POLITICS: But Will Voters Still Love Health Policy Reform in the Morning?

We hear lots of talk about health care reform and the presidential campaign, and certainly it registers in the polls. But is it resonating enough to make a difference in November—and will the next president, whoever that is, put the issue front and center if voters don't demand it?

As John Whitesides of Reuters wrote the other day:

"The sharply contrasting health care visions of Republican John McCain and his Democratic presidential rivals offer the promise of a grand campaign debate—if the candidates find room on a crowded agenda.

While health care reform ranks as the second-biggest domestic issue after the economy in most national opinion polls, it will compete with the Iraq war, taxes, high gas prices, and other topics for a prime-time spot in the campaign."

The history of public opinion and health care reform is worth recalling. It's only a slight oversimplification to say that "the public" identifies problems in the health system and demands change in the abstract. But then after hearing politicians argue about reform proposals for months, and being bombarded with critiques from interest groups, the public can end up quite change-averse. That support for abstract ideas about change becomes fear or opposition to concrete proposals. And the public tends to worry more about what health insurance means to them—can they afford it, can they count on it—than what it means to society as a whole and the uninsured. As Mollyann Brodie, the Kaiser Family Foundation's public opinion expert, told a gathering of health policy veterans recently (a few slides from her presentation below):

• Goals are easy to agree upon
• Solutions are hard
• Change is scary

Health care is further complicated because people hold rather contradictory views—they don't trust government meddling in their heath care, but they want government to fix it. With a free lunch on the side. As Larry Jacobsen, a political scientist who studies health politics at the University of Minnesota and its Humphrey Institute of Public Affairs wrote recently in the New England Journal of Medicine:

"Health care reform efforts have been undermined not only by Americans' ambivalence toward government but also by the split between public dissatisfaction with the overall system's performance and patients' satisfaction with personal health care. Whereas more than 70% of Americans are quite negative about the country's coverage and costs, less than 40% are disappointed with their own circumstances. A mere 15% complain about the quality of care they receive."

 

 

 

 

 

 

 

 

All this suggests that public is more likely to follow if leaders have some kind of consensus among themselves on where to lead. Heated, divisive, partisan debates about complex topics tend to push voters back into a cocoon of the status quo. Only the status quo doesn't really exist anymore. Our system is hurt, and inaction will only make it worse.

Of course heated presidential campaigns aren't the best venue for working out consensus on complex social and economic policy. But on the morning after November 4th, we'd like to see the next president, whover that may be, articulating a vision and starting to build the coalitions that will give Americans the health care they need and deserve.