This is the first article in a two-part series on how partisanship affects views about healthcare.
With discussions brewing among Republican Party leaders about potential healthcare legislative initiatives, changes to the U.S. healthcare system are likely to be on the political agenda in the coming months. In response to a Nov. 11-14 Gallup Poll*, 54% of Americans say the U.S. healthcare system has major problems, and an additional 11% say it is in a state of crisis. Clearly, a substantial majority thinks that changes to the current system are needed.
Yet the degree of concern over healthcare issues varies considerably by partisanship. Specifically, Democrats are far more likely than Republicans to say they think the healthcare system is in a state of crisis, that the quality of healthcare is fair or poor overall, and that healthcare coverage in this country is fair or poor overall. And aside from the depth of the problem, Republicans and Democrats also disagree about who is responsible for healthcare. Democrats overwhelmingly say it is the federal government's responsibility to ensure that Americans have health coverage, while Republicans are likely to disagree.
In a State of Crisis?
Respondents were asked which of the following four phrases best describes the U.S. healthcare system today: "in a state of crisis"; "has major problems"; "has minor problems"; or "does not have any problems." Members of the different partisan groups responded differently -- only 5% of Republicans say that the system is in a state of crisis, while 12% of independents and 18% of Democrats say the same.
While independents are somewhat less likely than Democrats to say that the healthcare system is in a state of crisis, they are more likely to say that it has major problems. Taken altogether, 69% of independents and 70% of Democrats think that the healthcare system has major or crisis-level problems, versus 59% of Republicans.
Quality and Coverage Concerns
Concerns about the quality of U.S. medical care and medical coverage also vary significantly by party affiliation. In general, Americans are significantly more concerned about coverage than the quality of care. But while just one in three Republicans says the quality of healthcare in this country is "only fair" or "poor," nearly half of independents and Democrats give this assessment.
Similar partisan differences exist regarding health coverage -- a slight majority of Republicans (56%) rate coverage in the United States as only fair or poor, compared to 75% of both independents and Democrats.
Who Is Responsible?
The question of who is responsible for healthcare coverage in the United States solicits some of the most widely variant responses among Republicans, independents, and Democrats. Specifically, there is a huge partisan split in their responses to the question "Do you think it is the responsibility of the federal government to make sure all Americans have healthcare coverage, or is that not the responsibility of the federal government?" Eighty-three percent of Democrats think that it's the responsibility of the federal government to ensure all Americans have healthcare coverage, compared to 68% of independents and only 39% of Republicans.
Why the Difference?
Why do Democrats and independents have a more negative outlook on the current state of the healthcare system than Republicans do? One possibility is simply that Democratic leaders, traditionally more focused on domestic issues, emphasize problems with the healthcare system to a greater extent than Republican leaders.
Furthermore, Democrats may tend to have higher expectations for the scope and breadth of the healthcare system -- from that perspective, the system is more likely to fall short.
But a simpler reason must be considered as well: We can't assume that the partisan groups have equal access to high-quality medical care and coverage. Democrats tend to have lower incomes than Republicans, and thus may have less favorable perspectives of the healthcare system because of personal experience. Lack of access to high-quality medical care or coverage may negatively influence one's view of care quality and coverage options for the country as a whole, and may lead to an enhanced perception of looming crisis in the medical system.
The second article in this series will examine how Democrats, independents, and Republicans rate their own healthcare quality, coverage, and access to medical care.
*Results are based on telephone interviews with 1,001 national adults, aged 18 and older, conducted Nov. 11-14, 2002. For results based on the total sample of national adults, one can say with 95% confidence that the maximum margin of sampling error is ±3%.