Saturday, September 25, 2004

Health Care Policy as a Political Factor

The New England Journal of Medicine has published a Special Article, that they have posted on their website, with free access.  Normally, they provide free access only for items more than six months old; sometimes, though, the editors decide something is a great importance or interest to the public, and put it up for free. 

The Special Article, Health Care in the 2004 Presidential Election, provides the results of several national opinion surveys:

Results Voters ranked health care as the fourth most important issue in deciding their vote for president in 2004. The top health care issues for voters were the costs of health care and prescription drugs, prescription-drug benefits for the elderly, the uninsured, and Medicare. Bioterrorism and abortion were also important issues for voters. The voters most concerned about health care were older persons and those who identified themselves as Democrats. Four issues less salient to voters were racial disparities in health care, aid to developing countries to prevent and treat human immunodeficiency virus infection and the acquired immunodeficiency syndrome, medical malpractice, and the quality of care.

Conclusions Although health care ranks higher in importance among voters than most other domestic issues, it is only fourth in importance in deciding their vote for president. The health care issues of greatest concern are the affordability of health care and health care insurance. Health care issues do not appear likely to play a decisive role in the presidential election in 2004, but they might make a difference in some swing states if the race is close.

Note that people ranked the cost of health care as a greater concern than the quality of care.  I suspect that has to do with the context of the questions.  Probably most people think the quality is more important than the cost, but realize that the President can't do much about the quality, but can do something about the cost. 

The authors reviewed some background information pertaining to the current election situation:

The environment of the presidential election campaign of 2004 is very different from that of the past several elections. Since the election in 2000, the United States has experienced its first attack on American soil since Pearl Harbor, has participated in war in Afghanistan and Iraq, and was the object of an unresolved bioterrorist attack in which several persons in the nation's capital were infected with anthrax. Moreover, in 2000 there was a large federal budget surplus, whereas in 2004 the federal budget is in deficit.

In the field of health care, Congress enacted legislation in 2003 to provide a prescription-drug benefit for people receiving Medicare benefits that accounted for the largest expansion of the program since it began in 1965. Yet since 2000, the number of Americans without health insurance has risen from 39.8 million to 45.0 million.1
1Census Bureau. Income, poverty, and health insurance coverage in the United States: 2003. Table C-2: health insurance coverage by age: 1987 to 2003. (Accessed August 27, 2004, at http://www.census.gov/prod/2004pubs/p60-226.pdf.)

The three issues that people ranked as being more important than health care were: the economy, the wat in Iraq, and the campaign against terrorism.  The first two make sense, of course, but the third reflects a fundamental misunderstanding of the issues.  The accessibility of the health care system is an issue that is much more likely to have an impact on pepole's lives than the antiterrorism campaign.  We cannot predict the future, but we can say with confidence that inadequate access to health care is likely to have a much greater negative impact on public health, compared to the risk posed by terrorist attacks.  In my opinion, the public misunderstanding of the relative risks is a result of a failure of the leadership and the news media in this country to provide a realistic perspective of relative risks. 

I suppose that the leadership can be forgiven, to some extent, since it is in their best interest to have public concern focused on terrorism (instead of health care), but the news media should be able to retain and portray a rational understanding of the issues.  It is inexcusably short-sighted of them to focus on terrorism instead of health care.  Sure, terrorism makes for mmore compelling headlines, and such reporting no doubt boosts readershiip and viewership in the short run.  But in the long run, public health is what will determine how many people are alive to buy tomorrow's newspapers.  Politicians do not care how many  voters their are; their only concern is with the percentage  of voters who are on their side.