09/08/2009 05:12 am ET Updated May 25, 2011

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.