Poor Federal Reserve. As a Gallup poll showed last week, it would lose a popularity contest to the IRS. That's too bad, especially considering that many economists I read credit the Federal Reserve's historically easy money for saving the economy, or at least keeping New York's Financial District from committing mass hari kari. But, of course, the economy still stinks, and when Americans are asked to rate the institution behind the stinky economy, they're going to focus on that stinkiness. So no surprise there. But I do think this poll offers an important lesson -- for health care.
Huh? Hear me out.
Take a look at the agencies rated in the Gallup poll.
It seems to me that the agencies are mostly ranked in the opposite of their visibility. That is, the most popular agencies are the ones Americans interact with the least, and the most unpopular are the ones we feel the closest connection to. Except for the CDC (which I suppose gets high marks because cable news convinced everybody that swine flu would be an eleventh plague), the top ranked agencies are the ones you would never hear unless they made news: a spaceship exploding; an international spy crisis; a terrorist attack and so on. But Americans hate the IRS because we pay taxes every year. And Americans hate the Fed now because its name appeared in headlines that mentioned bank bailouts and a bad economy. The upshot is: If you want your agency to get high marks, stay the heck out of Americans' news and lives.
What in the world does that have to do with health care? One of the
hallmarks of Obama's vision for health care reform is to empower an
independent council of health care advisers. Many writers have compared
this to a Federal Reserve or Supreme Court for health care. But if the
stay-the-heck-out-of-our-lives theory applies to this independent agency
as well, that's not very good news for Obama, because this health care
council would be impacting people's lives on daily basis. For example,
if the council advised doctors not to use certain gratuitous
treatments to save money, some patients could scream to a pollster (or
representative) about unfair rationing. The same way that Americans
draw a line from the bad economy straight to the Federal Reserve, they
would likely attach problems with their health care to the independent
health care council, which would, inevitably, make it susceptible to
political pressures. That's not to say that a independent health care council wouldn't save any money. It's to say that an independent agency designed to ruthlessly cut fat from our health care system could wallow in IRS-type unpopularity.