In a recent Washington Post story about food labeling, Sarah Kliff quotes Nigon:



I did find one customer who had noticed the calorie labels: Dick Nigon of Sterling, Va. He and his wife, Lea, had stopped by McDonald’s after seeing an exhibit at the Renwick Gallery. Dick had ordered for the couple, noticed the calorie labels and liked them. “I like that you have the information before you order,” he told me, when I asked about the labels. “It’s better than some kind of government health mandate in Obamacare.” I told him that the calorie labels were, in fact, a government health mandate in Obamacare. “Well that changes things a bit,” he responded. “I thought this was more of a voluntary sort of thing. Now I’m not quite sure how I feel about it.”

As one of my favorite bloggers succinctly summed up: "What’s dumber: the notion that McDonald’s would voluntarily tell customers the calorie count of their greasy-ass food, or the way that the mere mention of Obama' changes his mind?"

Now imagine sound of health policy teacher banging her head against the wall....

~*~

Thanks, all, for all of the comments - my head doesn't hurt from the wall-pounding. And thanks, especialy, to theotherside for your thoughtful comment and questions. I think that the answers to your question are fairly complex, especially if we set aside the libertarian "you can't make me" knee-jerk response to mandates. I'll try to answer succinctly, but forgive me if I start to geek out:

ADDENDUM:

Generally, when think about health care quality, we think of three factors: Access, Quality, and Cost. We know we rank poorly compared to other countries on both access and cost because: A) 28.4% of Americans 25-64 have no insurance (this is the most useful statistic because, after preliminary ACA implementation, young adults under 25 can remain insured on their parents' plans, and all adults 65 and over are eligible for Medicare); B) the complexity built in to our multiple insurance company system means that we pay approximately $68,000 per physician in overhead (and this does NOT include the overhead charged by insurance companies, which is now capped under ACA); C) we are chronically over-tested and over-treated, especially in the last six months of life.

And this is where the rubber meets the road on quality measures. On one hand (and I oversimplify), there are those who argue that broadening access, especially to preventive care equals quality. There is some evidentiary support for this claim. For example, according to the most recent Commonwealth Fund data, the US ranks highest among Western industrialized nations in mortality amenable to healthcare (preventable deaths), a problem caused primarily by a lack of early intervention for those who lack access to primary care and screning. However, others think that quality equals being able to treat any illness at any age, regardless of risks or co-morbidities.

To give an example of this latter conundrum, countries with Universal Coverage tend to view health care as a limited resource and therefore use evidence-based guidelines to assist in governing care decisions. So, for example, "frailty scales" are used to estimate the likelihood of successful surgery in the oldest old. An eighty-five year old with robust health may come through joint replacement surgery very well, while an eighty year old with numerous other ailments may have a successful joint replacement but never recover from the surgical assault on the body or the effects of anesthesia. In some countries, like the UK, this kind of "comparative effectiveness" assessment is used to allocate care. Not in the US. If the patient wants the procedure and has coverage, they will get the procedure, even if the physician knows that the likelihood of post-surgical dementia, disability, and institutionalization are high. And yes, using instruments like frailty scales is a form of rationing.

Currently we ration health care based on ability to pay. If we were to implement comparative effectiveness guidelines in order to expand access and make healthcare affordable for all, we would ration based on the likelihood of treatment success. Of course, this kind of change would be implemented VERY slowly in the U.S. Still, using evidence to allocate health care resources is a radical change in the zeitgeist of a free-market health care economy, and would likely be a tough pill to swallow. And is, I think, the true dividing line between those who oppose reform and those who support it.