Health Care Issues Rise to Top in Presidential Run

What if there were an election without a great pressing issue facing the electorate?

That’s the dilemma in the 2000 presidential campaign. The United States isn’t at war, and the domestic economy is humming along. The technology sector is booming. Unemployment is low. The housing market is strong. The challenge for George W. Bush and Al Gore becomes how to differentiate themselves in the eyes of the voters at a time of peace and prosperity.

Robert Blendon, professor on Health Policy and Management in the Faculty of Public Health, says it is at moments like these when so-called “second-tier” issues rise to the forefront. This election year, he believes, health care is one of those issues.

Most voters are “not angry about America,” according to Blendon, but they are concerned, he says, about the solvency of Medicare, the uncertainty about prescription drug coverage, and the growing burden of the uninsured. Typically, these are considered “Democrat” issues, but in this election year, Blendon says, both parties are playing the health card as they reach for independent voters.

“The prescription medicine benefit issue plays” with most voters, according to Blendon, because it can hit them directly in the pocketbook, either due to their own costs, or due to the costs of caring for their parents. “It is also the easiest thing to describe in an 11-second commercial,” Blendon says. He characterizes it as the “most vote-moving issue in the 2000 election.”

Shiela Burke, executive Dean and lecturer in Public Policy at the Kennedy School of Government, believes a “dramatic shift to the policy of prosperity” is driving the issues this year, and health care is probably the most prominent example. “It is an issue that creates an impression about whether a candidate cares about people,” Burke says.

It is that character issue, Burke says, that will weigh most heavily on the minds of voters come election day – even more heavily than the specifics of any health-care plan on the table. “People will not really understand what the details are,” Burke says. “They just want to know will [the government] pay for drugs or not?”

Burke and Blendon agree that Bush has taken a risk by crossing the political threshold to discuss health care, but they both believe he had more to lose if he didn’t. “This is someone who wants to reach out to women and to moderates,” Blendon says. “He is trying to portray himself as someone who can reach across a broad array of constituencies. It certainly hasn’t done him any harm [to discuss the issue] at this point.”

Just how the issue plays out during the general campaign remains to be seen, although voters are already getting a hint of what’s to come. Bush calls Gore’s state-based health care reforms “more big government,” while Gore portrays Bush’s tax credit plan as not big enough. Both candidates claim they’ll use government surpluses to pay for their programs, but Blendon says neither candidate has shown there’s enough money to foot the bills.

“The absence of details will make it a bit easier” for both candidates to talk about the issue during the campaign, Burke says. It will be later, after the election, she says, when the winner will have to pick up the pieces and actually craft a health care plan that Congress will support.