04/11/2008 11:47 am ET | Updated May 25, 2011

AFL-CIO Survey Turns Politics of Health Care Reform Upside Down

Despite all the hubbub about health care, the secret belief in the Washington punditry has long been that real health care reform in America is a political non-starter. They know that nearly all voters are insured, and they believe insured voters fear health care reform more than they desire it.

Now we know otherwise, thanks to the more than 26,000 people who told us so.

Our informants were the vast and varied respondents to a health care survey launched by the AFL-CIO and our community affiliate, Working America, to better map the landscape of the health care crisis in America and to provide that information to candidates running for public office in 2008. You can find the survey results at

Most of those who took the survey are insured and employed. Most are college graduates. More than half are union members. Almost all of them believe the health care system is broken and needs fundamental change, and they are planning to vote about it in November.

The news here is the demographics. These are the people who, it would seem, would have the best access to high-quality health care.

But it turns out that having insurance is no guarantee of getting the care you need at a price you can afford. More than half of people in insured families say their insurance does not cover all the care they need at a price they can afford. Despite having insurance, they report not being able to afford prescription drugs, follow-up care and even preventive care, which are either not covered or covered insufficiently.

Take Marie, from Madison, Wis., one of 7,500 people who wrote in to the survey with their own compelling stories. "What would you do if you had to choose between food or medicine," she asks. "Because of rising health care costs, that is a question that is frequently asked in my home. I work full time and have health care through my employer, but only a percentage is paid by them...I recently needed medication for an ailment, but did not get the medicine--I couldn't. What would I choose? I choose my children and what they need, whether it be food or medicine. I am the one who will go without before they suffer."

Chances are, Marie will vote, and it is voters like her who will turn the conventional wisdom about the politics of health care reform on its head.

That old saw about health care reform as a political sinkhole was born in the early 1990s when attempts at reform were met with scare tactics by the insurance and pharmaceutical industries. With misleading advertising and lobbying, they convinced Americans with insurance that change would be worse for them than the status quo.

The belief in political circles became that only the uninsured care about health care reform. The uninsured generally don't turn out to vote in large numbers. In this scenario, there is no political payoff for trying to make things better, so no one tried.

Fast forward to today. Forty-seven million people in this country have no health insurance, which effectively means no health care. But, as our survey shows, the misery and fear runs further and deeper than only those who have no health insurance.

One-third of college graduates report they or a family member skipped medical care because of cost. People who buy their own insurance in the private market--the place Sen. John McCain would like to push all of us--are more likely than those with employer-provided health care to report that critical needs are not covered or not affordable.

Fully half of our survey respondents say they or a family member have been stuck in a job they would have preferred to leave to keep health care. For many, the only raises they've gotten in years have been eaten entirely by increases in health costs.
This affects employers, too, who have to compete in a world market with companies based in countries providing health care. Health care has become such a burdensome cost that many employers are helping to lead the charge for change.

Note to political consultants: These dissatisfied health care survey respondents are voters. In fact, 97 percent say they plan to vote this November. Dissatisfaction spans generations. Seventy-four percent of those aged 18-29 who took the survey count health care as a very important voting issue, as do 80 percent of those aged 50-64.

That means, of course, political candidates today have no choice but to address the issue of health care reform. The presidential candidates are all doing so, although McCain's plan to tax employee health benefits barely rates a mention. For candidates up and down the ticket, the question now is only how far they are willing to go and--our unsolicited advice is they had best go all the way, if they want to be elected, that is.

And once in office, they had better stand their ground and fight for real, comprehensive health care reform that reins in the outrageous health costs in America and expands access to care to all. If not, they'll be held accountable. Enough already. In America, no one should go without health care, and no one should be held hostage by health care costs.