PUBLIC OPINION ON HEALTH CARE IS NOT AFFECTING CHANGE, ACCORDING TO JACOBS
 U.S. health care reform has not advanced on the political agenda since the 1992 presidential election, and presidential candidates will face a similar electorate in 2008, according to Professor Larry Jacobs, director of the Center for the Study of Politics and Governance. In new research published in the May 1, 2008, issue of the New England Journal of Medicine, Jacobs argues that presidential candidates must understand the complexities of public opinion on health care if they expect to woo voters. At the end of the 1992 primary season, as now, Americans ranked health care among the four most important problems facing the country, making public opinion on this issue as critical as ever.
“The current moment in U.S. health care reform is eerily reminiscent of the lead-up to the 1992 election. Then, as now, the country was facing an economic downturn and had been engaged in a war in the Middle East that threatened to distract attention from domestic matters,” said Jacobs. “But there also was unusually broad agreement among Americans and the presidential candidates that our health care system needed reform—a negative consensus that still holds today.”
Though 90 percent of Americans (polled between 1991 and 2007) consistently agree that the U.S. health system needs reform, there is no convergence on reform proposals. Adding to the confusion, surveys have found that when given a choice between a new government-run system and the current, mostly privately managed health care system, respondents have chosen to keep what they have. Even supporters of reform were swayed when presented with possible downsides of a new system—greater cost sharing, limited choice, and increased waiting times.
“There are no easy answers that address what Americans want in theory and what Americans will accept in practice. Discussion of the public’s attitudes toward health care reform too often misses these contradictory strains,” said Jacobs. “An accurate assessment requires recognition of Americans’ multiple and competing considerations, which will affect the debate over the government’s role in health care during the presidential campaign.”
So what are we to do? Jacobs finds that without dramatic change in public sentiment, Democrats and Republicans face daunting obstacles in rallying broad support for particular reforms. Yet, public opinion may be overruled by visionary leadership.
“Although public opinion influences legislators’ agendas, legislators themselves still must choose to overcome differences and work together on this issue,” said Jacobs. “Broad agreement on a reform proposal—and on the details—is critical among policymakers. It is worth remembering that Medicare was passed in 1965 with only 46% of the public’s support.”
The full article, “1994 All Over Again? Public Opinion and Health Care,” may be found in the May 1, 2008, issue of the New England Journal of Medicine, a weekly general medical journal that publishes new medical research findings, review articles, and editorial opinion on a wide variety of topics of importance to biomedical science and clinical practice.
April 30, 2008 |
