Presidential Candidates' Platforms Reflect Sharp Differences in Perspectives of Democratic and Republican Primary Voters on Health Care Problems

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Wednesday, January 23, 2008

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Presidential Candidates’ Platforms Reflect Sharp Differences in Perspectives of Democratic and Republican Primary Voters on Health Care Problems

Analysis Draws On Data From New Kaiser/Harvard Survey of Likely Voters in Early Primary States, As Well As 10 Recent National Polls

With the next wave of presidential primary elections quickly approaching, researchers from Harvard School of Public Health and the Kaiser Family Foundation, writing in the Jan. 24, 2008 New England Journal of Medicine, find that the sharply contrasting health care platforms of the leading Democratic and Republican presidential candidates reflect dramatic differences in the perspectives of their primary voters.

Written by Robert J. Blendon, Sc.D., Professor of Health Policy and Political Analysis at the Harvard School of Public Health, Drew E. Altman, Ph.D., President of the Kaiser Family Foundation and four co-authors, the article analyzes a newly released Kaiser/Harvard survey of likely primary voters in 35 states (and the District of Columbia) with January or February primaries or caucuses, as well as data from 10 other recent surveys by national media polling organizations.

“Although Americans agree that health care is an important problem in this country, there are huge differences between Republicans and Democrats on what should be done to improve health care,” Dr. Blendon said.

“In the primaries, we’re seeing the presidential candidates adopt health plans that to some extent mirror the concerns of their party’s core voters – with leading Democrats aiming for universal coverage by building on the employer-based system and Republicans offering tax-based incentives to encourage more people to buy coverage on their own,” Dr. Altman said. “Finding a way to bridge these differences will be important to winning independents in the general election and to fashioning a legislative compromise in the new Congress in 2009.”

The researchers conclude that Democratic and Republican voters in the early primary states are looking for different things when it comes to health reforms. For example, the Kaiser/Harvard poll conducted for the article finds that about two-thirds (65%) of likely Democratic primary voters say they would like presidential candidates to propose plans for universal (or nearly universal) coverage even if it involves a substantial increase in government spending. In contrast, only about one in four likely Republican primary voters say they want to hear about this kind of major effort (23%), with about the same proportion saying they would prefer no action on this front (27%). The plurality of likely Republican primary voters (42%) says that they would prefer a more limited, less costly expansion.

Early primary voters also differ on the specific health care issues they say would be most important in choosing a candidate. Democratic voters are divided between a focus on expanding insurance coverage and controlling costs, while cost issues dominate among Republican voters, with substantially fewer citing improving the quality of medical care or expanding health insurance coverage, the Kaiser/Harvard poll of likely primary voters finds.

The researchers conclude that the candidates’ approaches to health reform are rooted in the different experiences and views of Democrats and Republicans. For example, substantially more Democrats than Republicans say there is so much wrong that the health care system needs to be completely rebuilt. Republicans are also considerably more satisfied than Democrats with the cost and quality of their own care and are less likely to be worried about losing their coverage.

“These marked differences in satisfaction – both national and personal – coexist with real differences in terms of where Republicans and Democrats turn to look for solutions to the problems of high costs and the uninsured,” the authors write in the article. “Although a plurality of Democrats say that government should have primary responsibility for making sure that Americans have health care, and the majority say they are willing to pay higher taxes for increased coverage, the plurality of Republicans say health care coverage should be an individual responsibility.”

The article, Health Care in the 2008 Presidential Primaries, was written by Harvard School of Public Health Professor of Health Policy Robert J. Blendon, Sc.D.; Kaiser Family Foundation President Drew E. Altman, Ph.D.; Kaiser Associate Director of Public Opinion and Media Research Claudia Deane, M.A.; Harvard Opinion Research Program Managing Director John M. Benson, M.A.; Kaiser Director of Public Opinion and Media Research Mollyann Brodie, Ph.D.; and Harvard Opinion Research Program Assistant Director Tami Buhr, A.M. A link to the article is available online here, along with full results from the new Kaiser/Harvard survey.


Data for the NEJM article were drawn from a public opinion survey of likely primary voters in the early primary states, designed and analyzed by researchers at the Henry J. Kaiser Family Foundation and Harvard School of Public Health. The survey, which included voters in the 35 states (and the District of Columbia) with primaries or caucuses scheduled for January or February 2008, was conducted by telephone November 1-11, 2007, before any primary elections had occurred, in order to reflect voters’ initial views on the issues. The survey included 674 self-reported registered voters who said they were likely to vote in their state’s Democratic primary or caucus, and 508 voters who reported they were likely to vote in the Republican primary or caucus. The margin of error for likely Democratic primary/caucus voters is plus or minus four percentage points, and plus or minus five percentage points for likely Republican primary/caucus voters. This main survey was supplemented with data from 10 additional telephone surveys conducted by national media polling organizations between November 2006 and September 2007.


The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community, and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.

Harvard School of Public Health is dedicated to advancing the public’s health through learning, discovery, and communication. More than 300 faculty members are engaged in teaching and training the 900-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit

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