How healthcare issues will affect this week's Democratic primaries in seven states is unclear, particularly after last week's results in New Hampshire, where voters said healthcare was their chief concern, but their votes said otherwise.
At last week's New Hampshire Democratic primary-won by Sen. John Kerry of Massachusetts-several polls showed healthcare as the top issue on voters' minds. In one poll, conducted by the University of New Hampshire Survey Center, healthcare (22%) topped the economy (16%) and the war in Iraq (10%). According to an exit poll taken by Edison Media Research and Mitofsky International, concerns about healthcare and Medicare (28%) also were the top issue, outranking the economy and jobs (22%).
But experts said those concerns did not influence voters' decisions in New Hampshire. "You would be hard-pressed to read (the New Hampshire results) as a referendum on the candidates' healthcare policies," said Richard Killion, a professor and pollster at Franklin Pierce College in Rindge, N.H.
Part of the problem is that there are many similarities among the proposals, which all seek to build upon public programs such as Medicaid and the State Children's Health Insurance Program while trying to create new group options, modeled after the health plan available to federal employees.
Healthcare is a notoriously difficult topic for the public to comprehend, and when many consumers can't say whether they are in an HMO or a fee-for-service plan, it may be too much to ask them to figure out how Kerry's plan to incorporate tax credits is different from Wesley Clark's.
"Most people don't understand the system now, much less trying to understand in a short discussion how things may change," said Art Nichols, senior vice president and chief financial officer at 150-bed Cheshire Medical Center in Keene, N.H.
Messages left with the campaigns of Kerry, Howard Dean, Clark and John Edwards were not returned. At a healthcare conference last week, however, Sarah Bianchi, Kerry's national policy director, alluded to the difficulty of stumping on healthcare issues when she talked about the senator's plan to have the federal government pay 75% of a patient's healthcare cost when it exceeds $50,000.
"I hate talking about these things on the campaign trail," she said. "It's very difficult."
On Feb. 3, representatives from the campaigns of Bush, Kerry, Dean, Clark and Joe Lieberman will discuss their healthcare policies at a forum in Lansing, Mich. Seven states are hosting Democratic primaries this week, and Michigan and Washington will hold their caucuses later this week as well.
William Schuler, president and chief executive officer of 185-bed Portsmouth (N.H.) Regional Hospital, said the swiping and sound-bite nature of the campaigns made it difficult for voters to separate the candidates' stands on issues.
"What happened is that the tone of negativity and attacks and (who was the most electable) and having so many candidates obscured any real issue," he said.
Even with concerns about healthcare central among voters in New Hampshire, in the end what shaped their election decisions was a candidate's electability, Killion said. In polling questions that dealt with that, Kerry did exceptionally well.
In the Edison exit poll, one in four voters said that what mattered most in their decision was whether a candidate could beat President Bush in November. Among that group, Kerry won 60% of the votes. He also won most of the votes among those who said that having the right experience was the most important factor in their decision. Meanwhile, 40% of voters said Dean did not have the right temperament to be president and among this group, most voted for Kerry.