The New Voice in Health Care Reform: Voters

One of the first lessons that any politician should learn is to listen -- really listen -- to the voters. This is not as easy as it sounds, because voters are not like policy wonks. They don't list the pros and cons of specific pieces of legislation or weigh the fiscal impact of a bill. They are too busy going to work and raising their families. Only when voters get really riled up do they send their message -- loud and clear -- to public officials. Hence the growing public debate over reform.

The debate over health care reform is one of those instances where politicians need to listen very carefully to what voters are saying, and what the voters really want. What's more, politicians and public officials need to take a much closer look at the political realities of health care in America. While there was a lot of discussion about health care during the presidential campaign and in its aftermath, most of the public had only a very foggy notion of what health care reform would mean to them. Only now are they forming more cogent opinions, and this fact alone could present a grave threat to health care reform efforts.

To begin with, "health care reform" is, in purely political terms, an abstract and therefore meaningless concept. Unless voters know who is going to be impacted by reform and how it will be paid for, it is one of those "motherhood and apple pie" ideas that means very little. For example, during the campaign, there was much emphasis, particularly from the Democratic side, on the 47 million uninsured Americans. While there is some dispute about the actual number of uninsured, it has become quite clear that the issue of the uninsured is a political loser. If 47 million Americans are uninsured, this means that over 250 million are insured, and therefore the plight of the uninsured, while a matter of vital social concern, is not an overriding daily issue for the vast majority of Americans. Although we may wish that Americans had a more altruistic, responsible attitude toward the poor and disadvantaged - perhaps along the lines of European societies - this has never been the attitude of Americans and is unlikely to change anytime soon.

So the problem remains - "what do most voters want?" The 250 million Americans who have insurance aren't that interested in universal coverage since it won't impact them directly, at least not in any positive way. What they are upset about is the cost of their own health care. With rising health insurance premiums and deductibles, Americans believe they are paying too much for health care. By and large, they are happy with the quality of care they receive, and while they might be worried about losing coverage, that is an abstract fear about the future rather than a concrete, present-day concern. Most polls bear this out, and reflect rising public unease about the direction of health care reform.

If policy makers want to address the primary concern of voters, the goal of health care reform should be to lower the real, out-of-pocket expenses of most Americans. That means lower insurance premiums and lower deductibles, without a significant rise in taxes. If health care reform could provide, say, $1,000 annually in net savings to consumers, they would probably support it, provided it didn't mean diminished quality of care, the loss of insurance or higher taxes. Maybe that's an impossible goal. If so, the policy makers need to rethink their approach to health care reform.

The bottom line? What is the average voter going to get out of all this and what will it cost? In times of economic uncertainty, most people are not going to jump on the reform applecart when it might well topple over. Why risk throwing what everyone knows is a fragile health care system off the rails, especially when the payoff for the average person is so little? Sure, we've heard the arguments that we are heading for disaster, that people are being thrown into bankruptcy daily by health care nightmares. But voters figure we don't have a disaster yet, and health care reform might just well hasten it. And while thousands of people go bankrupt, millions are merely annoyed by high costs.

Despite the ambivalence of the public, some form of health care reform is likely to pass. The question is whether it will be effectively sold to the public after it passes. The Obama administration and Congress would be wise to listen carefully to the voters, discerning their real concerns about health care and tailor legislation to those concerns. And when health care reform finally passes, in whatever form, politicians on both sides of the debate ought to continue the dialogue with the public, focusing on the issues that matter most to voters, rather than on the abstract or the ideological.

Follow Hoyt Hilsman on Twitter: www.twitter.com/HoytHilsman

Comments

[dennis181]

Another great post. Thoughtful and realistic, which is always a nice change in tone from the usual partisan nonsense. Good job!

[philosopete]

Who will administer the 'public option' insurance? If it is the same companies who are now the MAC's, it will be no bargain. When you have for profit insurance companies running public services, their profit will come at the expense of the services they are supposed to administer.

[ShelbyGT500]

I want the same plan the Government officials are going to get to keep. You know the "gold plan". If their own healthcare reform isnt good enough for them then it definitely is not good enough for me or my family. Who says they get special healthcare, after all we the people are responsible for keeping government in line. I say when they come up with a plan every single person including them can use then so be it. Until then leave my health care alone.

[Benblanken]

I'll believe Congress is really serious about health care reform when they include tort reform as part of the package. That won't happen, so anything that is adopted will cost much more than projected. The lawyers in Congress will never vote against their fellow lawyers bringing outrageous malpractice suits.
So it looks like we're heading to govt control of health care, like Obama has said he wants. It will be as efficient and thrifty as Medicare, Social Security and Medicaid have been.

[SilenceDoGood1776]

In my opinion health insurance costs are to high and the main reason is that it covers too much. Health insurance should be like car insurance, there for real emergencies like back when it first began it was called hospitalization insurance. People should pay for their check ups and normal doctors visits. Just have insurance cover hospitalization and prescriptions and the cost will come down. If car insurance paid for oil changes, transmission fluid and other normal maintenance you would see car insurance rise.
The worst thing we could do is to let the Gov't control healthcare. It is a very inefficient entity. How much money can't be accounted for in Iraq, Medicare, Medicaid, and the VA? You want them to run health care. If you read the bill now the can tell you that your too old for a certain treatment?
You want us to be more like Canada and the UK? Why? The quality and timeliness of care for a serious medical condition is terrible. There are thousands of people from those two countries alone that come to the US for health care. You have to ask yourself why, if there model is so good? Why would anyone come here if ours is so bad.

[Wnde1drs]

Silence said:
"If you read the bill now the can tell you that your too old for a certain treatment?"
-------
Wrong. The part of the bill you are referring to concerns Living Wills. Living Wills were first introduced Missouri's Republican Senator John Danforth in 1990. Living Wills were introduced for those who wish to make decisions in consultation with their doctor about their care in the event they are unable to make these decisions due to a coma or vegetative state. This way the doctor and the family all know exactly what the patient's wishes are. It's not to choose the way you die, you can choose to stay on life support forever, if that's what you want. It's up to you. Ask yourself this, if living wills are "execution orders" then why does Sean Hannity advertise for Legal Zoom, who does Living Wills?

From Legal Zooms website:
A living will lets you specify decisions about artificial life support in advance. It not only ensures your wishes will be heard, but also protects your loved ones from having to make these difficult, deeply personal choices for you.

Does Hannity support the euthanasia of the elderly? The reason this is coming up now, even though it is already part of policy, is that under Health Care Reform, they are asking that the insurance companies pay for these consultations with your doctor. Before they didn't pay for them, now they will. It's really simple.

[ShelbyGT500]

Health insurance costs to me are the same I had 10 years ago as far as a family Hospital,Dental,and Vision plan go. Ive had the same old deductible and co-pay for visits and meds. Government needs to leave my healthcare and my money alone. Revamp their medicaid/medicare or what not to cover people that can not afford it or its unavailable to them thru their jobs.
If the government would quit trying to control every single aspect of life as we know it we would not be in such a hole in the first place. Its our fault for ever putting up with this crap to begin with. We put them in office we can take them out of office. The people have the power not the government.
What about the Trillions we have wasted recently on the Bail outs and such? That money could have went to healthcare and education. What about the Trillion dollars that have been wasted on a failed Drug War against our own people? That money should be spent on healthcare and education, not incarcerating otherwise innocent people.
There are hundreds of ways to save costs we just have to shrink all this flab in our federal and state Govts'.

[suegar]

Yes, but the ultimate bill also needs to be a coherent and rational plan-not a Frankenstein sausage of compromises that may sound good but will not actually improve things. Medicare for all is the just,simple, rational and effective approach-too bad it was eliminated before we even began this endless discussion.

[bonfuture]

Sadly, what you say is true.

To win health care reform, it must be made very clear that most Americans will benefit financially with lower premiums and lower costs to employers. Bring on the bar charts that show US citizens and employers paying more for health care than other industrialized nations. Why should we pay more for less?

Bring on the numbers that show what our employers could save if health costs were lower. Isn't it possible for individuals to earn more if wages weren't being diverted to the for-profit insurance/pharmacy companies and CEO salaries? How will we compete with other nations if our health care and medications are so costly? How does this burden to the economy influence our national security. I'm not sure why, but the financial perspective gets to the wallet of an issue and motivates change far bertter than other arguments of sentimental nature.

Keep on talking about the financial benefits. Use the broken record routine. It's the bottom line. It's the economy stu............

[Merlin7]

Spoken like a true Republican. Everything comes down to how much the economically comfortable will have to give up. Baloney. The real bottom line is that REAL health care reform -- not the industry-driven version being crafted in Congress -- is vital for our national security. Without it in a few years America will simply collapse economically, and then socially. Now is not the time to urge the public or the government to sheepishly accept another hosing by a powerful industry.