Iowa Day 1 -- Tornado Evacuation

Last night was a first. About half way through the first group sirens started blaring, windows were rattling, and the building shook – Tornado. I had no idea what was going on and just kept plugging along until one of the supervisors at the facility told us we would have to evacuate to a secure room. About half an hour passed, the storm blew over, and we resumed.

As has been the case in all of the sessions so far the biggest concern was cost. Quite a few of our respondents were self insured, many with catastrophic policies, and for them they pay out-of-pocket for all of their routine medical care. One respondent had brain surgery a few years ago – his policy costs him $30,000 a year with a 20% co-pay and $1-million cap – his initial surgery cost $75,000. We were surprised by the number of employed without health insurance. In several cases their employer offered a group plan, but did not contribute, the entire cost of insurance came out of the employees pay check -- $800 to $1,000/month.

Another finding that differed from the other markets was the number of respondents that got their primary care through physician assistants. They were all very pleased at the level of care they provided, and the amount of time that was spent in understanding their individual health concerns. They saw this in stark contrast to the treatment they had experienced from physicians that would spend at most 15-minutes with them. The physician assistants would ask question, let them ask questions, spend a great deal of time going over treatment options, even breaking out the books to show them exactly what they were talking about.

Drug advertising took a beating – “Drug advertising makes us think that taking a pill will cure everything.” They wondered if drug advertisings only purpose was to drive demand and increase sales. An example they came back to regularly was the new drug for restless leg syndrome – “what is this”, “never herd of this condition”, “sometimes my leg falls asleep do I need a drug?” They saw little good in advertising, though one respondent thought that it might provide information that he then could discuss with his doctor. Do they support the idea of regulating or banning ads – yes and no – some support an outright ban others do not.

Forget about it as a right, Iowans saw health care as an essential service such as the fire dept. – something everyone contributes to so it is there when needed. They think they can expect little support from Washington -- “Politicians know that Americans are complacent we just like to complain” – as a result they feel there is nothing to persuade politicians to take a stand against the special interest.

They firmly believed that there is enough money in the current health care system to fix the problem but cost and allocation of resources have to be addressed. They see a two tiered system, one in which the governments primary role is the control of prices for products and services and insuring that all have access to the system, they also feel their could be a private element – but the biggest issue they want addressed is cost.