The Stanford Center on Longevity’s Politics, Scholars and the Public program brings together political experts, academic scholars and members of the voting public to find workable solutions to societal challenges. Health Security Project: Building Sensible Health Care Solutions was the Center’s inaugural project. The project was made possible with the generous support of the Stephen Bechtel Fund.

Building Sensible Health Care Solutions focused on health care, an issue that touches every American at every stage of life. The results supplemented the national conversation on health care with information and ideas that were fact-based, politically viable and publicly supported.

The Center on Longevity assembled an unprecedented group of experts representing the views of academia, politics and the public.

• In academics: noted scholars, both conservative and liberal, representing economics, psychology and political science from Stanford and other top institutions around the nation.
• In politics: bipartisan experts whose backgrounds include presidential campaigns and health care policy development.
• In the public: elite bipartisan professionals in public opinion polling and interpreting.

List of expert participants 

The project, conducted over an 18-month period, included:

• A series of face-to-face intensive dialogue sessions among Stanford professors and political, policy and polling experts on the Stanford campus were held to better define the challenges in the health care system, understand areas of disagreement and weed out ineffective or unviable options.
• Ongoing dialogue among the academic and political experts was facilitated to establish potential policy options aimed at the two areas identified for focus: access and cost.
• Contributors developed a framework for dialogue with the public that emphasizes transparency about the trade-offs involved with each of the policy options.
• Feedback from Washington-based policy and political experts was solicited through discussion sessions and written comment.
• Discussion groups were held with voters in key states, as well as individuals who deal with health insurance issues on a daily basis, either in the context of small business or as human resource managers. The groups were conducted utilizing the Interactive Dialogue Systems, which provides more data than typical groups because participants are able to respond to all questions simultaneously using laptops.
• Online quantitative surveys informed by the discussion groups were conducted to get a nationwide sampling of feedback on the proposed policy solutions.
• A web-based, interactive program was developed to allow various constituencies and public service groups to participate and provide feedback on alternative health care reform proposals.

Building Sensible Health Care Solutions accomplished the following:
The Center convened a group of academic, policy and political experts who were able to identify key factors in effective health care reform and the tradeoffs involved in adopting each one. Although these experts differed on preferred solutions, they largely agreed about the tradeoffs associated with particular reforms. These reforms along with their associated tradeoffs were put to three focus groups of business leaders, voters in Denver and Cleveland, and policy experts in Washington, DC. The focus group discussion honed the options and helped to develop them further.

In summary, the options presented were:

Options to contain costs:
• Change incentives for doctors and hospitals
• Change incentives for patients
• Develop an independent health board for cost/benefit information

Options to Expand Access:
• Expand existing governmental programs
• Provide national insurance with required participation
• Provide universal health vouchers

The Center also launched a web-based quantitative instrument in March 2009 to test these solutions among a large representative sample of 2,000 voters. This survey, developed and overseen by Hart Research Associates and VJ Breglio and Associates revealed that there had been little serious engagement with voters on health care reform issues.

Key results from the survey included:

• While voters rated health reform a very high priority, they did not form a consensus around any one of the six proposals. They expressed ambivalence as they weighed the tradeoffs involved in the implementation of each. Notably, none of the six proposals were clearly rejected outright either. Instead, the findings reflected voters’ willingness to engage in a serious and substantive way on the topic of health care reform and their need for more detailed information about the relative pros and cons of various reform proposals.
• The findings also revealed that voters’ reactions to various health care proposals are heavily tied to political party affiliation. In particular, Democrats showed a willingness to support proposals designed to expand access to health care. Republicans were insistent on keeping the government out of the health care system. Voters across the partisanship spectrum – Democrats, Republicans and Independents – shared strong concerns about health care costs.
• While 62 percent of voters stated that they feel the health care system works well for them, 68 percent believed it does not work well for most Americans.
• 58 percent of voters were not satisfied with cost and affordability of health care, but 50 percent were satisfied with quality reported to the participants.

In distributing results from the study in May 2009, the Center noted that proponents of health care reform would need to engage with the public in order to better understand the serious concerns with the political, psychological and economic issues involved in health care change.

Read full survey report

One of the major challenges in this project derived from the very mission of the Politics, Scholars and the Public program – how to bring bipartisan academic scholars and political experts together to craft viable solutions to practical problems. In this case the problem – health care reform – was particularly thorny. After working together extensively on a problem of common concern, these experts were able to come to consensus about the options that should be presented and tested with voters. Although the expert groups had strong differences of opinion and ideology, they were able to craft solutions to test with voters.

The voter results did not converge in a consensus on health care reforms. Despite expecting to see partisan divides between Republicans and Democrats, but the Center was struck by the degree to which the majority of the voters seemed to be communicating a bias for the status quo and a reluctance to embrace health care reform. The continuation of the Health Security program, which has received funding from the Stephen Bechtel Fund, will address this issue directly.