Reaching Voters on Health
As we inch closer to the midterms, our latest tracking poll shows that health care costs have some staying power as a voting issue, hanging in as a top voter concern, tied with gas prices as the number one economic worry, even as gas prices have soared with the Iran war and are in the news every day. That says a lot about the salience of health care costs as an issue right now. I had expected gas prices to take the top spot decisively, at least temporarily.
But candidates have to capitalize on voters’ worries to make them matter in elections. Another question in our poll provides clues about how best to do that, and it’s not what I expected it to be (more on that below).
The first and most basic thing is simply for candidates to talk about health care costs a lot. In case you take this for granted, I recently watched a televised debate between California’s candidates for governor. It featured three advocates for single-payer health care—always a controversial debate topic—including a former Secretary of Health and Human Services. Surprisingly, health and health care costs, the voter’s top economic concern according to polls, weren’t mentioned once by the moderators or the candidates themselves.
But health care will get airtime in the midterm campaigns. This is another area where our survey findings weren’t what I expected: My assumption was that the single most important thing for candidates to do was to show voters that they care about, and can relate to, the struggles they have paying for health care. Candidates do this a lot, talking about their family experiences with illness and health care costs and telling stories about people they met on the campaign trail. No doubt that registers, but according to our poll, it may not be the most important thing to do.
Voters said what matters most to them is to see candidates show some “fight” by taking on the big health care interests they have come to see as villains. Thirty-six percent said “what matters most to them” about candidates is their willingness “to take on drug and insurance companies.” (The poll doesn’t tell us how much the voters value rhetoric versus substantive proposals that would have consequences.)
After that, voters also wanted to have some confidence that candidates would deliver something. Thirty-three percent want to know that they “have a plan to address health care costs.” That doesn’t tell us a lot about whether the plan has to be sweeping or small and tangible, or what voters mean by “having a plan.”
Then, coming in third, 21% said they want to see that candidates “care about the problems people are having with their health care costs.” Democrats are a little bit more into candidates showing empathy, at 25% v. 17% for Republicans.
And then 10% said none of these, presumably looking for something else.
I wouldn’t make too much of the distinctions between these perceived candidate virtues. After all, showing “fight” and taking on big interests are also forms of showing you care. And voters always say they want to see a “plan,” then most tune out the details, as if having a plan is more important than the plan itself. Poll respondents may also think that having a plan is something they should say to pollsters. The news media also pushes candidates for plans they then dissect, while candidates try to keep their intentions general. And stakeholder groups push for plans to advance their goals. However, as any political adviser knows, candidates are best off with general plans that signal direction and values and are plausible, but don’t have enough detail to attack. It’s not clear that voters crave detailed plans, but they do want a sense that candidates will “do something,” and maybe also that the “something” won’t hurt them or upset their own current health care arrangements (long a red line for health reform).
What jumped out from the poll is the value voters place on villainizing health care’s big interests now. It’s like serving up a big fat slow curveball for every candidate to hit. And the polling makes sense at this moment. Once the territory of the left, even President Trump has been taking on drug and insurance companies, ending this as a no-fly zone for Republicans. (Hospitals, where much of health spending is, so far have remained relatively safe).
Of course, candidates also know that health care’s big interests won’t just sit there and take it; they will respond with political contributions to their opponents if they believe a candidate, if elected, might do something that damages their interests, or that their rhetoric and agenda-setting power might add momentum to actions they want to block. The polling may foreshadow growing candidate courage to take on health care’s big interests that we’ll see unfold in this election cycle, but not necessarily a change in how the system works.
