Support for affordability Model for crafting health-care reform

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By Gary Andres

As with many issues in American politics today, partisan attachments create a prism through which citizens evaluate presidential candidates' positions on health- care reform. For example, self-identified Democrats overwhelmingly think Sen. Barack Obama would do a better job at reducing costs and covering the uninsured, while Republicans like Sen. John McCain's approach to achieving these goals. This leaves independent voters - always a key electoral constituency - somewhere in between.

Party differences are most pronounced on issues related to the role of government in financing and regulating this sector. But in other areas of health care - like promoting prevention and coordinated care - partisan differences shrink, highlighting some opportunities for bipartisan cooperation.

In the most recent American Survey (conducted Aug. 18-28; 800 registered voters), we asked voters to evaluate the presidential candidates on several key health care concerns. On the issue of which candidate would do a better job of reducing health-care costs, Mr. Obama holds a nine-point edge over Mr. McCain (43 percent-34 percent). The Democratic nominee's advantage expands on the question of which candidate would do a better job of reducing the number of people without health insurance (49 percent-30 percent).

Yet as the chart demonstrates, partisan identification heavily shapes these views. Mr. Obama's lead among Democrats is 74 percent-8 percent on the issue of reducing costs, while Republicans choose Mr. McCain 72 percent-11 percent. Independents split almost evenly on the question, with 36 percent thinking Mr. Obama would do a better job and 32 percent believing Mr. McCain would.

The same pattern holds true on reducing the number of people without health insurance. Seventy-six percent of Democrats believe Mr. Obama would do a better job, while 64 percent of Republicans pick Mr. McCain. Here, the Illinois senator holds a more substantial 46 percent-25 percent edge over Mr. McCain among independents.

By a two-to-one margin (61 percent-30 percent) voters believe "the free market" rather than "the government" would provide better health care for them and their families. Here too, partisan differences emerge. Republicans overwhelmingly choose the free market (80 percent-14 percent), while a plurality of Democrats prefers government-run health care (47 percent-43 percent). Significantly, independents heavily side with the Republicans on this issue, picking the free market 67 percent-23 percent.

Despite strong overall support for the "free market," voters are not as lopsided in their thinking when asked if they believe more government control would lead to healthcare rationing. Fifty-one percent of registered voters believe it would, while 39 percent say it would not. But again, within this result, some significant partisan differences emerge. A large share of Republicans (63 percent-26 percent) and a majority of independents (52 percent-42 percent) anticipate rationing, while Democrats by a slim margin (46 percent-43 percent) say no rationing would occur.

Finally, while partisanship shapes attitudes toward health care policy in many areas, reimbursing providers for providing preventative care - such as flu shots, regular physicals and helping people manage weight - draws strong support from both sides of the aisle. When asked if they support reimbursing providers for preventative care, 77 percent of self-identified Republicans, 80 percent of independents and 83 percent of Democrats support such an approach.

And, as I discussed in the last American Survey column, voters across party lines favor a focus on making health care more affordable over reducing the number of people without health insurance. Eighty-five percent of Republicans, 83 percent of independents, and 82 percent of Democrats agree the priority of health care reform should be affordability.

So despite predictable partisan patterns in voters' views of many health-care reform ideas, areas such as reducing costs and reimbursing for prevention draw strong bipartisan support and may serve as the foundation for legislative action in the next Congress.

Gary Andres, who served in the first Bush administration, is vice chairman of Dutko Worldwide.