ANDRES: Health care and the election

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By Gary Andres

Despite a slowing economy and rising energy costs, healthcare still ranks among voters' top concerns as the November election approaches. While voters convey some clear general preferences about the issue, confusion exists about its details and where the two presidential candidates stand on the topic. These gaps in public knowledge make the bridge between citizen opinion and public policy-making particularly challenging. Those are some findings from the most recent American Survey, conducted Aug. 18-22 (800 registered voters, +/-3.5 margin of error).

First, voters clearly prefer a focus on containing health-care costs compared to covering more of the uninsured, according to the survey. When asked to choose between, "making healthcare more affordable or having fewer people without health insurance," lowering costs overwhelmingly trumps broader insurance coverage, 83 percent to 9 percent. As the chart above demonstrates, this preference holds irrespective of party identification. These results are consistent with other public polls — such as those done by the Kaiser Family Foundation — demonstrating that over the past 15 years, public concern over health-care costs has risen compared to worries about the number of uninsured.

But registered voters also display confusion when it comes to the details and implications of health-care reform policies. While a plurality (40 percent) believes having more people with health-insurance coverage would cause rates to go down, nearly one out of three (28 percent) thinks broader coverage would make insurance rates go up. Twenty-two percent say rates would stay the same if more people had insurance.

Registered voters also exhibit limited knowledge about the specifics of the presidential candidates' health-care plans. Sixty-five percent say they have heard "not much" or "nothing at all" about Sen. John McCain's health-care plan, while 50 percent say that about Sen. Barack Obama's plan.

This lack of awareness is highlighted again with answers to another question, probing further about policy details. When we asked respondents which of the two major candidates "plans to offer a direct refundable tax credit of $2500 for individuals and $5000 for families to offset the cost of health insurance" (the centerpiece of the McCain plan), 33 percent attribute this plan to Mr. Obama, 27 percent to Mr. McCain and 33 percent say they do not know.

These results all underscore a critical caveat when it comes to public-policy polling. Despite voters registering serious concern about an issue, they often don't know a lot about the specifics, creating a fertile environment to shape the debate through aggressive messaging. When it comes to health care, it seems both sides have some opportunities, but also some work to do.