Trust in Science Now Deeply Polarized

The Associated Press is reporting that Republicans' faith in science is falling as Democrats rely on it even more, with a trust gap in science and medicine widening substantially during the COVID-19 pandemic, new survey data shows (Figure 1) (1).

Figure 1. Percentage of adults who say they have a great deal of confidence in the scientific community.

Overall, 48% of Americans say they have "a great deal" of confidence in the scientific community, the 2021 General Social Survey data shows. Sixty-four percent of Democrats say that, compared with roughly half as many Republicans, 34%. The gap was much smaller in 2018, when 51% of Democrats and 42% of Republicans had high confidence.

It's the largest gap in nearly five decades of polling by the General Social Survey, a widely respected trend survey conducted by NORC at the University of Chicago that has been measuring confidence in institutions since 1972. The most recent survey was conducted Dec. 1, 2020, through May 3, 2021, and includes interviews with 4,032 American adults. Results for the full sample have a margin of error of plus or minus 2 percentage points.

That is unsurprising to more than a dozen scientists reached for comment by The Associated Press, but it concerns many of them. "We are living at a time when people would rather put urine or cleaning chemicals in their body than scientifically vetted vaccines," University of Georgia meteorology professor Marshall Shepherd told the AP in an email. "That is a clear convergence of fear, lack of critical thinking, confirmation bias and political tribalism."

Science used to be something all Americans would get behind, Rice University historian Douglas Brinkley said. "But we now see it falling prey to the great partisan divide," he said. "The world of science should be a meeting house where right and left can agree on data. Instead, it's becoming a sharp razor's edge of conflict."

The deepening polarization was not evident for other institutions asked about on the poll, according to Jennifer Benz, deputy director of The Associated Press-NORC Center for Public Affairs Research. "It's certainly plausible that this is a result of how politicized the pandemic became in the months between when it emerged and when the survey ran," Benz said. "It is definitely a stark change for these particular trends on confidence in scientific leaders and leaders in medicine, to see this degree of polarization."

Kelvin Droegemeier, former science adviser to President Donald Trump, said he thinks the pandemic increased the general public's insight into how scientific research works but the ever-evolving science probably seemed chaotic at times and the urgency of the pandemic complicated policymaking. "We hear 'follow the science,' but which results? The challenge lies in how to best use the scientific results, recognizing that what appears to be an 'answer' one day may be overturned, wholly or partly, another day," Droegemeier told the AP in an email.

That messiness, sometimes weak communication and political philosophies play into the trust gap, said Marcia McNutt, president of the National Academy of Sciences, which was set up by President Abraham Lincoln to offer the federal government expert advice. Scientists and policy makers tend to be conservative — not politically but in terms of being cautious and wary of risk — pushing safety, masks and vaccines while "Republicans as a group value individual liberty," McNutt said.

John Holdren, who was President Barack Obama's science adviser, said he blames GOP leaders' "nonstop denial and deception." The consequence of declining trust in the scientific community among Republicans is clear: AP-NORC polling shows Republicans continue to be less likely than Democrats to be vaccinated. Sudip Parikh, chief executive officer of the American Association for the Advancement of Science, the world's largest general science organization, said it's clear that science has become a wedge issue for many politicians. Some have tied themselves to it, he said, and others have seen value in shooting at it "because it helps them politically."

Parikh said he found it ironic that much of the distrust in science is spread by technology — social media, smartphones — that only exists because of scientific advances. Astrophysicist Neil deGrasse Tyson agreed: "The struggle continues, trying to get the general public to embrace all of the science the way they unwittingly embrace the science in their smartphones."

At the SWJPCCS we look at these numbers as disturbing. Rather than mistrust one wonders if political expediency might be a better term. Unfortunately, it has cost many, predominately Republicans, their lives (2). Faith in a demagogue can be potentially fatal.

Richard A. Robbins, MD

Editor, SWJPCCS

References

1. Borenstein S, Fingerhut H. Americans' Trust in Science Now Deeply Polarized, Poll Shows. Associated Press. January 26, 2022. Available at: https://www.usnews.com/news/politics/articles/2022-01-26/americans-trust-in-science-now-deeply-polarized-poll-shows (accessed 1/26/22).
2. Leonhardt D. Omicron Threatens Red America. NY Times. December 17,2021. Available at: https://www.nytimes.com/2021/12/17/briefing/omicron-spread-red-america.html (accessed 1/26/22).

Cite as: Robbins RA. Trust in Science Now Deeply Polarized. Southwest J Pulm Crit Care Sleep. 2022;24:8-9. doi: https://doi.org/10.13175/swjpccs005-22 PDF

MedPAC Votes to Scrap MIPS

The Medicare Payment Advisory Commission (MedPAC) voted 14 to 2 on January 11^th in favor of telling Congress to do away with Merit-based Incentive Payment System (MIPS) (1). Instead they favor moving to what the panel termed a voluntary value program (2). Lawmakers mandated MIPS as part of the bipartisan 2015 Medicare Access and CHIP Reauthorization Act (MACRA) ending the sustainable growth rate formula that had repeatedly threatened to cause deep cuts in Medicare payments to doctors.

On a slide presentation before the vote, the MedPAC staff said MIPS cannot succeed. The cited the following reasons for MIPS’ probable failure (3):

• Replicates flaws of prior value-based purchasing programs
• Burdensome and complex
• Much of the reported information is not meaningful
• Scores not comparable across clinicians
• MIPS payment adjustments will be minimal in the first two years, large and arbitrary in later years
• MIPS will not succeed in helping beneficiaries choose clinicians, helping clinicians change practice patters to improve value, or helping the Medicare program to reward clinicians based on value

Supporters of the MedPAC approach argued for fast action. It will be difficult to dismantle MIPS if it becomes entrenched, said MedPAC panelist Rita Redberg MD (1).

One of the four physician members of the committee, Alice Coombs MD, an anesthesiologist and critical care specialist, dissented. "We have not seen one specialty physician group yet say, 'You know what, I like getting rid of MIPS and I like this [Voluntary Value Program], let's go with it.' " The American Medical Association (AMA) protested the MedPAC vote arguing to keep MIPS in place (1). "Where we are is that we'd like to fix it rather than kill it," Sharon McIlrath, assistant director of federal affairs at the AMA, told the MedPAC panelists during the public comment period. The AMA separately issued a statement from its president, David O. Barbe MD (1). "The best remedy is to fix MIPS rather than jumping into another sweeping change that has not been fleshed out and would have many of the same methodological issues as MIPS," Barbe said.

It's unclear how Congress and CMS will greet the MedPAC recommendation on MIPS. Congress in recent months has struggled with healthcare legislation, for example, reauthorization of the Children's Health Insurance Program. Routine appropriations have not yet been completed for fiscal 2018, The AMA's McIlrath told MedPAC that it doesn't appear "politically viable to think that you are going to go up there and think that you are going to get the Hill to kill MIPS (1)."

Richard A. Robbins, MD

Editor, SWJPCC

References

1. Young KD. MedPAC backs bid to scrap MIPS Medicare pay system amid dissent. Medscape. January 11, 2018. Available at: https://www.medscape.com/viewarticle/891240 (accessed 1/13/18).
2. Robbins RA. CMS announces new payment model. Southwest J Pulm Crit Care. 2018;16(1):29-30. Available at: http://www.swjpcc.com/news/2018/1/11/cms-announces-new-payment-model.html (accessed 1/13/18).
3. Bloniarz K, Winter A, Glass D. Assessing payment adequacy and updating payments. Available at: http://www.medpac.gov/docs/default-source/default-document-library/jan-2018-phys-mips-public.pdf?sfvrsn=0 (accessed 1/13/18).

Cite as: Robbins RA. MedPAC votes to scrap MIPS. Southwest J Pulm Crit Care. 2018;16(1):42-3. doi: https://doi.org/10.13175/swjpcc010-18 PDF 

Senate Health Bill Lacks 50 Votes Needed to Proceed

Yesterday (7/17), two additional Senators – Sen. Roberts (R-KS) and Sen. Lee (R-NE) joined Senators Paul (R-KY) and Collins (R-ME) in announcing their intention to vote “no” on the motion to proceed on considering the Senate ACA repeal and replace legislation – effectively blocking Senate consideration of the current Senate Republican health care bill. Senators Paul, Lee and Roberts opposed the bill for not going far enough, while Senator Collins expressed her concern the bill goes too far.

With the 4 publicly announced NO votes – Senator Majority Leader Mitch McConnell does not have the 50 votes needed to begin debate on the bill, let alone assure final passage.

Speculation now turns to what happens next. President Trump has tweeted his preference to let Obamacare fail as a way to force Democrats to negotiate new legislation. Senator McConnell has suggested a series of symbolic votes on full repeal with multi-year delay to work on a replacement plan or voting on the House passed bill. However, three moderate senators, Capito (R-WV), Collins (R-ME) and Murkowski (R-AK), announced today they will not support procedural votes on an immediate ACA repeal bill.  Alternatively, Congress may abandon the health reform effort for the time being and pivot to other legislative priorities (tax reform and infrastructure). The failure of McConnell to lead the Senate effort may clear the way for a bipartisan effort to address the shortfalls of the ACA.

Please keep in mind the House repeal and replace effort “died” before the House ultimately passed its repeal legislation, so while the Senate effort looks to be “permanently stalled” it is probably premature to call it “dead.”

Nuala S. Moore

American Thoracic Society

Washington, DC USA

Cite as: Moore NS. Senate health bill lacks 50 votes needed to proceed. Southwest J Pulm Crit Care. 2017;15(1):45. doi: https://doi.org/10.13175/swjpcc093-17 PDF 

Clinton's and Trump's Positions on Major Healthcare Issues

As the presidential election nears, the positions of the two major candidates on healthcare have received more attention. Both Clinton and Trump have their healthcare positions listed on their websites (1,2). Below is a table listing their positions from their websites and occasionally other sources followed by a brief discussion of each of the issues. 

Table 1. Presidential candidate positions on healthcare issues. A questions mark denotes an unclear position.

Affordable Care Act (ACA, Obamacare)

This is a major difference between Clinton and Trump. Clinton favors its retention (1). Trump favors its repeal (2).

Access to reproductive health

Clinton supports reproductive preventive care, affordable contraception, and safe and legal abortion (1). Trump's position is unclear. He currently is pro-life but would not use Federal funds for abortion (2). Federal funding for abortions us is prohibited by law (3).

Allow importing drugs to reduce costs

Both candidates favor importation of prescription drugs to reduce prices (1,2).

Block-grant Medicaid to the states

Trump block-grants asserting that "the state governments know their people best and can manage the administration of Medicaid far better without federal overhead" (2). This idea is not new with Congressional Republicans pushing for block-granting Medicaid at least since the 1990s (4) Clinton's position is unclear (1).

Coverage of poor

Both candidates favor universal healthcare including the poor (1,2).

Healthcare for illegal immigrants

Clinton favors extending healthcare to families regardless of immigration status by allowing families to buy health insurance on the health exchanges (1). Trump's website notes that providing healthcare to illegal immigrants costs us some $11 billion annually and he favors strict enforcement of the current immigration laws (2).

Healthcare savings accounts

Trump favors savings accounts which are permitted under the ACA but with restrictions (2,5). Clinton's position is unclear.

Increase access to healthcare

Both candidates favor increased access to healthcare (1,2).

Increase income tax deductions for healthcare costs

Both candidates favor increasing income tax deductions for healthcare costs but their plans are different (1,2). Trump favors full deduction of health insurance premium payments from tax returns. Clinton favors a refundable tax credit of up to $5,000 per family for excessive out-of-pocket costs.

Price transparency

Both candidates favor increased healthcare price transparency (1,2).

Public option

Clinton favors a public option (1). Trump's position is unclear.

Reduce copays and deductibles

Clinton favors reducing copays and deductibles (1). Trump's position is unclear.

Sell insurance across state lines

Trump favors insurance companies selling healthcare insurance across state lines (2). This has been a part of the platform of every Republican presidential nominee and is permitted in 5 states but insurance companies have been reluctant to sell these policies (6). Clinton's position is unclear.

References

1. Hillary Clinton for America. Available at: https://www.hillaryclinton.com/issues/health-care/ (accessed 9/6/16).
2. Donald J. Trump for President. Available at: https://www.donaldjtrump.com/positions/healthcare-reform (accessed 9/6/16).
3. Salganicoff A, Beamesderfer A, Kurani N, Sobel L. Coverage for abortion services and the ACA. Kaiser Family Foundation. September 19, 2014. Available at: http://kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-and-the-aca/ (accessed 9/6/16).
4. Dickson V. GOP's Medicaid block-grant plan won't happen while Obama's in office. Medscape. March 19, 2015. Available at: http://www.modernhealthcare.com/article/20150319/NEWS/150319877 (accessed 9/6/16).
5. Norris L. Under the ACA, can I still have an individual HDHP and an HSA? Healthinsurance.org. May 16, 2016. Available at: https://www.healthinsurance.org/faqs/i-have-an-individual-hdhp-and-an-hsa-will-i-still-be-able-to-have-them-under-the-aca/ (accessed 9/6/16).
6. Cauchi R. Out-of-state health insurance - allowing purchases (state implementation report). National Conference of State Legislators. December, 2015. Available at: http://www.ncsl.org/research/health/out-of-state-health-insurance-purchases.aspx (accessed 9/6/16).

Cite as: Robbins RA. Clinton's and Trump's positions on major healthcare issues. Southwst J Pulm Crit Care. 2016;13(3):126-8. doi: http://dx.doi.org/10.13175/swjpcc091-16 PDF