Why Health Care Never Wins Elections

Despite Barack Obama's recent surge in the polls, much could change between now and election day. While it looks like this election will be decided by the economy, unexpected events could dramatically change the campaign narrative. Terrorists could conduct an attack inside the US. Obama, despite his two years of steady poise, could say something really stupid between now and November, that would cause independent voters to flee.

But one thing is certain: this presidential campaign, like all recent campaigns, will not be decided by the candidates' health care proposals.

The US health care system is a bigger threat to the American population than terrorism ever was. As horrific and evil as were the attacks on 9/11, and as much as we needed to mobilize our troops to depose the Taliban from Afghanistan, the more than 3000 people who died on 9/11 are dwarfed in numbers by the tens of thousands of people who die, needlessly, because they have no health insurance.

Ask people what they are worried about, and health care usually sits near the top of their list. Almost 50 million people in the US have no health insurance, people who have to decide whether that gash really requires stitches, or whether that heartburn is a mere stomach problem or sign, instead, of a potentially fatal heart attack. A similarly vast number of people have too little health insurance to cover the basic health needs. Consequently, they hover in economic peril, one serious illness away from bankruptcy.

To make matters worse, persistently rising health care costs threaten our global competitiveness, handcuffing US industries with huge expenses. This health care inflation also adds to state and federal budget problems.

Yet despite this dire situation, health care doesn't win elections, because health care problems never feel as immediate as other threats. When the Dow Jones plummets 800 points, people understandably worry. They can see their life's savings dwindling, and their hopes of early retirement evaporating. When a student conducts a school massacre, everyone is caught up in the terrible drama, with their view of gun control quickly rising up their list of concerns: gun control advocates will feel even more passionately than before the massacre that we need to restrict gun ownership, while gun control opponents will become even more convinced that the whole situation could have been averted if more of the teachers were packing.

There is no aspect of the health care crisis that has the immediacy of a bank foreclosure, a terrorist attack, or even a verbal gaffe from one of the candidates. Our health care crisis fails to win elections in part because it doesn't feel like a crisis to enough people. It also fails because it is hard for candidates to come up with a simple solution to such a complicated mess, and therefore any solution a candidate puts forth is easily caricaturized and criticized.

Both candidates have proposed ways they think will improve our health care system. I feel strongly that Obama's approach, even in its preliminary form, is far superior to McCain's. But that probably won't matter on election day. Ultimately this campaign will be won over other issues.

Comments

[Sneaky]

Is that cryin' I here!?

Item: military involvements ALWAYS remain in the hot seat as the most or one of the most important items people vote on (American History 101).

Item: economic crises tends to follow the same trend in terms of importance as aforementioned military involvements. Interestingly, sitting administrations are usually the first to go, regardless of whether or not they caused or helped to cause said crises.

Item: America is still largely divided on how it feels about "health care". For some, that's an automatic association with nationalized/socialized health care. For others, it's primarily about the medical-industrial complex (you know, subsidizing and pharmaceutical companies with excessive influence over the legislature). Radiclib makes a good point in that the intensity isn't really there for "health care" as a topic, which I would attribute to the current American medical doctrine of managed/reactive care instead of preventative care.

Mr. Ubel, no offense, but there are historically two dominant voting issues and no solid foundation or widespread understanding of exactly what "issues" the "health care issue" constitutes. Even moreso, we're talking about someone running for the position of PRESIDENT of the United States, not LEGISLATURE of the United States; Obama or McCain could have the world's best plan for healthcare, but neither are running for a position to do anything more than show it to Congress and say "Please?".

[schatsie]

I don't think that the issue has been well FRAMED.... think of it in terms of productivity, probably 50% or more is spent in the last 6 months of life and the people are going to die, the only question is do we as a culture allow them to spend their last time in peace and comfort or in the sterile hospital atmosphere with lots of technology and unremitting expenses....

The other half actually recuperate to full health and it is only episodic in their life....

BUT THE REAL ISSUE is whether or not we can afford
1. To let 500,000 people suffer bankrupcy and a dearth of health care.
2. to let 50,000,000 people have restricted and or overpriced health care.
3. to take these monetary resources and spend them so profligately with no measurable improvement over other countries who spend about 50% of the amount we spend...

Health care in this country is a hidden tax, but it is costing us $6,000 for every man woman and child and I would rather this money was spent more rationally....

[fouchnickens]

Thanks, Mr. Ubel, for this forward-thinking article. Issues of public health and food security are given short shrift in the "war against terror," but as the continuing Chinese melamine contamination scandals and the late summer rice crisis have demonstrated, the stability which governments strive for are easily toppled when citizens' personal lives are disrupted by illness or inability to access essential resources and services.

When the United States suffered regularly from epi- and pandemics, government resources were enlisted against polio, rickets, yellow fever, malaria, and influenza. But like our aging transportation system, our public health system became entangled in parochial interests and a system more interested in making money off a necessity than protecting the commonwealth. Unfortunately, many people bought into the anti-communist rhetoric against single-payer health care, despite the growing and verifiable evidence from other developed nations that it improved health care outcomes for all citizens.

The question that has yet to be asked, will it take "the coming plague" (to borrow the title of Laurie Garrett's book on the challenges of public health and epidemiology in 20th and 21st centuries) to change how we as a nation view issues of health care? I am hoping against historical precedent that the United States people can answer "no" -- otherwise, the establishment of a more equitable health system may come at a bigger price than we are willing to pay for.

[Masonic81]

Continuing on radiclibs comments -- a sizeable portion of the 5% or less who are single-issue voters on health care are dead before they can vote in the next presidential election.

Gun culture and abortion single-issue voters, on the other hand, tend be around long enough to organize, and they don't have to deal with it every day the way someone with cancer does. The disaster of healthcare in this country is not a cultural or regional issue, which makes it very difficult to organize effectively.

This is the same problem we see with global climate change and pharmaceutical contamination of our waterways. Those of us in the "reality-based community" are aware and worried about the future implications of these issues, but apparently we are in the minority.

[WorkingClass]

The health insurance companies and the pharmaceutical companies own our government. They like the present system just fine and don't want it changed. The American people will continue to die and or go broke because our elected politicians are taking bribes. I thought everybody knew this.

[radiclib]

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There's more to it than this.
Although health care causes most people to worry in a low-intensity way, most people are not directly dealing with the mess at any current moment. In fact, probably only 10 per cent are fighting insurance companies or going bankrupt from bills at any one given time. That 10 per cent changes constantly. But 10 per cent of the voting public alarmed at one given time is not going to carry an issue.
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