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Fever Induces a Molecular Homing Response in Immune Cells During Infection.

universal coverage works are in the weeds compared with their primary concern— certain and affordable care. Polls show virtually every solution put in front of people that increases health care security and affordability are winners and everything that causes them to lose that or makes them more insecure to be losers. The health care skies are gray for the US public right now, with Republicans suing to declare the entire ACA unconstitutional. The trap for Democrats is an extended argument over whether they prefer the sky to be royal blue or powder blue. Politicians not listening well is not a function of too few political polls. Politicians can often point to polls proclaiming that the public favors one certain policy proposal or another. But politicians and the public should be wary of polls taken to demonstrate support for their views. Instead, they should listen to the trade-offs people are willing to make and how they talk to each other around the kitchen table. So what are people saying? One experiment shows how more than 200 people recently responded in their own words to a question on social media about what they believed were the health care concerns most common among their friends and families. The aim was not to be scientific but quite the opposite—to try to tap into the kinds of conversations people have when talking to each other around the kitchen table or in coffee shops. About 70% of people expressed concerns about affordability and health insurance coverage. Prescription drugs topped the list of cost concerns. Cost sharing and deductibles were also frequently mentioned, and when combined with insurance premiums, insurance costs rank even higher than prescription drugs. One may be tempted to conclude this means that people are most concerned with the cost of all health care, but to the public, it shows up as flaws in insurance. Specific cost concerns were diverse and followed people’s own specific personal experience, reflecting the breath and size of health care. About 13% of people who mentioned cost identified the affordability of dental care. Others mention long-term care, ambulance rides, emergency department bills, or hospital stays. When listening to people, one should avoid the temptation of simply clustering their responses and instead pay attention to how specific and idiosyncratic people’s concerns are. Health care often represents the greatest financial uncertainty and stress people face and they expect solutions to help them. The lesson is an important one for politicians to digest. If a politician says they’re tackling the cost of prescription drugs, people won’t believe it until the cost of their own insulin is affordable. Because people’s concerns are so fundamental and acute, they cross over party identity more than is often recognized. Nine out of 10 Republicans and Democrats believe surprise medical bills should be a top priority of their state legislature. Likewise, 9 out of 10 in both parties say the same for prescription drug costs. Pain and uncertainty trumps party identity. Obviously much more needs to be learned. Policy makers would be smart to elevate the voice of patients and reduce the influence of lobbyists and other lessrepresentative voices. The path the Republicans in Washington chose these last few years—drafting proposals behind closed doors, avoiding hearings, and limiting town halls—isn’t the right one. There are many choices to make to get health reform right. The best, most durable answers are going to come from an engaged public and paying attention to what problems we can solve.