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Contact Us Fall 2000; Volume 1, Number 1
Features: Election 2000

Health Care in the Upcoming 2000 Election
Robert Blendon, Sc.D.

Health care will be one of the top issues in the year 2000 election, but voter interest in health care is not as great as it was in 1992. There is no single unifying theme to the health care issue. Rather, there are multiple concerns: making Medicare financially sound, providing coverage for prescription medicines for seniors, covering the uninsured, and patients' rights. Voters favor an incremental approach to expanding health insurance coverage, rather than a major new program. They express about equal levels of support for plans similar in concept to those proposed by Vice President Gore and Governor Bush.

The year 2000 election is unusual in that the economy, foreign policy crises, and the federal budget deficit are all absent as dominant issues. In addition, Americans are faced for the first time in decades with the issue of what to do with a budget surplus. In the context of this environment, health care has reemerged as an important voting issue, but without a unifying theme.

Providing prescription medicines for seniors may become the most visible health care issue in the election. A majority of Americans prefer to see a prescription drug benefit extended through Medicare and paid out of the federal budget surplus or taxes, rather than by seniors themselves through additional premiums. If the plans proposed to provide prescription medicines look like they are very expensive for retirees or involve a large increase in taxes, popular support for providing this benefit may decline.

The issue of the uninsured will also be important in the year 2000 election. However, there does not seem to be a clear mandate for one particular type of plan to extend coverage. The reasons for this lack of consensus are not entirely clear since plans for increasing coverage have been debated for almost a decade. Two factors seem to be at work. First, the proposed plans are complex, and many people do not understand the implications of them. Secondly, there are aspects of these plans that appeal to different people according to their own ideology, demographics, and health care circumstances, and, at this stage, many people may not feel a need to rally behind one particular plan. Other priorities compete for money from the federal budget surplus or from tax revenues, so voters are more likely to favor candidates with less costly, incremental proposals.

If Congress does not pass a Patients' Bill of Rights, the issue of health care consumers' rights is likely to be prominent in the 2000 election because so many people believe they would be better off if patient protections are enacted. Surveys suggest that a more comprehensive bill would be more popular than some of the more limited proposals now being considered. However, given voters' concerns about the costs of comprehensive legislation, a more modest compromise bill that includes some limited right to sue, as well as most of the other main provisions, might also be popular with voters.

In summary, the health care issue in this election is not about the need for fundamental change in the U.S. health system. Rather, voters are seeking some incremental "fixes" to discrete health care problems that they see as important enough to be considered in the election.

Robert Blendon, Sc.D., is Professor of Health Policy and Political Analysis in the Department of Health Policy and Management at the Harvard School of Public Health and the John F. Kennedy School of Government.

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