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Health care policy-makers who take a look into the heart and soul of the American electorate may get a frightening reminder of how fickle voters are. Voters are nervous about new approaches to solving health care’s problems, its funding, and its delivery to the public. They want to ensure Medicare stays viable, medical errors barely register on their radar screen, and they are wary of government’s ability to get the job done. However, the electorate is no longer keen on waiting for the federal government to find solutions to health care’s challenges.
It will eagerly respond to state and local politicians who will talk about finding creative solutions and partnerships that might resolve health care’s seemingly intractable problems.
This is the political climate those who attended the recent National Academy for State Health Policy annual conference find themselves in.
The vast array of challenges policy-makers find themselves faced with are sometimes solved with the help of voters, and sometimes they are solved while voters look in the other direction.
"The public is concerned about health care issues, but it’s very hard to get the public to move forward," political analyst and pollster Celinda Lake, of Lake Snell Perry and Associates, told attendees on the first night of the conference in Charlotte, NC.
Ms. Lake charted the waters according to recent poll data, saying health care policy is ranked as being important mostly by women, lower income voters, and Democrats.
Voters have lots of concerns to keep themselves occupied, she added, and they are not necessarily looking for new health care issues to confront. One issue at a time is the way the electorate thinks and beyond that, progress will be slow, she said.
Voters have one health care issue per cycle," Ms. Lake said. "In 1998 it was the patients’ bill of rights cycle, in 2000, it was the prescription drugs cycle."
Looking ahead to November, there is a slight shift of concerns, Ms. Lake said. Prescription drugs will still be a hot-button issue, but nursing home reform is gaining momentum, she said, calling it a sleeper issue that will cause voters to demand more of state government when it comes to rules and policy. And if the states don’t grab the horns, then voters will turn to the cities, to any place that will give direction, she pointed out.
"For a while, national solutions were seen as the solution. Then we saw voters move back their concerns to the state," Ms. Lake continued. "Now it’s all over the map. People say they don’t give a damn who does it as long as someone does. People are even interested in cities offering insurance."
A two-tiered society is emerging, Ms. Lake said, in which voters have health insurance, are concerned about money and health care issues, and believe that they are paying more money for their health care. The other tier is the one without money and may not even vote.
Where does the voting public’s sympathy lay? With themselves, according to Ms. Lake, especially with the seniors who vote. But the public seems to care deeply about the welfare of children and about helping the working poor, those who are employed but are without health insurance.
"Medicare is a big issue on the agenda," she told policy-makers at the conference.
"Democrats will run on the tax cut as being irresponsible. Voters are not eager for tradeoffs. They say Medicare is sincerely in trouble. They would decrease spending on other programs to save it. When they were asked about commonly discussed reforms to make Medicare solvent, none of them are popular. The No. 1 reform for Medicare is to offer a prescription drug benefit," she explained.
Knowing that she spoke to policy-makers who believe government-sponsored health care should be more widely spread than it is, Ms. Lake offered caution.
"The public thinks welfare reform has been successful. Arguing that they are wrong is not good strategy," she said. "So what can we do to help the working poor? The area of welfare reform may be a chance to bring working families front and center. In a time of declining budgets, this won’t be easy."
As for medical errors as a motivating issue for voters, forget it, Lake advised, saying there is a more concrete issue to focus upon. "The shortage of nurses, that’s wildly popular with the public."