Family Foundation

(Music)

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, we have reached a milestone here at
th
Conversation s on Health Care ; this is our 300 show . It seems just like
yesterday , well not actually just like yesterday , but it does seem like we launched
the program pretty recently.

Margaret Flinter: Well, it was back in 2009 and we remember the nation was
very focused on the health care debate. We felt strongly that creating a forum for
discussion on these incredibly interesting and important issues was just the right
thing to do.

Mark Masselli: Our first guest was the Speaker of the House, Nancy Pelosi, and
we have had a lot of bright and top thought leaders in health reform and health
polic y. So it's been a good run.

Margaret Flinter: In addition to Nancy Pelosi, of course , we had Senator Tom
Daschle, public health leaders like Don Berwick and Tom Frieden of the CDC,
technology innovators and thoug ht leaders like Eric Topol and Esther Dyson, and
even some of our youngest game changers like Intel Science Fair Winner Jack
Andraka who represents such a smart and hopeful group of young innovators
who are poised to really transform health care and scienc e in the future.

Mark Masselli: So much has changed in such a few short years, Margaret. This
show has proven to m e time and time again how fortunate we are to have so
st
many great mind s shepherding the health care industry into the 21 Century.

Margare t Flinter: I am very grateful to all of our guests for sharing their
knowledge and wisdom with us, and we in turn get to share it with you , our
listeners , what a privilege .

Mark Masselli: We still look forward to welcoming many more guests to the show
i n the coming months and years . Health care both here and around the globe is
still r ife with much uncertainty . Epidemics like Ebola, HIV and malaria still must
be eradicate d , and we are entering an era of care coordination, pay for
performance, and a new focus on transparency on health data.

Margaret Flinter: And that ’s something that today’s guest is very knowledgeable
about . Mollyann Brodie is the Executive Director of Public Opinion and Survey
Research at the Kaiser Family Foundation, so we look for ward to our
conversation with her.

Mark Masselli: And Lori Robertson, stops by as she does every week, the
M anaging Editor of FactCheck.org, always on the hunt for misstatements spoken
about health policy in the public domain . But no matter what the top ic, you can
hear all of our shows by going to www.chcradio.com .

Margaret Flinter: And as always , if you have comments, please e - mail us at
[email protected] , or find us on Facebook or Twitter at CHC Radio . We love
to hear from you.
Mark Masselli: And you know we couldn’t do what we do without our great
producer Marianne O’Hare with this week’s Headline News.
(Music) Marianne O’Hare: I am Marianne O’Hare with these Hea lth Care Headlines .
California has become the fifth state in the nation to pass sweeping right - to - die
legislation signed r ecently by Governor Jerry Brown , but few approaching end of
life will be able to access that option . The law states those terminally ill patients
who wish to seek physician assistan ce in ending their lives will have to be of
sound mind to be able to administer the drugs themselves and to get approval
fr om more than one clinician. The law still l ea ves out a wide range of people who
mig ht want to be covered , p eople with progressive debilitating disease s that don’t
have an obvio us six months to live prognosis , people with dementia the fastest
growing health threat in the U.S.
California ’s Governor Brown has also signed another notable me asure , a bill
protecting children in foster care from being heavily medicated with antipsychotic
drugs . Over prescribing these powerful drugs is a national reality plaguing
children in foster care systems across the country. The California legislation
whi ch covers more than 60,000 children and teens in foster care , will allow public
health nurses access to medical records to monitor the foster children who are
prescribe d psychotropic drugs , i dentif y group homes that rely on most o n these
meds and potential ly require them to take corrective action.
Johnson & Johnson has begun a clinical trial of a two - shot Ebola vaccine in
Sierra Leone. The world already has one successful Ebola vaccine with Merck and NewLink Genetics product proving 100% effective in a cl inical study in
Guinea in July.
I am Marianne O’Hare with these Health Care Headlines .
(Music) Mark Masselli: W e are speaking today with Mollyann Brodie , Ph.D., Senior Vice
President for Executive Operation s and Executive Director of Public Opinion and
Survey Research at the Kaiser Family Foundation. She oversees all aspects of

the foundation’s public opinion and survey efforts, including the monthly Kaiser
Health Tracking Poll . Dr. Brodie is President of the American Association of
Public Opinion Res earch. Her research is published in multiple medical journals
including the Journal of American Medical Association, the New England Journal
of Medicine , and Health Affairs. Dr. Brodie received her MS in Health Policy and
Management , and a Ph.D. in Healt h Policy from Harvard University . Mollyann,
welcome to Conversations on Health Care .

Dr. Mollyann Brodie : Well, thank you so much for having me.

Mark Masselli: You know, I think most of our listeners know that Kaiser Family
Foundation is a nonprofit, nonpartisan health research organization . You also
partner with a number of news organizations for public opinion research and
analysis . Tell our listeners in this ongoing endeavor how research from the
Kaiser Family Foundation helps shape U.S. health po licy .

Dr. Mollyann Brodie : Yeah, that’s a good question. You know, our mission here
is to make sure that the real life experiences and views and opinion of people,
real people, are part of the policy debates and discussion . So we try to insert
facts an d analysis into these discussions that can often be quite contentious. We
try to make sure th e voices of people, especially those groups that might not
always be heard around the political tables, the uninsured, those who are most
likely to have highest h ealth care needs, those with lowest incomes or other
disadvantage population s , we just try to make sure that their voices and their
experiences and their opinions are part of the debates and discussions going on
in Washington .

Margaret Flinter: Well M o ll yann , the American public , those real people that you
reference have certainly been given a lot of health policy to consider . Outline for
us , if you will , some of the chief areas of public opinion research that’s be ing
examined by the Kaiser Family Founda tion , and how has perception and/or
acceptance or not of the health law evolved over these past few years at the
level of the American public /

Dr. Mollyann Brodie : We have been tracking the views of the American public for
decades now , but on a monthly b asis since the law was pas sed in 2010 . As I
said before , we mainly focus on the real life experiences and their views, and we
mainly focus our survey work on access to health care and the financing and
affordability of that care. Now what I would say abo ut the Affordable Care Act is
that what characterizes opinion on that act is in fact its stability over the five
years. There has been so much contentious debate , and there has been a
Supreme Court case, and the re have been some Presidential elections and mid -
term elections, but what we mostly see in terms of public opinion is its stability,
and in fact that from the very beginning , it's been viewed through a partisan lens ,
and in fact that persist s today. About 45 of us have an unfavorable view of it,

ab out 41 have a favorable view, but what that divide really mas ks is an incredibly
deep partisan di vide .

So Democrats have always like d the law, they liked it from the very beginning in
2010 and they still like it today . Republicans have never liked the la w. They
have always had unfavorable views of the law. They ha d that from the very
beginning in 2010, they still hold that today. Those of us in the nation who call
ourselves independent, well, we sort of look like we have middle of the road
opinion s on the law, but when we push the independen ts to say whether they
lean Democrat or lean Republican, we find that they share views on the ACA that
completely mimic their more partisan colleagues. So if you can imagine data
points for every month over the past five years, they virtually look like horizontal
lines. So about half of people say they haven't had any personal impact with the
ACA, but among those who have , about a quarter say it was a negative impact,
and about one in five say it's been a positive i mpact, and that really defers again
depending on your partisan l eanings.

Mark Masselli: If you have teased out and when you start to break this down into
its constituent pieces about coverage for kids up to 26 and no preexisting
conditions, do you see a difference if you take out sort of the partisan element?

Dr. Mollyann Brodie : Yeah, you know, it's interesting. One of the things we saw
early on is that many of the component parts of the law are actually quite
popular, and quite popular on a bipartisa n basis. So people like the idea of kids
under the age of 26 or young adults being able to stay on their parents’ plan, they
like the idea of insurance companies having to not be able to exclude people
because of preexisting conditions. The couple things that people don’t like
nobody likes to have to be told to purchase something. So the individual
mandate has been a component that’s always been unpopular , even on a
bipartisan basis.

Mark Masselli: Sure.

Dr. Mollyann Brodie : Views of the law overall are as much a reflection of
people’s views of the Presidential administration and of how things are going in
politics than they really are about health policy issues per se.

Margaret Flinter: Well, one thing that’s certainly very personal to people is co st,
and certainly out - of - pocket cost s are on the rise for many American health
consumers , and certainly the mandate to purchase insurance and then to choose
based on your financial responsibilities and deductibles and co - pays of course
have been really cha llenging for a lot of people. What are you seeing in your
polling about the American p ublic’s feelings about this shift in cost and financial
responsibility when it comes to health care and how might public opinion shape
future pricing?

Dr. Mollyann Brod ie : When you get down to it, what Americans worry most about
in terms of health care is the cost of care, and they have historically been worried
about it, they have been historically worried about the amount they have to pay
for the ir health care service s, and even though most experts and economists
have said that we had kind of a historic slowdown in the rise of prices, well for
average people, they still see their cost s going up. Three in 10 have t old us that
they are not confident that they have enoug h money to pay for just usual medical
costs, four in 10 say they are not confident they could pay for a major illness, and
not surprisingly , the se shares rise dramatically if we look specifically at the
uninsured or those who are lower income. I think wha t it come s down to is that a
big chunk of Americans say it is really difficult . Even insured Americans,
insurance is no panacea as we know, a third of insured American s say that it's
difficult to afford the ir deductibles, their co - pays and their premiums.

So I think that quite frankly it is sort of the underbelly of health policy and you see
that reflected in some of our more recent polling about the agenda that they
would like to see the new President and Congress take up , or where they would
really like to see some attention focused, and we were almost surprised to see
that when we put things like the cost of prescription drugs or prescription drugs
for specific medical conditions on our list , that they just jumped out to the top. I
think at least some of that is that more than half of Americans take prescription
drugs on a daily basis , and so it's something that’s very apparent in their daily
life. And so I think it's one of the reasons why that ’s a particular area where you
see a large number of peopl e tell us that they are worried about it.

Mark Masselli: W e are speaking today with Mollyann Brodie , Ph.D., Senior Vice
President for Executive Operation s and Executive Director of Public Opinion and
Survey Research at the Kaiser Family Foundation. She oversees all aspects of
the foundation’s public opinion survey efforts. Mollyann, there are still another
group of people who have benefited in terms of access t o health insurance and
they have plans that are offering more than the Affordable Care Act , so metimes
they are called the Cadillac plans, which the Obama Administration was hoping
to start taxing in 2018 , and there has been obviously on this side of the coin a lot
of pushback on that initiative . What are you hearing about the prevailing attitude
o n that subject, and more broadly perhaps how do Americans really believe
health care should be paid for?

Dr. Mollyann Brodie : Well, first in terms of the Cadillac Tax, I mean the name
itself will help you p r edict what the outcome is going to be, right?

Mark Masselli: That’s right.

Dr. Mollyann Brodie: We are Americans, and Americans are not very fond of
taxes.

Mark Masselli: Yes.

Dr. Mollyann Brodie: But what I will say is that when we gave people more
information and gave them some messages on ei ther side of that debate, it was
interesting that opinion will shift with information. So if they were told that it might
lower health care costs, right, which is certainly one of the policy reasons for the
Cadillac Tax, then opinion switched. On the oth er hand, if we use the arguments
for the opponents of the tax that it's going to actually increase out - of - pocket cost s
more , then opposition can grow as much as to 75%. We have to remember that
as much as Americans care about health care because it's such a personal issue
to people. So when you ask something about how do Americans really believe
health care should be paid for, I think it's tough. I know that people who have
employer - sponsored insurance are in fact generally quite grateful to their
employ ers for providing it and for helping to pay for it ; they recognize that it would
be very expensive for them to be trying to purchase it on their own. And we also
know that it's one of the core benefits that people look for in a job , and that
concept of jo b l o ck, that it's still very prevalent in people’s mind s. They get and
keep jobs because of the insurance it provides for their families.

Margaret Flinter: Mollyann, you recently partnered with the Commonwealth Fund
on the survey of primary care provide rs, and found that while millions of newly
insured Americans ha d gained coverage , it had not produced a significant
additional burden on those practices. Tell us more about your findings.

Dr. Mollyann Brodie : You know, we are asking them about the ir pra ctice
capacity , and asking them about whether they felt they ha d the capacity to
handle patients , and the re’s certainly not a sense that they were getting flooded.
You know, again, I think it's early on and you have a lot of states who haven't
expanded th e Medicaid Program, even though there has been quite an
expansion it hasn’t been at the rate that it might have been if all states had done
the Medicaid expansion. And s o at least at this early stage I think in the
implementation of the ACA , primary care physicians told us that so far so good .
It doesn’t necessarily mean they like the ACA. What was pretty interesting about
that study is that physicians ’ views of the law pretty much paralleled the public ’s
views , in that physicians who called them selves D emocrats like d the law and
physicians who called themselves Republicans didn’t like the law, and their
opinions didn’t seem to have much to do with actually what was happening on
the ground in their practices.

Mark Masselli: Mollyann, in addition to bein g the (inaudible 15:13) at the Kaiser
Family Foundation, you are also President of the American Association of Public
Opinion Research which is dedicated to the notion that good public opinion
research is essential to the healthy democracy. Could you tell our listeners more
about your organization’s missions and goals and how is Big Data changing the
polling landscape and how is transparency playing a role in the association ’ s
work as well ?

Dr. Mollyann Brodie : You know, we believe this is really excitin g and challenging
time for the polling industry generally. Big Data offers an awful lot of
opportunities , but also some challenges, and I think that there has been some
really exciting new experiments and new ways of thinking about how we actually
measure opinion and how we can collect data of that opinion. At the same time,
and it's one of the reasons the association has been so focused on transparency ,
because there are so many new methods and so many new ways of going about
collecting data we feel like it's more important than ever for people to make their
methods and their choices and their decisions and their assumptions transparent
to readers and journalists and the people who are consuming their data so
people can make judgments on their own. AAPOR has a new transparency
initiative really with that goal to try to make it easier for journalist or for a potential
client or for a reader to have confidence in the type of methods that were
employed. In the transparency initiative, it says that they will abide by a set of
rules in terms of what kind of disclosure information they make available, and I
think that can give for a journalist and for others on which organizations are
producing information that at least are being transparent about the kinds of
choices and decisions they are making.

Margaret Flinter: It strikes me that one thing we can count on is public opinion
sometimes does change overtime, and one thing I am thinking about is the
firestorm that was created in the early days of the Affordabl e Care Act
discussions around the idea of providers and patients having frank conversations
about end of life issues. You have recently conducted a survey on that topic and
found that maybe there has been some shift in the opinions in the medical
communit y as well as among patients . Tell us about that.

Dr. Mollyann Brodie: You know, the firestorm that you are I think referring to is
when Sarah Palin and others called a provision in the health care law, the
provision of creating a death panel. Well, I c an't imagine any American who like s
t he idea of a death panel. So the fact that there was so much opposition to that ,
really to that wording I don’t think is a s surprising. What we have recently a sked
is much more about end of life conversations, and it turns out that the vast
majority of Americans support the idea of doctors talking to their patients about
end of life decisions and choices , a lthough quite frankly only about 17% of
American s say they themselves have never had such a conversation with thei r
doctor. About a third tell us that they have been a part of such a conversation
whether it be for their own care or for family member’s care.

As the fi ery language l ea ves the headlines and instead we talk about a really
tough personal issue about the m edical choices and decisions that are available
at the end of somebody’s life and treatment , I think that basically what we are
seeing in our data is that Americans think it's important for doctors to be part of
that conversation. They believe that insura nce companies including Medicare
should reimburse doctors for the amount of time that they spend on those kinds
of conversations, and they themselves want to turn to their doctors and to other

trusted sources like their religious leaders, their friends, th eir family members
most especially , to talk about such issues.

Mark Masselli: We have been speaking today with Mollyann Brodie, Ph.D.,
Senior Vice President for Executive Operations and Executive Director of Public
Opinion and Survey Research at the Kais er Family Foundation. You can learn
more about their work by going to www.kff.org or by following her on Twitter
@Mollybrodie and @KaiserFamFound. Mollyann, thank you so much for joining us on Conversations on Health C are today.

Dr. Mollyann Brodie: You are welcome. Thanks for having me.
(Music) Mark Masselli: At Conversations on Health Care, we want our audience to be truly in the know when it comes to the facts about health care reform and policy. Lori Robertso n is an award - winning journalist and managing editor of
FactCheck.org, a nonpartisan, nonprofit consumer advocate for voters that aim to reduce the level of deception in U.S. politics. Lori, what have you got for us this week? Lori Robertson: We are goi ng to look at a public health issue today which is
firearm deaths. After a mass shooting in Oregon on October 1

st
, President
Obama claimed that, “States with the most gun laws tend to have the fewest gun deaths.” Looking solely at the numbers, the data b ack up Obama, but he went
on to imply a causation that’s impossible to prove with a scientific random study
that gun control laws lead to fewer gun deaths. He said, “So the notion that gun
laws don't work, is not borne out by the evidence." Let’s take a closer look at the
evidence. The Centers for Disease Control and Prevention publishes statistics
on firearm death s and the age - adjusted death rate d, which would be the fairest
measurement to compare states. For 2013, the 10 states with the highest
firear m death rates led by Alaska, Louisiana, Mississippi and Alabama included
nine states that got a grade of F for their gun laws by the Brady Campaign to
Prevent Gun Violence , and the Law Cent er to Prevent Gun Violen ce , both groups
that advocate for strong gu n laws. The 10 states with the lowest firearm death
rates led by Hawaii, Massachusetts, New York and Connecticut included seven
that got a B or higher for their gun laws, but that’s a correlation and not
causation.

The states with the most gun deaths als o tended to have higher rate s of poverty
and more rural areas that can make get ting to a hospital in time difficult, and 63%
of all gun deaths were suicides. When we look only at homicide rates , eight of
the 10 states with the highest homicide rates and e ight of the 10 with the lowest,
all got D or F grades for their gun laws. Researchers at Boston Children's
Hospital looked at 2007 to 2010 data and found a higher number of gun laws in
the state was associated with a lower rate of gun deaths, both overall and for

homicide alone. But that reports said that it couldn’t determine cause and e ffect.
And that's my fact check for this week. I am Lori Robertson, Managing Editor of
FactCheck.org.

(Music)

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country's major political players, and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact, that you would like
checked, email us at www.chcrad io.com . We will have FactCheck.org's Lori
Robertson check it out for you here on Conversations on Health Care.
(Music) Mark Masselli: Each week, Conversations highlights a bright idea about how to make wellness a part of our communities and everyday l ives. No parent wants to
hear their young child’s chronic health issues are a result of serious defects,
requiring complex and risky surgery. But that was exactly the case for three - year
old Mia Gonzales, pla gued for years with severe life threatening re spiratory
issues and multiple hospitalizations. Her doctors discovered the cause was a
severe aortic abnormality that would eventually kill her without intervention. Dr. Redmond Burke, Head of the Pediatric Cardiovascular Surgery at Nicklaus Children’s H ospital in Miami would once have deemed her situation inoperable.
So we chose a new tactic, created 3 - D printed model of her actual heart to offer
surgeons a chance to map out an approach to the complex surgery.
Dr. Redmond Burke: This was printed out b ecause she was thought to be inoperable, and by having this type of model we were able to conceive of an operation that ha d n't been done before connecting the small veins from her lungs
up to her heart.
Mark Masselli: Dr. Burke said he carried the heart around him for weeks ,
analyzing the problem from every conceivable angle, sharing ideas with colleagues until they agreed upon the best surgical solution.
Dr. Redmond Burke: Her operation was extremely successful, and she is
recovering very well in the h ospital now and is just about ready to go home. And
now her life instead of being measured in terms of days and weeks, is going to be measured in terms of years and decades.
Mark Masselli: Dr. Burke said that prior to 3 - D printing technology like this t hey
would have deemed her case too risky to chance. W hile scientist s say creating
stem cell generated 3 - D printed organs for implementation is still years away , this
method of deploying 3 - D technology could help surgeons everywhere, create
workable soluti ons to complex surgical problems. A 3 - D printed model of a
patient’s organ offering surgeons a visual tool to help tackle complex surgical

dilemmas , leading to better surgical outcomes for high risk patients , now that’s a
bright idea.
(Music)
Margaret F linter: This is Conversations on Health Care. I am Margaret Flinter.
Mark Masselli: And I am Mark Masselli, peace and health.
Conversations on Health Care, broadcast from the campus of WESU at
Wesleyan University, streaming live at www.wesufm.org and brought to you by
the Community Health Center.