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Americans ranked health care among the four most important problems facing the country, making public opinion on this issue as critical as ever.

On public opinion and health care

From eNews, May 1, 2008

According to new University of Minnesota research, presidential candidates must understand public opinion on health care if they expect to woo voters. Americans ranked health care among the most important problems facing the country.

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 Larry Jacobs, director of the Center for the Study of Politics and Governance at the University of Minnesota Humphrey Institute of Public Affairs.

In new research published in the May 1 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," says Jacobs. "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. 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," Jacobs adds. "Discussion of the public's attitudes toward health care reform too often misses these contradictory strains. 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, visionary leadership may overrule public opinion.

"Although public opinion influences legislators' agendas, legislators themselves still must choose to overcome differences and work together on this issue," says 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 percent of the public's support."