By Evan Falchuk

As I’ve blogged about before (here, here, here and here), a big reason reform is going so badly is this:  Reformers don’t understand how people react when you try to make changes to their health benefits.

Companies across America have been making changes to health benefits for years.

Reformers seem to have ignored the lessons of their experience.

Take one of the hottest trends in benefits – evidence-based plan design.

These are plans that offer better coverage if care is done based on evidence-based guidelines.  It’s similar to the “comparative effectiveness” ideas that are so important to some of the reform proposals.

The National Business Group on Health published a study of challenges companies face implementing these plans.   The study tried to understand how employees feel about these kinds of changes to their benefits.

Here are three of the major findings.

1.  Most employees believe that more care is better care. Employees tend to view the idea that sometimes less care is the right care as “both unfamiliar and counter-intuitive.”  Quality care is viewed as “trying as many things as possible, including new or alternative treatments.”  In other words, you get what you pay for, and efforts to pay less are interpreted as efforts to give less.

2.  Employees are suspicious of their employer’s motives. Employees tend to assume that their employer just wants to save money, and doesn’t really care about the quality of care they get.  They suspect that moving to an evidence-based plan design is really just the first step toward more severe restrictions on choice and access.

3.  Employees worry that employers are overstepping their bounds. Employees report worries that their employer wants to influence treatment decisions. They feel strongly that those decisions should be made by them and their doctor.

Reformers made a big mistake by focusing so intently on health care cost savings as the “single most important fiscal issue we face as a country.” It’s almost as if they decided to pick a way to promote reform that would create the most resistance.

Spend less on health care?  That was almost certain to be understood as meaning you want to deny me or my loved ones the care we deserve.  A panel of government experts deciding what treatments are effective?  Who are they to tell me and my doctor what’s right? And don’t you dare tell me the reason you want to do all this is to make sure I get the best care.

Reformers have stumbled into a trap of their own making.  Based on the continuing effort to demonize those who raise objections, they still don’t see it.

This is why reform is going so badly.