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The four year itch

Healthcare costs: the most and least important factor

Take a look at the graphic below. The beauty of the American election cycle is that we get a quadrennial peek (conducted by some polling firm or the other) at seminal issues that supposedly are key barometers in picking candidates and parties. One could literally write a book chapter on this incredibly rich tapestry of healthcare-related questions and answers depicted in this graphic and still have more to say.

Alas, however, I have only 800 words. So let's get on with it. The obvious caveat is that we have to assume that the polling is done correctly, is representative of the American electorate and meets the usual 'accurate within +/- 3%, 19 times out of 20' disclaimer - otherwise there's no point in even discussing the graphic. If you're going to take the position that there's geographic bias, gender bias, age bias or even baseline health bias, then that's your prerogative. If you're going to take the position that these questions may not have been well defined or well understood by respondents (a few columns ago in this very publication I wrote about the importance of health literacy), then that too is your prerogative.

So, with this said, let's look at the first histogram from the top. Isn't it fascinating that there are more people who describe their candidate's position on the 'cost of healthcare' as being 'not an important factor' versus those who describe it as being 'the single most important factor'? With all the hoopla around the Affordable Care Act and mandated health insurance and all the sabre-rattling around drug pricing transparency and the front-page headlines around massive prescription (and generic) price increases (thank you Mr. Shkreli) it turns out that people don't care about the cost of healthcare as much as we thought. Let's forget, for a moment, about the fact that more people view their candidate's position on the cost of healthcare as 'not an important factor' versus it being the 'single most important factor'. Just look at the raw percentages. We're talking about 8% and 9%. The fact that less than 10% of those polled view their candidate's position on the cost of healthcare as either 'not an important factor' or 'the single most important factor' is more staggering than the fact that there's no difference between those two groups.

It turns out that people don't care about the cost of healthcare as much as we thought

Can this intuitively be true? Can a 'line item' that represents close to 20% of GDP in the US really generate this amount of apathy? Do only less than 10% of people polled really care about their candidate's position on the cost of healthcare? Look carefully at the 5th and 6th histograms. These deal with the creation of a universal health plan and the ability to provide coverage for the uninsured. Don't these, too, impact the costs of healthcare? For that matter, let's look at the 2nd and 4th histograms as well. These are ambiguously entitled 'Medicare' and 'Medicaid'. It's not clear what exactly about Medicare and Medicaid the question put to registered voters in this Kaiser Family Foundation poll was but don't both Medicare and Medicaid have an impact on the cost of healthcare? Looking at these additional histograms through this filter, we can re-run the numbers of 'not an important factor' versus 'the single most important factor and we come up with an even larger disparity of 63% ('not an important factor') compared to 27% ('the single most important factor').

Or, perhaps people are as apathetic about the cost of healthcare as first described. And perhaps none of the questions raised in histograms 2, 4, 5 and 6 ought to be remotely associated with the question asked in histogram 1. Maybe they are all separate and independent questions with no interrelation and we're right back to 8% and 9% who view their candidate's position on the cost of healthcare as 'not an important factor' versus 'the single most important factor'.

I don't know if the exact same question has been asked every four years and whether these percentages have changed. My suspicion is that a very similar question is typically asked and my suspicion is that the numbers have gotten lower and the gap has closed. In other words, less and less people have deemed the cost of healthcare to be the single most important factor and the gap between those who view it as 'the single most important factor' versus 'not an important factor' has shrunk to the point that we end up with results as depicted in this graphic. Maybe what all this analysis, hand-wringing and introspection tell us is that a single candidate's position on the cost of healthcare is irrelevant because a single candidate can't do anything about the cost of healthcare.

Four year itch graphic

Article by
Rohit Khanna

is managing director of Catalytic Health, a healthcare communications, advertising and strategy agency. He can be reached at:

21st March 2016

From: Sales



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