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HEALTH REFORM: Time For A Wake-Up Call



October 30th, 2006
 
by Drew E. Altman and Robert J. Blendon

As numerous pre-election polls have made very clear, except in a few selected races, health care is playing a relatively minor role in determining the outcome of the 2006 midterm election. As a result, elected officials will arrive back in Washington with little pressure from voters to change the current direction of the country’s health care system.

Why is this so? Surveys conducted every two months at the Kaiser Foundation consistently show that health care is a top personal and family economic worry. People worry more about the costs of their health insurance going up than paying the rent or mortgage or being the victim of a terrorist attack. Similarly, other polls [2-week free access] report high levels of dissatisfaction with the current health system and support for fundamental changes. But in this election cycle, other issues -– most notably Iraq -– are paramount, and voters are not taking their worries about health to the voting booth.

Difference Between Today And 1990s

This is one of the biggest differences between the current era and the early nineties, when health reform last had salience as a national issue. In the early nineties there was no war in Iraq, no 9/11, and no lingering memory of Hurricane Katrina to capture voters’ attention. But something else also happened in the early nineties that transformed the political landscape for health that is missing today: In his senate race in Pennsylvania, Harris Wofford demonstrated for the first time that a candidate for national office could tap into the public’s underlying concern about health insurance and health care costs to help win an election. President Clinton picked up on that, made health care a top priority, and with the First Lady put forward his ill-fated reform proposal. Media attention and a superheated national debate followed, and health reform captured center stage, demonstrating that the national agenda does not just bubble up from the bottom but is driven by political leaders and media coverage from the top.

In sharp contrast, today none of the politicians most often mentioned as candidates for the presidency in 2008 are talking much, if at all, about health reform, and there is no real national debate. One poll trend demonstrates the differences between the two eras vividly: In October 1993, 55 percent of the American people named health care as one of the two most important issues for government to address; that number fell to less than 10 percent in 2002, was 11 percent in November 2005, and is now consistently below 15 percent.

Surveys show that the underlying level of public concern about health care issues today and in the early nineties is about the same. It is the presence of other issues winning voters’ attention and the absence of leadership by political figures on the health issue that explain why health care reform has little real political appeal today. Imagine the debate on health care today, or where it would stand in the polls without 9/11 and Iraq, or if the would-be candidates for Congress and the presidency had been on TV debating changing our current system.

Health Reform Needs To Be A Central Issue In 2008

For health reform to again gain a foothold at the top of the national political and policy agenda, it needs to become a central issue in the 2008 election campaign, so that candidates who are elected to office and the new president feel that they were elected, at least in part, to address the nation’s big health care problems when they start work in 2009. This is by no means guaranteed, but there is a scenario under which it could happen. First, if we are fortunate enough to see external problems like Iraq stabilize or subside and no new big ones arise, health would have the opening it needs to compete for center stage as an election issue. Second, as Americans pay more and more each year out of their own pockets for health care, they will become increasingly concerned about health as a voting issue and policy priority.

But what health needs most to rise up in American politics is for national political candidates, whether from the political left, right, or center, to begin talking about the issue again as they did in the early nineties. Most important of all are the presidential candidates, who receive so much national media attention. If even one major candidate begins to seriously address health reform, the others will be forced to follow suit. The presidential candidates’ level of attention to health will be decisive to where health ranks on the national agenda going into the 2008 election and 2009 Congress. If they do play a leadership role on health, the media will follow, and the agenda-setting power of a debate driven from the top will meet the public’s concerns rising up from the bottom like two weather fronts colliding.

The candidates need not have a detailed plan for their opponents to pick apart. The details can come later when they seek agreement with Congress if they are elected. History will recall that Senator Wofford had no plan.

The Next Opportunity For Action

The next significant moment of opportunity for national legislative action on health reform will not come until 2009, but it will not come at all unless the issue rises between now and then. If it does, formidable obstacles will still remain, such as reaching agreement on a plan of action and on a way to pay for it. But unless politicians believe that they were elected to solve this problem, they are not likely to want to do the heavy lifting necessary to take on these tough issues.

Public concern about the state of health care today is not enough to move this issue forward by itself. We poll the public all the time, and we believe that it is unrealistic to expect public opinion, on its own, to reach some new tipping point that will create a tidal wave for health reform. For health to compete more effectively with other issues on the national agenda, it will take leadership in the form of visible political candidates willing to champion the issue, and the media attention that follows. Greater attention on the part of all interested in achieving change in American health care should be directed towards that goal, and towards developing policy proposals that can bridge the ideological divide and provide a basis for legislative action when health reform makes it back to the national agenda. Unless these things happen, we are unlikely to see major change in health care in the foreseeable future.

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4 Trackbacks for “HEALTH REFORM: Time For A Wake-Up Call”

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    March 30th, 2007 at 1:23 pm
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    March 23rd, 2007 at 6:38 pm
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    November 8th, 2006 at 10:28 am
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10 Responses to “HEALTH REFORM: Time For A Wake-Up Call”

  1. John Louky Says:

    So here we are in April of 2009 and we are still hoping for universal health care reform. One of many fears I have on this issue is the the health insurance giants will jump of the universal health care bandwagon as an opportunity to sell more insurance polices….keeping the entire for-profit system in tact…along with its massive inefficiencies. The American people have been subject to propaganda and simply cannot believe that the government can do a better job than the free market. The private health insurance system has been given every opportunity to succeed and get it right….50+ years and the percentage of people without coverage just keeps increasing.

    John
    appointment cards

  2. Johnathon Ross Says:

    A wise politician once said to me “If you build the parade, the politicians will run to the front of it”. A conservative politician with a good heart said to me of my passion to get everyone covered, “Please, make me do it.”
    Nothing good in American social policy ever moves through congress without the support of the religious congregations and the unions. They are active again. Almost always a broad grassroots movement needs to be created and the middle class has to have a dog in the fight. There often needs to be a neutrality or split in the opposition forces. Business oftenthe opponent of government action of any type is now open to more3 govenment action: witness the meeting of the Auto execs with Bush. It is to building these forces that anyone serious about health reform should turn their attention. They need to be in place first and then the politicians will run to head of the parade. Johnathon Ross MD MPH Toledo Ohio

  3. birenbaum Says:

    Health Care for Everyone: The Problem That Won’t Go Away

    By Arnold Birenbaum
    As we approach the midterm elections and there is a strong possibility that the House and Senate will be reseated in 2007, with the Democrats in the majority in both chambers, we can attribute the change in party preference in some battleground states and Congressional districts to the voting public’s recognition that a sectarian war in Iraq has been the unintended consequence of the American-led invasion and occupation of that sad country. Americans are also learning via government studies that this foreign adventure helped attract alienated and marginalized young men from Muslim countries or Muslims from western nationals ready for jihad. A war without end is unacceptable today and it eclipses all other issues. Even concern for terrorism has dropped well down on the list of priorities. Still around as a perennial second-place issue, going back to 1993, is health care. We need to do the right thing in Iraq and we need to do the right thing at home.

    For those of us who have been calling for universal health care insurance coverage for all Americans under a single-payer system similar to Medicare, the recent survey data from multiple organizational sources, show that health care is an important but secondary issue when proposed government actions are prioritized by respondents. For the past twenty years, it has been designated the problem that won’t go away. In fact, when we drill down to see what the thousands of Americans surveyed are really worried about, it is the cost of health care and concern for those without insurance.

    How can health care coverage be advanced in this climate? A sharper image of what is happening to families is required. We need to demonstrate that there are people today burdened by medical debt to the point that they cannot maintain their homes, make car payments, or save for their children’s undergraduate education. We have a model for how to proceed. Prior to Medicare being signed into law (1965), Congressional hearings were held to graphically show that for poor senior citizens, the choice was often between food or a visit to the doctor. More expensive procedures, usually involving elective surgery, were often postponed indefinitely by the elderly on fixed incomes. The power to hold these hearings resides with the major party in both houses. A Democratic majority will help to start this process.
    Medicare was not just a proposal by the Democrats. There was bipartisan support for it.

    Today’s Federal legislatures are deeply divided along party lines but the cost of care impacts on citizens in all parts of the country. The states with the highest rates of uninsurance are red states where the Republican party is in the majority. The culture of caring for the elderly via the social insurance model (found in Social Security and Part A of Medicare) also relieved directly the younger generations of burdensome expenses, even though payroll taxes were increased.
    The culture of caring is not just for the elderly. The American family is being squeezed out of our current prosperity. Those in the workforce with moderate incomes need a victory in the struggle with increasingly limited coverage in employer-sponsored policies, greater premiums and co-pays, or the elimination of coverage altogether. Lower-paid workers often cannot afford the premiums and co-pays when insurance is available and so they do not take up these opportunities for coverage.

    Finally, we also need to show that the Congress in 1965 was able to take on the American Medical Association at the zenith of its power and prestige to create a universal health insurance program for Social Security recipients. The powerful players today are the managed care plans/insurers and the pharmaceutical industry. They need to learn how to do the right thing when it comes to creating quality care for everyone at a reasonable cost.

  4. Susan Blumenthal MD, MPA Says:

    Health Reform: The Alarm Has Gone Off at the
    Center for the Study of the Presidency

    Moving health care to the forefront of the national policy agenda in the 2008 Presidential elections and for the next Administration is a key initiative of the non-partisan Center for the Study of the Presidency (CSP). As Dr. Drew Altman and Professor Blendon point out in their article, health care concerns must be central to the 2008 election cycle to ensure that needed reforms occur in the future. In this regard, the Center for the Study of the Presidency has been organizing working sessions on critical national challenges for the 2008 Presidential candidates and, as part of this effort, convened several meetings with Kaiser Family Foundation leadership on the Center’s 2008 Health Agenda. This agenda is a critical component of CSP’s overarching mission to apply lessons learned from an historical examination of the Presidency to promote innovative solutions that address current vulnerabilities facing the nation and to anticipate opportunities ahead to promote progress and prosperity.

    A suite of health care concerns – soaring medical costs, uninsured citizens, the need to protect against and respond to natural disasters, pandemics, and possible bioterrorist threats, to emphasize prevention and preparedness, to strengthen health-related research, and to improve the delivery of quality medical and public health services – are issues that must be at the top of Presidential candidates’ lists. Indeed, these concerns, which cross over forty Federal agencies, underscore that strong leadership in the White House and in the Executive Branch of government on science, health, and technology is more important than ever.

    The Center believes it can help find a path forward to improve health. Utilizing a model that the Center for the Study of the Presidency first developed to help Secretary Ridge and his senior staff launch the Department of Homeland Security, CSP will convene a wide range of experts from the health community, Nobel Laureates, public policy organizations, academia and current or former government officials for frank, off-the-record discussions of each of the health care issues identified above. These sessions and conferences will produce one or more briefing papers that describe the nature of the challenge, set forth various policy options and the resources required to pursue each, and explain why Presidential action is critical to overcoming the national health vulnerability. A national conference will then be convened to examine lessons learned from previous Administrations and to gather broad input across expertise and geographic regions of the country. A national poll will be conducted of public and health care providers’ attitudes, hopes and expectations for health care in the next Administration.

    Findings from the national poll and recommendations from the working sessions and the national conference, summarized in an Executive Report, will build common ground among the participants, frame the Presidential debates on science, health and technology issues, and enable the next Administration in 2008 to begin its policy deliberations with a set of issues, strategies, and solutions with the support of committed Members of Congress, their staff, the private sector, public policy organizations, health groups, the media, and the American public to accelerate progress on health, science and medicine in the United States and globally. The Center for the Study of the Presidency looks forward to working with the Kaiser Family Foundation and other committed and concerned organizations and individuals to achieve these goals.

    Rear Admiral Susan J. Blumenthal, M.D., M.P.A.
    Senior Advisor for Health, Science and Medicine
    The Center for the Study of the Presidency
    Former U.S. Assistant Surgeon General
    U.S. Department of Health and Human Services

  5. LFBaltrucki Says:

    To the authors,

    Please comment on Newt Gingerich’s effort in the area of health care, “Center for Health Transformation” and the effects that this is having (or might have) on the national health care debate. Thank you.

  6. SteveBeller Says:

    There seems to be synchronicity in the healthcare blogs these past few weeks.

    For example, in two other popular healthcare blogs — The Medical Blog Network and The Health Care Blog — we’ve been discussing why fixing American healthcare is so difficult. The conversation threads covered many topics ranging from how to educate the public and get them motivated to demand change, to what role our government could take and whether it can be trusted. At the same time, on the Insurance Blog we’ve been hotly debating whether there even is a healthcare crisis and whether the insurance industry is part of the problem and whether healthcare should be considered a commodity subject to market forces.

    Not surprisingly, there’s a wide range of opinions as to what the problems are and how to deal with them. As we continue to discuss and debate the issue of reform in HealthAffairs and other open forums, I believe a clear vision of the “big picture” will emerge and a rational path to solving the complex problems we face will surface.

  7. chamilton Says:

    Senator Barak Obama is talking about health care coverage and how it relates to industry. A while back, he proposed a plan to help the big 3 automakers – the people (Fed Govt) will cover your health care costs, in exchange for better fuel efficiency. I think it is a brilliant plan.

    In my opinion, one of the reasons for the lack of interest among the public in quality is that they don’t know what is going on. What if you went to the hospital for surgery or an inpatient stay and were handed a card that said, “You have a 40% chance of acquiring a staph infection that may kill you. You have a 10% chance we will perform your surgery on the wrong part of your body. You have a 37% chance of getting the wrong medication that may kill you.” These are made up numbers, but how many people do you think would continue to admitting?

    I think there needs to be an awakening among the public to spur the grass roots and the industry. In the role of an employer, I would not want my employee to die because of the care they received through my insurance. I have made an investment in that employee. I want them to be healthy and work.

    I completely agree with the authors. What if we did not have these ‘distractions’ and were able to focus on issues like this? Will it take a 9/11 in the health care industry? Is that the new standard for public outcry and reform?

    Christopher Hamilton, MPH

  8. SteveBeller Says:

    I suggest that a combination of consumers (grass-roots) and employers/business putting pressure on politicians to transform the healthcare system (improving safety, quality and efficiency) is what we need. While some of this is beginning to happen, a more coordinated and widespread effort to educate people about the problems in American healthcare today and stimulate dialogue about potential solutions is required.

    Steve Beller, PhD
    WellnessWiki

  9. JohnEMcDonough Says:

    Valuable and well done post. I agree on the absolute necessity for political leadership to move health reform forward. I take issue with several assertions:

    “…none of the politicians most often mentioned as candidates for the presidency in 2008 are talking much, if at all, about health reform …If even one major candidate begins to seriously address health reform, the others will be forced to follow suit.”

    There is a candidate talking about health reform. It’s Republican Mitt Romney from Massachusetts bragging about MA health reform enacted in April of this year. Last I checked at the National Journal website, Gov. Romney is ranked the #2 candidate for the Republican nomination after John McCain. To have a leading Republican talking big health reform can have a transformational impact on this issue in both parties. No Democrat can be perceived as less expansive than Romney, and Romney’s stance will require every Republican contender to advance their own plan. At this point, none of the candidates for the presidency is talking about much of anything – so don’t fret. It’s coming.

    “One poll trend demonstrates the differences between the two eras vividly: In October 1993, 55 percent of the American people named health care as one of the two most important issues for government to address; that number fell to less than 10 percent in 2002, was 11 percent in November 2005, and is now consistently below 15 percent.”

    October 1993 was less than 30 days after Clinton’s national address on health reform to a joint session of Congress and after nine months of intense national front page discussion of health reform. I don’t think this is an apt comparison.

    “The next significant moment of opportunity for national legislative action on health reform will not come until 2009.”

    On September 30 2007 the ten year authorization for the State Children’s Health Insurance Program expires and coverage for five million lower income kids turns into a pumpkin unless Congress acts. Already, legislators in both house of Congress are itching to promote a major expansion of kids’ coverage, touting SCHIP as the demonstration, and the next phase as the opportunity to finish the job. That’s the next significant moment of opportunity and let’s not forget it!

  10. nmcharney Says:

    Good point but it is unrealistic to think that the politicians will change their tunes unless they see that it is costing them votes.

    The state of the health care system is also having a profound effevt on the business community. If we can get them riled up and back their concern with dollars for politicians who raise the healht care isue to the top, we might get their (pols) attention.

    Also, all the medial organizatioons need to get on the wagon and promiote the changes and do some real lobbying i.e AMA, AAFP. State orgamizations, etc.

    All physician’s offices need to encourage their patients to contact their legislators about their needs

    Norman M. Charney MD, JD

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