Too complex, costly to be top priority for candidates, voters

Concern is growing, but fresh ideas about what to do are in short supply

Issue: Health Care

October 15, 2006|By M. William Salganik | M. William Salganik,sun staff

Some political issues - immigration, crime, gas prices - can heat up rapidly, rising to the top of lists of voter concerns, and cool down just as quickly.

Health, however, often seems stuck at lukewarm.

It is an issue that almost always gets mentioned in campaigns, but often not in detail. It is always somewhere on the list of serious voter concerns, but is almost never at the top.

In Maryland this year, major candidates have issued proposals and position papers on health, but the issue hasn't been a major feature of most campaign ads.

The problem is: Health care - and paying for it - is a large and growing concern for most Americans, including many in Maryland, but neither politicians nor voters have many fresh ideas on what to do about it.

Since the year 2000, the number of uninsured in the country has increased from 39.8 million to 46.6 million, according to the latest estimates from Census Bureau surveys. In Maryland, the number without health coverage has gone from 547,000 to 788,000.

And over that time, health insurance premiums have jumped in cost by 87 percent, according to an employer survey by the Kaiser Family Foundation. A typical family policy this year, the Kaiser study found, costs $11,480 annually.

"There is a great disconnect," said Drew E. Altman, president and CEO of the Kaiser foundation. "Health care is a top personal and family economic issue, but it's not breaking through as an election issue."

His comment is supported by Kaiser polling. In an August survey, 46 percent of respondents to a survey about personal concerns said they were "very worried" about health costs - tied for the top on a list of potential personal worries with income not keeping up with prices in general. That was well ahead of the proportion very worried about not being able to meet mortgage payments (22 percent), about being the victim of a terrorist attack (21 percent) or a violent crime (16 percent) or about losing savings in the stock market (15 percent).

But a Kaiser poll in May and June found health care overall ranking behind Iraq, the performance of the president, gas prices, terrorism and the economy as "the single more important" election issue.

"Events drive the agendas, and people can only worry about a small number of issues in a campaign," said Robert Blendon, professor of health policy and management at Harvard School of Public Health, who has done issues polling in every national election since 1988.

As events change, issues can rise or fall rapidly on the priority scale. "Gas prices are no longer in the top five," Blendon said. "A few weeks ago, I had that on my bar chart way above health care."

Health only made it into the top tier of issues in 1992, Blendon said, when "suddenly, across the country, candidates were running against HMOs."

Generally, however, health concerns rank somewhere between fifth and eighth, he said - and consistently higher on the list of concerns for Democratic voters than Republicans.

That doesn't mean candidates don't talk about health.

At some level, "Health is an issue ... because there's a feeling it ought to be an issue," said Thomas Firey, a senior fellow at the Maryland Public Policy Institute, a group which supports free-market solutions. When it is mentioned in campaigns out of a vague sense of obligation, he said, "health gets a lot of lip service if nothing else."

Part of the reason is that it can be hard to talk about complicated health issues in a campaign dialogue conducted through sound bites, short commercials and lawn signs. Dr. Peter Beilenson, the former Baltimore city health commissioner who ran unsuccessfully for the Democratic nomination for the 3rd District congressional seat, said he tried to explain health proposals in detail, but "the easy thing is to take the bumper-sticker approach because that's all you have time for in a 30-second spot."

"The less you say about how you're going to solve the problems," Blendon said, "the more people are with you."

The problem isn't only complexity, said Altman. Real solutions require sacrifices of some kind - higher taxes to pay for covering the uninsured, for example.

"The moment you have a plan, you put a big target on your back," said Altman, who has served as a health official in a Republican administration in New Jersey and a Democratic federal one. "Every plan has three or four fatal flaws, or gores somebody's ox.

"There's no simple or painless health reform plan."

Sometimes, Blendon said, politicians avoid controversial health positions, falling back on "stuff that gets you unanimous support: medical research, preparing for avian flu."

Gerard F. Anderson, a professor of health policy and management at the Johns Hopkins School of Public Health, suggested that health may be muted in a campaign because the problems are so difficult to solve.

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