Q and A: Are we having a crisis yet?
The president’s pollster talks about health care and the American
voter
Angst about heath care is the sleeping giant of american politics,
says Jan van Lohuizen, the principal pollster for the Bush campaign. Though
concerns about the economy, terrorism and war in Iraq dominated the 2004
presidential race, van Lohuizen believes the focus will shift in future
campaigns. Looking ahead, he believes that by 2008 health care will be
the dominant issue in the presidential race.
Along with polling for the Bush campaign in 2004, van Lohuizen’s
firm, Voter Consumer Research, does survey research for the Republican
National Committee, Senate Majority Leader Bill Frist (Tenn.) and other
GOP leaders. Van Lohuizen spoke with Stanford Medicine about
the American electorate and health care.
You’ve said that health care is the sleeping giant issue
for the American electorate. How so?
Van Lohuizen: Concern with health-care cost and access
have increased steadily over the last few years, as more people have no
coverage at all, and as people who do have it are required to pay more
for it. This concern has not become a front-and-center domestic policy
issue yet; emphasis on not yet, because other issues have been a greater
concern: domestic security, the war in Iraq, the economy, all are issues
that currently are a higher priority. However, as the economic recovery
continues, and, hopefully, as the conflict in Iraq subsides, I fully expect
health care to become the top issue, if not by ’06, then almost
certainly by ’08.
What does the average American most want to tell their political
leaders about health care?
Van Lohuizen: “Do something.” I don’t
think the voters know what the fix is, or even if there is one, but they
sure want to see action. The voters are not in the mood to do just anything,
however. The California electorate voted on four different initiatives
that dealt with health care in one fashion or another and was quite selective
in its choices.
When it comes to addressing the most pressing problems of health
care, are Americans looking for major reforms or incremental changes?
Van Lohuizen: Voters are realistic about the complexity
of the issue and (at least Californians) are willing to pick and choose
the fixes. I think incrementalism will satisfy them.
What do we know so far about seniors’ attitudes toward
the new drug benefit program authorized by the Medicare Prescription Drug
Act of 2003?
Van Lohuizen: The initial results suggested seniors
were deeply unhappy. We are now seeing data that suggests this is changing.
It is not so much that seniors are now happy, as that they are less unhappy.
The arrival of prescription drug benefits may have something to do with
it, but that is only a guess.
When Americans describe the state of health care in the nation,
are there any words that stand out?
Van Lohuizen: Yes: cost. In addition, there’s
something that cannot be pinned down as precisely. If you had to use a
single word it would be “uncertainty.” People who do have
coverage are deeply concerned that they might lose it or that the cost
will increase to such an extent that they cannot afford it. People are
concerned that at some time in their working lives they will not have
any coverage, and this is a seriously scary prospect, even if their current
situation is OK.
Is it accurate to assume that when it comes to health care America
is not divided blue or red?
Van Lohuizen: Not quite: if you ask what the problems
are, blue and red voters agree; but if you ask them to rank health care
relative to other priorities, blue voters tend to rank it higher than
red voters. The red/blue differences increase when you ask people how
to address these problems.
What most surprises you when you talk about health care with
Americans?
Van Lohuizen: From my personal experience the greatest
loss in our health-care system is the personal relationship between physicians
and patients. Voters are concerned about this, but to a far lesser extent
than I think they should be.
Are Americans more interested in questions of cost or questions
of quality?
Van Lohuizen: Americans are used to having both and
think they are entitled to both reasonable cost and high quality. The
public does not appear to see a decline in quality but does see enormous
cost increases. Right now cost is the issue because the public believes
it is getting quality care.
So who do Americans blame the most for the health-care crisis?
Van Lohuizen: Everyone, with the possible exception
of physicians: drug companies, HMOs, insurance companies, trial lawyers,
etc. We see some signs that voters are blaming other patients: overuse,
unnecessarily expensive use, misuse of emergency rooms, fraud in the system,
etc.
Who’s most trusted on questions of health care?
Van Lohuizen: Physicians continue to be the most credible.
Also very credible: nurses.
Who’s got a lot of explaining to do?
Van Lohuizen: HMOs and drug companies. People truly
don’t see why their costs should be that much higher or why HMOs
are so profitable.
Think about the midterm congressional elections in 2006.As far
as health care, will voters be evaluating incumbents on any short-term
progress between now and then?
Van Lohuizen: So far voters have evaluated effort more
than results. Voters understand these are complex issues and are realistic
in their expectations. Whether this will change to a more results-oriented
evaluation remains to be seen.
Is there any one individual who has a lot of political capital
with the American public when it comes to talking about health care?
Van Lohuizen: It used to be C. Everett Koop. Not sure
who that would be today, or if there is one such person.
Comments? Contact Stanford Medicine at
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